Slides
LM Bifurcation Lesion Treated by Crushing Technique
- Operator : Seung-Jung Park
LM Bifurcation Lesion Treated by Crushing Technique |
- Operator: Seung-Jung Park, MD |
Case Presentation |
A 75 year-old gentleman was referred for the treatment of known LM disease. About two weeks ago, he visited another hospital with resting chest pain. At that time, his coronary angiogram showed LM disease, and CABG was recommended to him. But he refused open heart surgery. His coronary risk factors were diabetes, hypertension, hyperlipidemia, and ex-smoker. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal LV systolic function (EF=56%) without RWMA. |
Baseline coronary angiography |
1. The left coronary angiogram showed significant stenosis at LM bifurcation lesion ( Movie 1, Movie 2). 2. The right coronary angiogram showed diffuse and significant stenosis at distal RCA ( Movie 3). |
Procedure |
An 8 Fr JL 4 guiding catheter with side holes was engaged at the left coronary artery ostium through right femoral artery. We inserted two 0.014 inch BMW wires into LAD and LCX, respectively. Predilatation was performed at LM to pLAD using a Black Hawk 2.5x20mm balloon (Figure 1). We also predilated at LM to pLCX with a Pantera 3.5x20mm balloon (Figure 2). Despite predilatation, angle between LM and proximal LCX was so acute and stent passing was not easy. So, we used a 5 Fr Heartrail catheter to cross over the lesion and deployed a Promus Element 4.0x12mm stent at LM-pLCX. Following crushing of LCX stent with a Ryujin 3.0x20mm balloon was performed (Figure 3). After that, we deployed a Promus Element stent 4.0x20mm at LM to pLAD (Figure 4). Additional balloon dilatations were performed at LM to pLCX using Maverick 1.5x15mm and TREK 3.0x15mm balloons, sequentially (Figure 5). After dilatation with a Pantera 3.5x20mm balloon at the LM to pLAD (Figure 6), final kissing balloon dilation was performed with a Pantera 3.5x20mm balloon at LM to pLAD and with a TREK 3.0x15mm balloon at LM to pLCX (Figure 7). And additional balloon dilatation was performed using Quantum 4.5x18mm balloon at LM (Figure 8). Final angiogram showed that the procedure was successful ( Movie 4, Movie 5). |
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