LM Bifurcation Treated by Crush Technique

- Operator : Seung-Jung Park

LM Bifurcation Treated by Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 71 year-old male was admitted with dyspnea on exertion. Her coronary risk factor was only ex-smoking. The ECG showed normal sinus rhythm. Treadmill exercise test showed positive at stage II with symptom. The physical examination was normal.
Baseline Coronary Angiography
The left coronary angiography showed significant stenosis of distal LM bifurcation lesion and subtotal occlusion of distal RCA. ( Movie 1, Movie 2, Movie 3)
Procedure
An 8F sheath was inserted through right femoral artery and a 7F sheath was inserted left femoral artery for IABP preparation. Before performing intervention at LM, we decide to fix distal RCA. The right coronary artery was engaged with a 7F JR4 guiding catheter with side hole. The 0.014-inch BMW wire was inserted into the distal RCA to PL branch. We performed pre-dilatation using 2.0 x 16 mm Black Hawk balloon and successfully deployed 3.0 x 15 mm Resolute integrity stent at the distal RCA to PL branch (Figure 1, Movie 4). Sequentially, the left coronary artery was engaged with an 8F JL4 guiding catheter with side hole. The 0.014-inch BMW wire was inserted into the LAD and LCX. The proximal LCX to LM was predilated with 2.0 x 16 mm Black Hawk balloon. And then, we deployed 2.75 x 22 mm Resolute integrity stent at LM to proximal LCX (Figure 2). We performed balloon crushing with 3.5 x 18 mm Fortis balloon at LM to proximal LAD (Figure 3). Then, a 3.5 x 22 mm Resolute integrity stent was successfully deployed at LM to proximal LAD (Figure 4). We re-insert a 0.014 inch BMW wire into LM to proximal LCX. And then additional kissing ballooning was performed by using a 3.5 x 18 mm Fortis balloon at LM to proximal LAD and a 2.75 x 15 mm Quantum balloon at LM to proximal LCX (Figure 5). Final left coronary angiogram and IVUS showed that the procedure was successful ( Movie 5, Movie 6).

Comments

  • Jangwon Kim 2013-05-24 Its a fantastic result. But, I want to know the final IVUS finding of LCX lesion
  • Arash Gholoobi 2013-05-27 Why an 8 Fr. guiding catheter for a step crush technique?
  • Bing Liu 2013-05-27 Why not cross-over only!?wire protection for LCX was enough! And if step crush tech was used,why not DK-crush?
  • M Tarek Mounir Zaki 2013-06-01 Fantastic result....
  • Zhonghan Ni 2013-06-08 Dr Park's team usually use 8F Judkins GC for good support . If perform IVUS, I will perform it before intervention to assess the stenosis and the diameter for decision-making,just as taught by our pioneers,so I don't understand why you omitted it this time,thank you!

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