Slides
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). |
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