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 58 year-old male was admitted with effort chest pain for 2 months. His coronary risk factor was an ex-smoker. The physical examination was normal. His baseline ECG and cardiac markers were not remarkable.
Baseline Coronary Angiography
  1. The left coronary angiography showed tubular 90% stenosis of distal LM, tubular 90% stenosis of proximal LAD, tubular 80% stenosis of LCX ostium with Medina classification (1,1,1) ( Movie 1, Movie 2).
  2. The right coronary angiogram was normal ( Movie 3).
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F JL catheter with 4.0 cm curve. 0.014-inch BMW wire was inserted into the LCX. 0.014-inch 190cm BMW guidewire was inserted into the LAD. Proximal LAD to LM was predilated with 2.5 x 20mm Maverick balloon (Figure 1). And then, we pre-dilated pLCX using 2.5 X 20mm Maverick balloon (Figure 2). A Resolute integrity 2.75 X 14 mm Stent was successfully deployed at pLCX (Figure 3). We performed crushing with a Resolute 4.0 X 22 mm Stent at dLM to pLAD (Figure 4). Additional kissing ballooning was performed by using a Pantera LEO 4.0 X 20mm at dLM-pLAD and a Empira NC 2.75 X 15mm at pLCX (Figure 5).

Final left angiogram and IVUS showed that the procedure was successful ( Movie 4, Movie 5).

Comments

  • Long Bui 2014-11-29 Nice result. Congratulation
  • Dr Joy Sanyal 2014-12-01 good result and a classical textbook case
  • Jugessur Rabindranath 2015-10-03 any plan for the mid lad lesion?
  • Kunal Bikram Shaha 2016-07-28 Do you decide on the basis of IVUS or angiogram itself whether to go for dirent stenting or preparing the lesion before stenting
  • Se Hun Kang 2016-07-28 Thank you for your comment. When we considering direct stenting or preballooning, lesion characteristics such as plaque burden, calcification, length of lesion were important factors and these information can be acquired angiography or IVUS evaluation. The information could be sufficient or not, it depends on the physician`s judgement.
  • Kunal Bikram Shaha 2016-07-28 Thanks DR SE HUN KANG for such prompt response.I am enjoying this learning forum a lot.
  • Kunal Bikram Shaha 2016-08-09 Sir why didnt we do minicrush rather than simple crush in this case
  • Se Hun Kang 2016-08-09 Thank you for your comment. In this case, very tight stenosis of LM bifurcation was checked and polygon of confluence was not easy to define due to tight stenosis. If we tried minicrush technique in this case, there would be risk of missed lesion and we had to put another stent in bifurcation area. If we choose complex two stent technique, we should try to make procedure complete and simple as possible.

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