Slides

LM Bifurcation Disease Treated by Crush Technique

- Operator : Seung-Jung Park

LM Bifurcation Disease Treated by Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 85 year-old female was admitted with effort chest pain for 1 months. Her coronary risk factors were hypertension and hyperlipidemia. The physical examination was normal and baseline ECG showed left ventricle hypertrophy and cardiac markers were unremarkable. The echocardiography showed normal LV systolic function (EF=64%) without regional wall motion abnormality. Thallium test showed reversible small sized perfusion defect at LCX territory.
Baseline Coronary Angiography
  1. A left coronary angiography showed LM with bifurcation disease. Discrete lesion with 60% stenosis of LM ostium was observed and disease was extended to mLAD with 60% stenosis with calcification and tight stenosis of pLCX (Figure 1, Movie 1).
  2. A right coronary angiogram showed chronic total occlusion of mRCA ( Movie 2).
Procedural Steps
An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F JL 4.0 guiding catheter. A 0.014-inch 180cm Sion blue wire was inserted into the LCX and another 0.014-inch 180cm Sion blue wire was inserted into the LAD. We checked the IVUS and confirmed atherosclerotic lesion of LM and bifurcation disease. Predilatation was performed with 2.4 * 15mm Quantum balloon at pmLAD, LCX ostium, and LM. After predilatation, Resolute Intergrity stent 3.0 x 30mm was implanted at pmLAD ( Movie 3). Second, Resolute Integrity stent 3.5 x 18mm was implanted at pLCX ( Movie 4). Third, Resolute Intergrity stent 3.5 x 26mm was implanted at LM to pLAD ( Movie 5). Thereafter, adjunctive post-stenting balloon dilatations using a 2.0 x 15mm Maverick balloon at pLCX and a 3.0 x 15mm Empira NC balloon from LM to mLAD were performed. The stents of LM to mLAD and pLCX were successfully deployed by crush technique. Additional kissing ballooning was performed by using Empira NC 3.5 x 15mm LM-pLAD and Empira NC 3.0 x 15mm at LM-pLCX (Figure 2, Movie 6). The final angiogram and IVUS showed that the procedure was successful ( Movie 7, Movie 8).

Comments

  • Kunal Bikram Shaha 2016-11-07 Sir I have a suggestion: since these are left main cases so how about adding IVUS images or clips to make it more understandable.If they image file is too large atleast If you could put the focused labelled IVUS images. Comment:During kissing a new concept of snugging or mini kissing is emerging,here in this case we can observe the kissing was done with significant overlap.So what are your comments. Ususally do you tracepass nominal pressure or stay below nominal pressure during kissing tech.

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