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 63 year-old male was admitted for 3 months of effort chest pain. His coronary risk factors were hypertension, hyperlipidemia. The physical examination was normal. His baseline ECG and cardiac markers were unremarkable.
Baseline Coronary Angiography
  1. The left coronary angiography showed diffuse stenosis from LM to proximal LAD and tight stenosis at proximal LCX with Medina classification (1,1,1). ( Movie 1, Movie 2)
  2. The right coronary angiogram revealed intermediate disease at proximal RCA. ( Movie 3)
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F XB catheter with 3.5 cm curve. 0.014-inch 190cm BMW wire was inserted into the LAD. 0.014-inch 190cm BMW guidewire was inserted into the LCX. LM to proximal LAD was pre-dilated with 2.75 x 15mm Empira NC balloon. (Figure 1) And then, we pre-dilated LM to pLCX using 2.5 X 20mm BH PLUS balloon.(Figure 2) An Orsiro 2.75 X 26 mm Stent was successfully deployed at LM to pLCX firstly.(Figure 3) Then we did crushing with a balloon, TREK 3.5 X 15mm at LM to pLAD.(Figure 4) An Orsiro 3.5 X 30 mm Stent was successfully deployed at distal LM to proximal LAD.(Figure 5) Additional kissing ballooning was performed by using an Empira NC 3.5 X 15mm at LM-proximal LAD and an Empira NC 2.75 X 15mm at pLCX.(Figure 6). Final left angiogram and IVUS showed that the procedure was successful.( Movie 4, Movie 5)

Comments

  • Kunal Bikram Shaha 2016-07-26 Sir why do you prefer minicrush in most cases than other two stent strategy
  • Se Hun Kang 2016-07-26 Thank you for your comment. Actually we do not prefer certain two stent strategy. We choose the most appropriate two stent strategy in every cases.

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