Slides

Left Main Bifurcation Disease Treated with Mini Crush Technique

- Operator : Seung-Jung Park

Left Main Bifurcation Disease Treated with Mini Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 67 year-old gentleman visited our hospital with effort chest pain. His coronary risk factors were diabetes and ex-smoker. The physical examination was non-significant. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=62%) without regional wall motion abnormality. Thallium SPECT showed reversible large sized mild to moderate perfusion defect in anterolateral and inferolateral wall.
Baseline Coronary Angiogram
  1. A left coronary angiogram showed significant narrowing of left main bifurcation ( Movie 1).
  2. A right coronary angiogram showed mild luminal narrowing of middle to distal RCA ( Movie 2).
Procedure
A 8Fr sheath was inserted through right femoral artery, and the left coronary artery was engaged with a 7 Fr JL4 SH guiding catheter. 0.014-inch NEO’s (Sion) 180cm wire was inserted into the LCX and LAD. Predilatation was performed with TREK RK 2.5 x 20mm at proximal LCX and proximal LAD (Figure 1, Figure 2). And then, Xience Alpine 2.75 x 23mm was successfully deployed at proximal LCX (Figure 3). Another Xience Alpine 3.25 x 33mm was successfully deployed at left main to proximal LAD (Figure 4). Additional ballooning was done with Pantera LEO 3.0 x 15mm Empira NC 3.5 x 15mm at left main to proximal LAD and Lacrosse 1.0 x 5mm and Sprinter legend 1.25 x 15mm at proximal LCX. And then kissing ballooning was performed by using 3.0 x 15mm Pantera LEO at left main to proximal LAD and 2.75 x 15mm Quantum at proximal LCX. Final coronary angiogram showed successful result ( Movie 3).

Comments

  • Bing Liu 2016-05-28 Single-stent strategy should be the 1st option for the old lady. Two-stent strategy will bring her series trouble in future. If I do, just one DES cross-over and wire-protection for LCX. LCX was small and the lady was old, so it was not good choice to stent lcx.
  • Seung-Jung Park 2016-05-30 Patient was 67 yr old gentlemen.Not small (large size reversible ischemia in LCX territory) LCX. Any 2 stent technique would be good if you have a IVUS concept. Effect stent area 5,6,7,8 mm2 after any 2 stent procedure can make a good clinical outcomes, TLR rate <2%.
  • Kunal Bikram Shaha 2016-07-29 Well said and an excellent end result sir. Sir in this case how did you select the stent size in left main-LAD & Circumflex because we couldnot even apply Mc Murrays law in it. .Is it after balooning or you did an IVUS.
  • Se Hun Kang 2016-07-29 Thank you for your comment. In left main bifurcation case, we checked the distal reference diameters and during balloon inflation, we also assessed the lesion characteristics, length, and etc. From these information we select the proper size. As you mentioned, we can use the IVUS or other imaging modalities.

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