LM Bifurcation Stenting with Crush Technique

- Operator : Jung-Min Ahn

LM Bifurcation Stenting with Crush Technique
- Operator: Jung-Min Ahn, MD
Case Presentation
A 56 year-old male patient was admitted for chest discomfort, 1 day ago during mountain climbing. His coronary risk factor was ex-smoking and chronic kidney disease. He underwent coronary angiography from other hospital. There was severe stenosis at LM bifurcation. The physical exam was normal. The ECG showed no ST segment change but cardiac enzymes was elevated compatible for Non-ST elevation myocardial infarction. Echocardiography showed akinesia of Left ventricle apex and mid anteroseptum with moderate left ventricular systolic dysfunction with ejection fraction 40%.
Baseline Coronary Angiogram & IVUS
  1. Left and coronary angiogram & IVUS showed severe stenosis at distal LM, severe stenosis at proximal LAD and severe stenosis at proximal LCX (Figure 1, Figure 2).
  2. The right coronary angiogram showed normal coronary angiogram.
Procedure
A 8Fr sheath was inserted thorough right femoral artery and, left coronary artery was engaged with a 8 Fr JL 4 guiding catheter. 0.014-inch BMW 190 cm wire was inserted into LAD and 0.014-inch BMW 190 cm wire was inserted into LCX. Without predilation, XIENCE Alpine 3.0 x 28 mm was successfully deployed at proximal LCX and XIENCE Alpine 3.5 x 23 mm was successfully deployed at LM to proximal LAD by Crush technique ( Movie 1, Movie 2). And additional NC balloon was performed by using NC TREK 4.0 x 15 mm at LM and Emerge NC 3.0 X 20 mm at LCX. Additional kissing ballooning was performed by using Emerge NC 3.0 x 20 mm at proximal LCX and NC TREK 4.0 x 15 mm at LM to proximal LAD ( Movie 3). And additional NC balloon was performed by NC TREK 4.0 x 15 mm at LM os for optimization. Final angiogram and IVUS showed that the procedure was successful (Figure 3, Figure 4).

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