LM Bifurcation and LAD Bifurcation Stenting with the Crush Technique

- Operator : Jung-Min Ahn

LM Bifurcation and LAD Bifurcation Stenting with the Crush Technique
- Operator: Jung-Min Ahn, MD
Case Presentation
A 57-year-old male patient was admitted for effort chest pain aggravated from 4 weeks ago. He had a history of hypertension and diabetes mellitus. He underwent coronary angiography which revealed severe stenosis at LM bifurcation and LAD involving the diagonal branch. The physical examination and electrocardiogram were unremarkable. Echocardiogram showed normal left ventricular systolic function without regional wall motion abnormality.
Baseline Coronary Angiogram & IVUS
  1. The Left coronary angiogram showed severe stenosis with heavy calcification at LM bifurcation and mid LAD bifurcation. ( Movie 1, Movie 2)
  2. The right coronary angiogram showed mild diffuse stenosis with at proximal to distal RCA. ( Movie 3)
Procedure
An 8 Fr long sheath was inserted through the right femoral artery and the left coronary artery was engaged with a 8 Fr XB 3.5 guiding catheter. 0.014-inch Sion 180 cm wire was inserted into LAD and 0.014-inch Sion 180 cm wire was inserted into LCx. Another 0.014-inch Sion 180 cm wire was inserted into diagonal branch ( Movie 4). Pre-dilation was performed with a FORCE NC 2.75 x 15 mm balloon and a XIENCE Alpine 2.75 x 23 mm was successfully deployed at diagonal branch ( Movie 5). Balloon crushing was performed by using Raiden 3 3.25 x 20 mm at proximal to mid LAD ( Movie 6). Pre-dilation was performed with a FORCE NC 2.75 x 15 mm balloon and A Xience stent 3.5 x 23 mm was deployed at proximal LCX ( Movie 7). The TREK NC balloon 4.0 x 20 mm was used at LM-pLAD. Then, XIENCE Alpine 3.25 x 38 mm and 4.0 x 23 mm were successfully deployed at LM to mid LAD by Crush technique ( Movie 8, Movie 9). And additional NC ballooning was performed by using Raiden 3 3.25 x 20 mm at proximal to mid LAD and TREK NC 4.0 x 20 mm at LM. Re-wiring was performed by 0.014-inch Sion 180cm wire and in-stent balloon was performed by using Emerge 1.5 x 15mm and Euphora 2.0 x 15mm at the diagonal branch. Additional kissing ballooning was performed by using Raiden 3 3.25 X 20 mm at proximal LAD and NC Emergy 2.75 x 20 at the diagonal branch ( Movie 10). Re-wiring was performed by 0.014-inch Sion 180cm wire and in-stent ballooning was performed by using Emerge 1.5 x 15 mm, Euphora 2.0 x 15 mm, and Pantera leo 3.5 x 20 mm at the proximal LCx. Additional kissing ballooning was performed by using NC ROVL 4.0 x 20 mm at LM to proximal LAD and Pantera leo 3.5 x 20 mm at proximal LCx ( Movie 11). The final angiogram ( Movie 12, Movie 13) and IVUS showed successful results.

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