LM Bifurcation Intervention with Crush Technique

- Operator : Duk-Woo Park

LM Bifurcation Intervention with Crush Technique
- Operator: Duk-Woo Park, MD
Case Presentation
A 67-year-old male admitted for intermittent resting chest pain. His coronary risk factor was diabetes. She underwent PCI at pdRCA 1 month ago. Her treadmill test showed positive results with ST elevation in V2-4 at stage 2. Echocardiogram showed normal LV function without wall motion abnormality.
Baseline Coronary Angiogram
  1. The left coronary angiogram showed diffuse severe stenosis at pLCX and pLAD ( Movie 1, Movie 2).
  2. The right coronary angiogram showed patent previous stent at pdRCA.
A 8 Fr femoral sheath (Terumo®) was inserted through the right femoral artery and left coronary artery was engaged with a 8 Fr XB 3.5 guiding catheter. Each two 0.014-inch BMW 190 cm wires were inserted into LAD and LCX, respectively. Before the intervention, IVUS was used to identify lesion characteristics of LAD and LCX. Rotablation using rotablator 1.5 burr with upto 220,000 rpm was done at LM to pLAD (Figure 1). Xience Sierra stent sized 3.0 x 23 mm and 2.75 x 28 mm at denovo LM to pLCX lesion and Xience Sierra stent sized 3.5 x 33 mm and 3.0 x 33 mm at denovo LM to pLAD lesion were inserted. First, the stent at LM to pLCX was inflated (Figure 2), thereafter the stent at LM to pLAD was inflated, so the proximal strut of the former was crushed (Figure 3). Sapphire NC balloon sized 3.0 x 15 mm was used to dilate stenotic lesion of pLCX, and so was NC Trek 3.5 x 15 mm for stenotic lesion of LM to pLAD. IVUS was checked, and POT and kissing balloon were applied using Sapphire NC balloon 3.0 (15) upto 10atm (2.95) and NC Trek 3.5 (15) balloon upto 10 atm (3.42) in LM-pLCX and LM-LAD, respectively (Figure 4). The final angiogram showed no stenotic lesion and good flow ( Movie 3, Movie 4), and IVUS showed no immediate complications.

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