LM Bifurcation Treated by Mini Crush Technique

- Operator : Seung-Jung Park

LM Bifurcation Treated by Mini Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 73 year-old male was admitted with effortchest pain for 6 months. He underwent CABG (LIMA-LAD, SVG-PDA, tRA-OM) 10 years ago. His coronary risk factors were hypertension, hyperlipidemia, and ex-smoker. The physical examination was normal. His baseline ECG, echocardiography and cardiac markers were unremarkable.
Baseline Coronary Angiography
  1. The LIMA-LAD and SVG-PDA grafts were totally obstructed and only tRA-OM was patent. (Figure 1, Figure 2)
  2. The left coronary angiography showed tubular 80% stenosis of distal LM, mild stenosis of LAD ostium, and discrete 95% stenosis of LCX ostium with Medina classification (1,0,1). ( Movie 1, Movie 2)
  3. The right coronary angiogram showed total occlusion of middle RCA. ( Movie 3)
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F JL catheter with 4.0 cm curve. 0.014-inch BMW guide-wire was inserted into the LAD and another 0.014-inch 190cm BMW guide-wire was inserted into the LCX. Proximal LCX was pre-dilated with 2.5 x 20mm BH PLUS balloon. And then, we pre-dilated LM to proximal LAD using 2.5 X 20mm BH PLUS balloon. (Figure 3, Figure 4) An Orsiro 2.75 x 18 mm Stent was successfully deployed at proximal LCX. (Figure 5) Consecutive Orsiro 4.0 x 22 28mm Stents was successfully deployed at LM to proximal LAD by Mini Crush technique. (Figure 6) A 0.014-inch Choice PT guide-wire was exchanged into the LCX. Additional kissing ballooning was performed by using Nimbus Salvo 4.0 x 17mm balloon at LM to proximal LAD and Quantum 2.75 x 15mm balloon at proximal LCX.(Figure 7) Final left angiogram and IVUS showed successful.( Movie 4, Movie 5)

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