LM Bifurcation Stenting with Crush Technique

- Operator : Duk-Woo Park

LM Bifurcation Stenting with Crush Technique
- Operator: Duk-Woo Park, MD
Case Presentation
A 68 year-old male patient was admitted for chest discomfort for several months. His coronary risk factor was ex-smoking and hypertension. He underwent coronary angiography from other hospital. There was severe stenosis at LM bifurcation. He had continued on medical treatment. The physical exam was normal. The ECG and cardiac enzymes were unremarkable. Echocardiography showed hypokinesia of mid anteroseptum with normal left ventricular systolic function.
Baseline Coronary Angiogram
  1. Left and coronary angiogram showed moderate stenosis at LM, severe stenosis at proximal LAD and severe stenosis at ramus intermedius. ( Movie 1)
  2. The right coronary angiogram showed normal coronary angiogram. ( Movie 2)
Procedure
A 7 Fr 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 Sion 180 cm wire inserted into LCX. Predilation performed with Tazuna 2.5 x 15 mm balloon. ( Movie 3) And then XIENCE Alpine 3.5 x 18 mm was successfully deployed at proximal LCX and XIENCE Alpine 3.5 x 28 mm was successfully deployed at LM to proximal LAD by Crush technique. ( Movie 4, Movie 5) And additional NC balloon was performed by using Empira NC 4.0 x 8 mm at LM. Additional kissing ballooning was performed by using NC TREK 3.5 x 15 mm at proximal LCX and Powered Lacrosse 3.5 x 15 mm at LM to proximal LAD. ( Movie 6) And additional NC balloon was performed by using Powered Lacrosse 3.5 X 15 mm at proximal LAD and NC TREK 3.5 x 15 mm at proximal LCX for optimization. Final angiogram and IVUS showed that the procedure was successful. ( Movie 7)

Comments

  • Jae Hong Park 2017-03-25 It is so wonderful classic mini-crushing technique that I think. Conglutulation for your procedure. I have a question. I think you would better do procedure for R.I lesion such like POBA or PTCA using DEB. anyway thanks for your showing great crushing technique.
  • Hanbit Park 2017-03-27 Thank you for your comment. We also considered adjunctive ballooning for Ramus branch before procedure. However, blood flow at R.I was excellent after bifurcation stenting, and to avoid too complex procedure, we decided not to perform additional procedure for Ramus.

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