Slides
LM Bifurcation Stenting with the Crush Technique
- Operator : Seung-Jung Park
LM Bifurcation Stenting with the Crush Technique |
- Operator: Seung-Jung Park, MD |
Case Presentation |
A 48 year-old male was admitted for dyspnea on exertion started from 2 months ago. His medical history was unremarkable. Physical examination, simple chest radiograph, electrocardiography were unremarkable. Echocardiogram showed normal left ventricular systolic function without regional wall motion abnormality. |
Baseline Coronary Angiogram & IVUS |
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Procedure |
An 8 Fr long sheath was inserted through the right femoral artery and left coronary artery was engaged with an 8 Fr JL 4.0 guiding catheter. Two 0.014-inch BMW 190 cm wires were inserted into LAD and diagonal branch. 0.014-inch Sion 180 wire was inserted into LCX to OM. Xience Sierra sized 2.75 x 38 mm was deployed at proximal to mid LAD ( Movie 5) and two Xience Sierra stent sized 2.75 x 28 mm and 2.75 x 15 mm were deployed at proximal LCX to OM and proximal LCX respectively ( Movie 6, Movie 7). After IVUS evaluation for stent optimization, mini-crush ballooning using Sapphire NC 3.5 x 18 mm up to 14 atm (3.56) was performed ( Movie 8). Another Xience Sierra sized 3.5 x 28 mm was inserted into LM to proximal LAD. Post-ballooning with Emerge NC 3.0 x 20 mm up to 18 atm (3.1) and Euphora 2.0 x 12 mm up to 18 atm (2.35) at mid to proximal LAD stent and Sapphire NC 3.5 x 18 mm up to 28 atm (3.9) at LM to proximal LAD stent were performed. Subsequent post-ballooning procedures at proximal LCX to OM stent using Emerge NC 3.0 x 20 mm up to 28 atm (3.3) and at proximal LCX stent using Lacrosse 1.3 x 10 mm up to 18 atm (1.74) were performed. Kissing balloon procedure was performed at LM to proximal LAD and proximal LCX using Sapphire NC 3.5 x 18 mm up to 10 atm (3.44) and Emerge NC 3.0 x 20 mm up to 10 atm (2.96) respectively ( Movie 9). Another kissing ballooning was performed at same site using stent balloon 3.5 x 28 mm up to 10 atm (3.47) at LM to proximal LAD and Emerge NC 3.0 x 20 mm up to 10 atm (2.96) ( Movie 10). Final angiogram showed successful results ( Movie 11, Movie 12). |
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