Slides
Left Main Bifurcation Coronary Intervention with Balloon Crush Technique
- Operator : Seung-Jung Park
Left Main Bifurcation Coronary Intervention with Balloon Crush Technique |
- Operator: Seung-Jung Park, MD |
Case Presentation |
A 72 year-old man was admitted with stable angina pectoris. His coronary risk factor was hypertension. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal left ventricular function (EF=60%) without regional wall motion abnormality. |
Baseline Coronary Angiography |
The left coronary angiogram showed a tubular 60% stenosis at left main shaft, significant diffuse narrowing from the proximal to middle left anterior descending artery (LAD) and diffuse 70~80% stenosis at proximal left circumflex artery (LCX) ( Movie 1, Movie 2, Movie 3).The FFR value using 140 mcg/kg/min intravenous adenosine infusion was 0.63 at mLAD portion. |
Procedure |
A 8Fr XB 3.5 SH guiding catheter was engaged in the left coronary artery through the right femoral artery. A 0.014-inch BMW wire was inserted into the LCX, another 0.014-inch BMW wire was inserted into the LAD. We predilated at LM to pLCX using Maverick 3.0 X 20mm balloon and Dura Star 3.0 X 15mm balloon (Figure 1, Figure 2) and deployed a PROMUS Element stent 3.0 X 28mm at dLM to pLCX, firstly. (Figure 3). And then, we performed balloon crushing with a Dura Star 3.0 X 15mm balloon at dLM to pLAD ( Movie 4). After predilatation with Dura Star 3.0 X 15mm balloon, PROMUS Element Stent 2.75 X 28mm and 3.5 X 38mm were implanted from mLAD to LM lesion, consecutively. (Figure 4, Figure 5). After IVUS examination, adjunctive post-stenting balloon dilatation using a Dura Star 3.0 X 15mm at proximal to mid LAD (Figure 6), another Voyager NC 4.0 X 15mm at LM to proximal LAD (Figure 7) and Sprinter legend 2.0 X 12mm at dLM to proximal LCX were performed. (Figure 8). Additional kissing ballooning was performed by using a Voyager NC 4.0 X 15mm at LM-pLAD and a Maverick 3.0 X 20mm at LM-pLCX ( Movie 5). Final left angiogram and IVUS showed that the procedure was successful ( Movie 6, Movie 7) |
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