LM Bifurcation Treated by Crush Technique

- Operator : Seung-Jung Park

LM Bifurcation Treated by Crush Technique
- Operator: Seung-Jung Park, MD
Relevant clinical history and physical exam
An 82 year-old gentleman visited our hospital because of recurrent episodes of angina. He already underwent PCI with Cypher stent at pRCA at 7 years ago. Treadmill test showed ST depression at stage 2. He had clinical risk factors for coronary artery disease such as hyperlipidemia and history of smoking.
Relevant catheterization findings
The left coronary angiogram showed a tubular 50 to 70% stenosis with heavy calcification at LM, tubular 70% narrowing at proximal LAD and diffuse 70% stenosis at proximal LCX (Figure 1, Figure 2). The previously inserted stent at proximal RCA was patent (Figure 3).
Procedural step
JL4 SH 8Fr guiding catheter was engaged into the left coronary artery through the right femoral artery. Each 0.014-inch BMW wire was inserted into the LCX and LAD, respectively. We pre-dilated pLCX using Maverick 2.5 X 20mm balloon and Dura star 2.75 X 20mm balloon; pLAD using Dura star 2.75 x 20mm; LM to pLAD using Fortis 3.5 X 18mm balloon (Figure 4, Figure 5). Thereafter, we deployed a Xience prime stent 3.0 X 23mm at LM to pLCX (Figure 6) and another Xience prime stent 3.5 x 33mm at LM to pLAD with ¡°Crushing technique¡± (Figure 7). Adjunctive post-stenting balloon dilatation was done using a Fortis 3.5 x 18mm at LM to pLAD and Maverick 1.5 x 20mm and subsequently Voyger NC 3.0 x 20mm at LM to pLCX. Final kissing ballooning was performed using Voyager NC 3.0 X 20mm at LM-pLCX and a Fortis 3.5 X 18mm at LM-pLAD (Figure 8). Post procedural left angiogram showed that the procedure was successful (Figure 9).

Comments

  • Marcelo Ribeiro 2011-10-04 Congratulations for the case, always a fantastic source of education! In your cases of crush technique, are you always using the mini crush technique, i mean, with only a few milimeters of crush stent in LM/lcx? And what about the recrossing, how often do you need to use a different guidewire to do this specific step? What is your preference when the task is difficult? Thanks!
  • ramasami nandakumar 2012-01-02 would be nice to have an answer!
  • Long Bui 2012-01-20 Good result for this kind of lesion. What is the antiplatelet strategy after stenting?

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