Slides
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). |
Leave a comment
Sign in to leave a comment.
Comments