Slides
Treatment of distal LMCA Bifurcation Stenosis Using Crushing Technique
- Operator : Seung-Jung Park
| Treatment of distal LMCA Bifurcation Stenosis Using Crushing Technique |
| - Operator: Seung-Jung Park, MD |
| Case Presentation |
| A 60-year old gentleman admitted our hospital for evaluation of abnormal electrocardiographic finding incidentally found at health promotion center. His coronary risk factors were hypertension, dyslipidemia and smoking. The echocardiography showed severe LV dysfunction (EF=27%) with regional wall motion abnormality at LAD territory. We strongly recommended the patient to be performed bypass surgery, however the patient refused. |
| Baseline Coronary Angiography |
The left coronary angiogram showed tight narrowing at dLM trifurcation, mLAD and 1st diagonal branch ( Movie 1, Movie 2, Movie 3). Distal circumflex artery revealed chronic total occlusion. The right coronary was normal. |
| Procedure |
| At first, we inserted the IABP catheter via left femoral arterial access. An 8 Fr JL 4.0 guiding catheter was engaged into the left coronary ostium. Two 0.014 BMW wires were inserted into the LAD and RI, respectively (Figure 1). Predilatation for lesion modification was done using a Maverick 2.0 x 20mm balloon at pmLAD (Figure 2). Another 0.014 BMW wire was inserted in D1 using 1.8Fr Finecross micro-guiding catheter with concomitant lesion dilatation using Maverick 1.5 x 15mm balloon (Figure 3). The distal LMCA bifurcation lesion was treated by a Crushing technique. We sequentially deployed a Resolute integrity stent 2.5 x 18mm at the RI (Figure 4) and a Resolute integrity stent 3.0 x 38mm at the LM to pmLAD (Figure 5). Further dilatation LM-pmLAD lesion was done using Empira NC 4.0 x 15mm balloon (Figure 6). After removal of RI wire, 0.014 BMW wire was reinserted into RI (Figure 7). After dilatation with Empira NC 3.5 x 15 at pmLAD and Quantum 2.5 x 15 at RI, final kissing balloon dilation was performed with the same balloons in pLAD to LM and in pLCX to LM, respectively (Figure 8). Final angiogram showed well-expanded and well-positioned stents ( Movie 4, Movie 5, Movie 6). |
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