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
This 66-year old gentleman admitted our hospital for LM intervention after PCI at RCA in another hospital. He had no coronary risk factors. The echocardiography showed normal left ventricular function (EF=55%) with wall motion abnormality in LCX territory.
Baseline Coronary Angiography
The left coronary angiogram showed tight narrowing of distal LM bifurcation and significant stenosis at LCX ostium ( Movie 1, Movie 2, Movie 3). The right coronary angiogram showed patent stent at proximal RCA.
Procedure
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 LCX, respectively (Figure 1). The distal LMCA bifurcation lesion was treated by a Crushing technique. We sequentially deployed a Resolute integrity stent 3.0 x 15mm at the proximal LCX (Figure 2) and a Resolute integrity stent 3.5 x 30mm at the LM to proximal LAD without predilation (Figure 3). After removal of LCX wire, 0.014 BMW wire was reinserted into LCX. Thereafter, Maverick 1.5 x 15 and Ryujin 2.5 x 15 were sequentially dilated at LCX ostium. The final kissing balloon dilation was performed with Dura Star 3.5 x 10 at proximal LAD and Empira NC 3.0 x 15 at proximal LCX (Figure 4). Final angiogram showed well-expanded and well-positioned stents ( Movie 4, Movie 5).

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