Slides

LM Bifurcation Treated by Mini Crush Technique

- Operator : Seung-Jung Park

LM Bifurcation Treated by Mini Crush Technique
- Operator: Seung-Jung Park, MD
Case Presentation
A 59 year-old male was admitted with effort chest pain for 6 months. He underwent stent implantation at middle LAD and proximal to distal LCX, 7 months ago. His coronary risk factors were hypertension, diabetes and ex-smoker. The physical examination was normal. His baseline ECG and cardiac markers were unremarkable.
Baseline Coronary Angiography
  1. The left coronary angiography showed tubular 80% stenosis of distal LM, mild stenosis of LAD ostium, discrete 95% stenosis of LCX ostium with Medina classification (1,0,1) and previous stents was patent. ( Movie 1, Movie 2)
  2. The right coronary angiogram showed diffuse 50% stenosis of distal artery. ( Movie 3)
Procedure
An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F JL catheter with 4.0 cm curve. 0.014-inch BMW guide-wire was inserted into the LAD and another 0.014-inch 190cm BMW guide-wire was inserted into the LCX. On the LAD pull-back IUVS, MLA of LAD ostium was measured 3.2mm2 with plaque burden 87%. Proximal LCX was pre-dilated with 2.5 x 20mm Maverick balloon. And then, we pre-dilated LM to proximal LAD using 2.5 X 20mm Maverick balloon. (Figure 1, Figure 2) A Promus Premier 3.0 X 16 mm Stent was successfully deployed at proximal LCX to overlap previous stent. (Figure 3) Consecutive Promus Premier 4.0 x 28mm Stents was successfully deployed at LM to proximal LAD by Mini Crush technique. (Figure 4) 0.014-inch Choice PT guide-wire was exchanged into the LCX. Additional kissing ballooning was performed by using Empira NC 3.5 x 15mm Balloon at LM to proximal LAD and Empira NC 3.0 x 15mm Balloon at proximal LCX. (Figure 5) Final left angiogram and IVUS showed successful. ( Movie 4, Movie 5)

Comments

  • Aristides Androulakis 2015-05-20 Nice result and good strategy. To me the distal RCA seems critical.
  • Kunal Bikram Shaha 2016-07-26 Thanks for an excellent case .sir what are the dilatation pressures you prefer during kissing balloon..ist it nominal.
  • Se Hun Kang 2016-07-26 Thank you for your question. During kissing balloon, there was no preferred dilatation pressure. The balloon dilatation pressure is chosen according to the lesion characteristics and balloon size in each cases.

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