LM Trifurcation Lesion Treated by Crush Technique

- Operator : Seung-Jung Park

LM Trifurcation Lesion Treated by Crush Technique

- Operator: Seung-Jung Park, MD

Case Presentation

A 74-year-old male was referred to our hospital for a second opinion. 2 years ago, he underwent percutaneous coronary intervention (PCI) at proximal LAD because of unstable angina. 2 months ago, the follow-up coronary angiogram showed severe stenosis at distal left main (LM) coronary artery with concomitant involvement of proximal LAD, LCX and ramus intermedius. His coronary risk factors were hypertension and hyperlipidemia and history of cerebrovascular accidents. His baseline ECG and cardiac markers were unremarkable.

Baseline Coronary Angiography

The left coronary angiogram showed severe stenosis at LM trifurcation with patent previous proximal LAD stent (Figure 1). The right coronary angiogram showed relatively normal RCA.

Procedure

An 8F sheath was inserted through right femoral artery, and the left coronary artery was engaged with an 8F JL4 catheter with 4.0 cm curve. The 0.014-inch 190cm Balanced Middleweight (BMW) wire was inserted into the LAD and another Sion Blue wires were inserted into the LCX and RI respectively. RI and proximal LCX were dilated with 2.5 X 15 mm Emerge balloon. After pre-dilation, Resolute Onyx stent 2.5 X 2.6 mm stent was successfully deployed at RI ( Movie 1). LM to proximal LAD was dilated with 3.5 X 20mm non-compliant (NC) TREK balloon. Another Choice PT guidewire was inserted into the LCX and dilated proximal LCX using Emerge 1.5 x 15mm. Thereafter a Resolute Onyx 2.75 X 22 mm stent was successfully deployed at proximal LCX ( Movie 2). And then a Resolute Onyx 3.50 X 30 mm stent was successfully deployed at LM to proximal LAD (Figure 2). And then kissing ballooning was performed by using a NC TREK 3.5 X 15mm at LM to proximal LAD and a Sapphire NC 2.75 x 15mm at proximal LCX (Figure 3). Final left angiogram and IVUS showed that the procedure was successful ( Movie 4).