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A Bifurcation Case With Acute Coronary Syndrome Treated With DK-Crush Method

Operators:Prof. Dr. Alp Burak Çatakoğlu

Istinye University Ulus Liv Hospital

56-year-old patient. Admitted to emergency clinic with chest pain started while resting. He has risk factors of hypertension and hypercholesterolaemia with no ST or T changes on his ECG. Despite CK and CK-MB levels are normal, high sensitive troponin T levels were high. After giving Aspirin 100 mg and Ticagrelor 180 mg coronary angiography was performed. In RCA (Figure 1) and CXA (Figure 2) critical stenosis was not seen. At LAD-D1 bifurcation level a subtotal stenosis with Medina 1,1,1 was seen ( Image 01, Video 01 and Video 01). Process steps, respectively:

  • 1 – 0.014 high-torque floppy was advanced to main branch (MB) and side branch (SB).
  • 2 – 14 atm predilatation was made to MB with 2 mm semi-compliant balloon (Video 03).
  • 3 – 14 atm predilatation was made to SB with 2 mm semi-compliant balloon (Video 04 and Video 05).
  • 4 – Images after predilatations (Video 04).
  • 5 – 2.5 x 22 mm ONYX RESOLUTE drug eluting stent (DES) was implanted to SB at 18 atm.
  • 6 – It was crushed in MB with 2.5 mm non-compliant(NC) balloon at 20 atm ( Image 07).
  • 7 – Image after crush (Video 06).
  • 8 – SB rewired.
  • 9 – SB postdilatation at 20 atm was made with 2.5 mm NC balloon ( Image 10 and Image 11).
  • 10 – SB postdilatation at 20 atm was made with 2.5 mm NC balloon ( Image 12).
  • 11 – With 2.5 mm NC balloon in SB and MB final kissing balloon at 10 atm was done ( Image 13).
  • 12 – In the LAD stent proximal at the level of carina with 3 mm NC balloon at 18 atm proximal optimization (POT) was done ( Image 14).
  • 13 – Stent apposition and SB opening was controlled with OCT ( Image 15).
  • 14 – Result (Video 08 and Image 16).

As a result in acute coronary syndrome with true bifurcation lesions intervention with double stent methods may be required. DK-CRUSH is a double stent procedure that has been shown to be successful with clinical trials. We presented you a DK-CRUSH case which has been carried out by implanting stent to side branch without making kissing balloon and making final kissing balloon after double stent implantation.

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