Successful PCI for LCX Bifurcation: Step-by-Step Culette Technique

Operators:Prof. Dr. Şevket Görgülü

Acibadem University of Medicine, Kocaeli Acibadem Hospital


57 years old   male patient with a 1:1:1 CX bifurcation lesion (Successful Culotte intervention step by step).


Right radial approach with a 7F ebu guiding catheter. Angiography indicating a 1:1:1: CX bifurcation lesion (video 1) . Main CX and OM artery were crossed with floppy wires.Unfortunately, during the advancement of the wire in the om artery we created a distal dissection (video 2) . The om artery was predilated with a 2x20m balloon (video 3) . Afterwards the main Cx was also predilated with the same balloon (video 4). Our intention was firstly to seal the distal dissection at the distal part of OM artery with a 2,25×23 drug-eluting stent(DES).However, the stent couldn’t cross the distal lesion so we had to predilate the distal part of the vessel as well (video 5). Eventually the dissection was sealed with a 2,25×23 DES (video 6). Evident dissection at the level of bifurcation (video 7) . A 2,75×48 DES was deployed fom the  main CX artery  to the side branch OM artery with minimal overlapping of the first distal stent (video 8) . POT was performed with a 3,5×15 NC baloon at level of carina (video 9). Rewiring of the distal CX artery was done with a  third floppy wire (video 10) . The proximal cells of the stent was dilated with a 2x15mm balloon(video 11) . A 2,75×28 DES was introduced from the main artery through the opened cells of the side branch artery stent and deployed (video 12) . Re-wiring of the OM artery with a floppy wire (video 13) . Kissing baloon inflation with 2,5×15 and 3×15 NC balloons (video 14) . Final result was satisfactory  (video 15).

Cath Lab Nurse:Buse Taşdemir

Cath Lab Technician: İsmail Topaç

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