PERCUTANEOUS CORONARY INTERVENTIONS

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Left Main Distal Disase: DK Crush Technique

Operators:Prof.Dr.Bilal Boztosun
Assoc.Dr.Beytullah Çakal
Dr.Ersin İbişoğlu

İstinye University Ulu Liv Hospital


Case

48-year-old female patient underwent PTCA and stenting due to chest pain at another clinic in February 2016. She had recurrent chest pain on follow-up. After performing coronary anjiography, medical follow-up decision was made. She admitted to our hospital with chest pain growing accelerating in the last days. The EF was % 65 in the transthoracic echocardiography.

Diagnostic Coronary Angiography

A lesion was seen proximal of the stent which is in the mid-zone of the left anterior descending artery (LAD) and vessel. There were lesions in the circumflex artery (CX) and the intermedial arteries (IM) (Video 01).

Procedure:

7F sheath was placed to femoral artery. The 7 FR 3.5 EBU guiding catheter was placed in the left main coronary artery (LMCA). IM was dilated with 1.25 x 10 mm RYUJIN PLUS PTCA balloon and 2.0 x 20 mm RYUJIN PLUS PTCA balloon. A 3.0 x 38 mm XIENCE ALPINE was parked to IM and another 3.0 x 33 mm XIENCE ALPINE was parked to CX arteries (Video 02). First, IM stent was opened (Video 03). The IM stent was crushed with opening CX stent (Video 04). With two 2.75 × 12 SIMPASS NC balloons, kissing PTCA to CX-IM was done (Video 05). Optimal expansion was achieved. MLA was measure 3.7 cm2 by doing intravascular (IVUS) to LAD proximal. 3.5 x 38 mm XIENCE ALPINE DES was implanted from LAD proximal to LMCA at 16 atm (Video 06). Proximal of the stent was postdilated with 4.0 × 12 mm SIMPASS NC balloon at 20 atm (Video 07). Then kissing PTCA to LMCA distal was done by putting 3.5 × 12 mm SIMPASS NC to LAD and 2.75 x 12 mm SIMPASS NC to IM (Video 08). After the procedure, proximal of the LMCA stent was observed malappositioned with IVUS (Video 09). Upon this, postdilatation was applied at 20 atm with 4.5 × 9 mm SIMPASS NC balloon (Video 10). Full expansion was provided (Video 11).

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Video 11

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