CASE20230911_001
Sequential Mini Crush
By Faisal Yousef Almajid, Do-Yoon Kang
Presenter
Faisal Yousef Almajid
Authors
Faisal Yousef Almajid1, Do-Yoon Kang2
Affiliation
Asan Medical Center, Kuwait1, Asan Medical Center, Korea (Republic of)2,
View Study Report
CASE20230911_001
DES/BRS/DCB - DES/BRS/DCB
Sequential Mini Crush
Faisal Yousef Almajid1, Do-Yoon Kang2
Asan Medical Center, Kuwait1, Asan Medical Center, Korea (Republic of)2,
Clinical Information
Relevant Clinical History and Physical Exam
A 49 year old male ex-smoker and ethanol consumer. who is known diabetic, hypertensive and has a history of rheumatoid arthritis maintained on methotrexate.
Presented to clinic with effort angina.
ECG: LVH, early repolarization
Coronary CT showed severe discrete stenosis of the mid LAD, and diffuse mild stenosis of RCA, dLCx
1.avi
2.avi
38.avi
Presented to clinic with effort angina.
ECG: LVH, early repolarization
Coronary CT showed severe discrete stenosis of the mid LAD, and diffuse mild stenosis of RCA, dLCx
1.avi 2.avi 38.aviRelevant Test Results Prior to Catheterization
Glucose 152 mg/dlCreatinine .91 mg/dlHb 14.7 g/dlPlatelet 222LDL 48 mg/dl
Relevant Catheterization Findings
distal left main to mid LAD stenosis
proximal RI stenosis- LAD bifurcation
proximal D1 stenosis-LAD bifurcation
Interventional Management
Procedural Step
Sequential mini crush technique.predilation of both diagonal and RI branches with compliant and NC balloons followed by two stents placement with minimal protrusion in both branches.balloon crushing both protruding side branch stents followed by deployment of two overlapping stents from distal left main to mid LAD wire recrossing of both side branches sequential Kissing balloon inflation to mid LAD - diagonal bifurcation followed by kissing balloon inflation to LAD- ramus bifurcation.final POT of distal left main stent
13.avi
18.avi
31.avi
13.avi 18.avi 31.aviCase Summary
The mini crush technique is a simple yet effective strategy for sequential bifurcation lesions and may be safely performed providing complete coverage of side branch ostiums and optimizing future side branch access.