Figure 2

pVAD-assisted left main DK-Crush Bifurcation PCI Post-ViV TAVR

Steve Attanasio*, Maria Isabel Camara Planek and Anshuman Das

Published: 16 April, 2021 | Volume 6 - Issue 1 | Pages: 029-032

jccm-aid1114-g002

Figure 2:

LM DK-Crush bifurcation PCI. (A) Pre-dilation (2.5 x 12 mm balloon) of ostial LAD. (B) Pre-dilation (2.5 x 12 mm balloon) of ostial LCX. (C) 3.0 x 12 mm drug-eluting stent (DES) deployed across LCX lesion with proximal portion of DES in the distal LM. (D) LCX wire removed and DES in LCX “crushed” with a 3.0 x 12 mm NC balloon extending from the LM to the LAD. (E) LCX rewired through “crushed” LCX stent and the struts of the “crushed” LCX stent were dilated with a 2.5 x 12 mm non-compliant balloon. (F) The first simultaneous kissing balloon inflation (SKBI) of the DK-Crush bifurcation PCI technique was performed using 3.0 x 12 mm and 2.5 x 12 mm non-compliant balloons in the LAD and LCX, respectively. The 3.0 x 12 mm non-compliant balloon was also used to pre-dilated the ostial LM (not shown). (G) Using IVUS-guidance, a 3.0 x 23 mm DES was positioned in multiple orthogonal views to span both the ostial LM and ostial LAD lesions before being deployed. The first proximal optimization technique (POT) was performed (not shown). (H) The proximal portion of the LM-LAD stent was flared with a 3.5 x 12 mm non-compliant balloon at high pressures. (I) After rewiring the LCX through the LM-LAD stent, 3.5 x 12 mm non-compliant balloons were positioned across both the LM-LAD and LM-LCX and the second SKBI was performed. A second POT was subsequently performed using the 3.5 x 12 mm non-compliant balloon (not shown). (J) Final result of the LM bifurcation (IVUS not shown but demonstrated excellent stent expansion and apposition without any evidence of edge dissection). (K) Final result of the ostial LM (IVUS not shown but demonstrated excellent stent expansion and apposition). (K) Final result of the ostial LM (IVUS not shown but demonstrated excellent stent expansion and apposition).

Read Full Article HTML DOI: 10.29328/journal.jccm.1001114 Cite this Article Read Full Article PDF

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