Case 180: Manual of PCI - Bifurcation troubleshooting скачать в хорошем качестве

Case 180: Manual of PCI - Bifurcation troubleshooting

A patient presented with inferior STEMI and underwent successful stenting of the culprit lesion in the RCA. He also had left main disease and severe mid LAD disease but wiring of the LAD failed likely also causing a dissection. The patient was referred for repeat attempt to treat the LAD/diagonal and distal left main bifurcations. The mid LAD appeared to be dissected at the origin of a diagonal branch. We advanced a workhorse wire in the diagonal and planned to use the reversed guidewire technique with a Sion black through a Sasuke microcatheter to wire into the LAD. The knuckled Sion black did not enter the diagonal but instead advanced into the LAD. After exchanging it for a workhorse wire IVUS showed dissection in the mid LAD around the origin of the diagonal branch. We successfully used DK crush to stent the LAD/diagonal bifurcation while maintaining wire position in the LAD at all times. Intravascular lithotripsy was need to expand the diagonal lesion. We then also used the DK crush technique to stent the distal left main bifurcation with a nice final result.