PCI of Long Calcified LAD/D2 Bifurcation using RA and Mini-Crush Technique-May 2023
CASE & Plan:
69-year-old male with CCS Class II angina and positive stress MPI. A Cardiac Cath on May 4, 2023 revealed 2 V CAD: long segmental calcified 80% mid LAD, 95% LAD-D2 bifurcation, 90% mid RCA with SYNTAX Score of 29 and normal LV function. Patient underwent successful PCI of mid RCA using rotational atherectomy and Promus Elite DES. Patient is now planned for imaging guided staged PCI of LAD/D2 bifurcation using RA and Mini-Crush technique
A.We use DK-Crush technique in approximately 8-10% of two stents bifurcations; mostly with radial approach using 6Fr guide catheter. Main reason of using our preferred MiniCrush over DK-Crush technique is 3 less steps with former. Also short and long-term results are comparable between two strategies
QIn what situations will you avoid mini crush?
A.MiniCrush technique can be used in any bifurcation lesion interventions where sidebranch is >2.5mm. It should be avoided in narrow angle bifurcations (<45 degree) to avoid too much metal crush in order to properly cover both side of the ostium.
QAbsolutely no purpose of POT with mini crush?
A.Yes usually POT is not required in MiniCrush technique
QWhat other guide wires could be tried for the angulated diagonal branch?
A.Fielder and Whisper are the wires of choice to cross the angulated side branches because of hydrophilic nature and 1:1 torque.
QCould a 1.25 burr have been used for the diagonal branch?
A.In current scenario, there is no role of Rota in the sidebranch and is not needed at all and may cause more complications of dissection, perforation or burr entrapment. Also we have small micro catheters and small balloons (1, 1.2, 1.25mm sizes and 8-15mm in length) which will cross any angulated diagonal once wire has crossed. Excimer Laser could be the next option in uncrossable diagonal sidebranches.
QCould OCT also have been used instead of IVUS?
A.Yes OCT is a good substitute to IVUS except for ostial LM lesions
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