case_images: PMC5228674_01
case_images: Stenting procedure for the thrombotic bifurcation lesion with double kissing Crush technique. (A) Coronary angiography showed a thrombotic occlusion in proximal LAD (arrowhead). (B, C) Coronary angiography revealed a "complex" bifurcation lesion on LAD/diagonal 2, which was also confirmed by OCT (a-c) after balloon predilation. (D) Stenting procedure for the bifurcation lesion with double kissing Crush technique (1-9). LAD = left anterior descending artery, OCT = optical coherence tomography.
case_images: medi-96-e5740-g001.jpg
case_images: PMC5228674_01_medi-96-e5740-g001.jpg
case_images: F1
case_images: Coronary angiography showed a thrombotic occlusion in the proximal left anterior descending (LAD) artery (Fig. 1). Fig. 1, Supplemental Digital Content, which showed the stent was fully expanded without flow restriction or dissection). First, a 2.75 x 14 mm drug-eluting stent was implanted in the D2 with 3 mm protruding in the main vessel (Fig. 1, D1). The protruded segment was crushed by a noncompliant balloon (3.0 x 12 mm) (Fig. 1, D2). The deployed stent in D2 was re-wired in which the wire position was confirmed by orthogonal projections and the ostium of SB was then dilated with a noncompliant balloon (2.75 x 14 mm) (Fig. 1, D3). Kissing balloon inflation was performed with a 2.75 x 20 mm noncompliant balloon in D2 and a 3.0 x 14 mm noncompliant balloon in LAD artery (Fig. 1, D4). Then, a 3.0 x 33 mm drug-eluting stent was deployed in the proximal LAD artery followed by postdilation (Fig. 1, D5). The stent in the D2 was re-wired through the proximal/middle stent cell of the stent in the LAD artery (Fig. 1, D6). Kissing balloon was performed using a 2.75 x 12 mm and 3.0 x 12 mm noncompliant balloons at 10 atm (Fig. 1, D7), and then proximal optimization technique was conducted with a 3.5 x 9 mm noncompliant balloon (Fig. 1, D8 and D9).
case_images: The results of angiography and OCT post-procedure and at 1-year follow-up. (A) Final angiography after stenting the bifurcation lesion. (B) Angiography at 1-year follow-up. (C) OCT longitudinal views postprocedure and (D) at 1-year follow-up, together with cross-sectional views (a-c and a'-c'). (E-H) Three-dimensional OCT reconstruction confirmed no malapposed stent struts in bifurcation carina and POC area postprocedure. (F-I) The stent struts in bifurcation carina and POC area were well covered by a thin neointimal hyperplasia at 1-year follow-up. OCT = optical coherence tomography, POC = polygon of confluence.
case_images: medi-96-e5740-g002.jpg
case_images: PMC5228674_01_medi-96-e5740-g002.jpg
case_images: F2
case_images: The protruded segment was crushed by a noncompliant balloon (3.0 x 12 mm) (Fig. 1, D2). Offline 3-dimensional OCT reconstruction confirmed no malapposed stent struts in the carina of the bifurcation and polygon of confluence area (Fig. 2). OCT and offline 3-dimensional reconstruction demonstrated that stent struts in both LAD and D2 were well covered by a thin neointimal layer that did not cause significant obstruction (Fig. 2).