Author + information
- Bing Liu1
Patient initials or identifier number
Relevant clinical history and physical exam
Complain aggressive chest tightness for 8 months.
Cardiac risk factor included hypertension, dyslipidemia.
Pre-PCI to LAD/D1 bifurcation lesion with two des of Crush tech.
ECG Non-special ST-T changes in chest leads.
ECHO EF 57% RWMA（-）.
Family History: Unremarkable
Physical exam: Unremarkable
Relevant test results prior to catheterization
LDL 2.62 mmol/L
Cre 79 mmol/L
Ccr 54 ml/min
Relevant catheterization findings
Double-vessel disease and right dominant.
Pre-DES noted in mid- to a dis-LAD and minor lesion in stented segment, covering ostium D2, D2 was wider, Pre-Des noted at ostium D2 and 90% lacol lesion in stented segment.
50% local lesion in mid-RCA.
Medtronic 6F EBU 3.75, ACS Whisper 0.014-190 cm GC to LAD and second GC to D2, Boston Emerge 2.5-15 mm balloon dilated osD1. Firstly, then Boston Flextome Cutting Balloon 2.5-10 mm dilated sequentially 3 times at 6 to 8 ATM. Abbott NC TREK 3.0-12 mm balloon dilated the lesioned segment where D2 branched out.
Moreover, final-kissing POBA completed with two DCBs at 8 ATM keeping on 45 s, B.BraunSequent Please 2.5-20 mm in D2 and B. Braun Sequent Please 3.0-20 mm in m-dLAD. Nice acute result.
Bifurcation lesion PCI still was a difficult problem, a Single-stent strategy was the 1st option and mostly got a nice long-term outcome. However, some operator would like two-stent strategy in most LAD/D bifurcation lesion with classic Crush-technique just like this case. In addition, D ostium ISR was the main cause of revascularization. In this case, POBA was the way and even second layer metal was inserted which means bad outcome. DCB technique had shown advance than 1st generation DES while treating ISR. SO for this case, DCB kissing-dilation may give a now chance for the complicated lesion.