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Lots of interesting abstracts and cases were submitted for TCTAP 2021 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don’t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!

TCTAP C-026 . Presentation

Presenter

Hosein Alavi

Authors

Hosein Alavi1

Affiliation

Shiraz University of Medical Sciences, Iran1,
View Study Report
TCTAP C-026
CORONARY - Bifurcation/Left Main Diseases and Intervention

Double Bifurcation Percutaneous Coronary Intervention in Acute Coronary Syndrome

Hosein Alavi1

Shiraz University of Medical Sciences, Iran1,

Clinical Information

Patient initials or Identifier Number

295468

Relevant Clinical History and Physical Exam

The patient was a 50-year-old gentleman with no prior history of coronary artery disease. He was admitted to the hospital after a new onset of chest pain. Physical examination did not show any significant findings. ST segment elevation and T-wave inversion in anterior leads were detected in the electrocardiogram. He received loading doses of aspirin and clopidogrel and was referred to cardiac catheterization laboratory for primary percutaneous intervention (PCI).

Relevant Test Results Prior to Catheterization

White blood cells 7.2 (×103/mcl)
Hemoglobin 13.1 (gm/dl)
Platelets 253 (×103/mcl)
Lymphocytes 0.5 (×10 3/mcl) 0.9–3.2 (×103/mcl)
Sodium 132 (mmol/L) 135–145 (mmol/L)
Potassium 5.1 (mmol/L)
Creatinine 0.90 (mg/dl)
Troponin‐T 3.6 (ng/ml) < 0.01 (ng/ml)

Relevant Catheterization Findings

Left Coronary angiogram showed significant stenosis in the mid of left anterior descending artery followed with muscle bridge. The first large diagonal branch had 90% stenosis ostial and proximal portions. The second diagonal branch also had significant narrowing at its origin. Right coronary angiogram was normal.
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Interventional Management

Procedural Step

After coronary angiogram, LCA was engaged with EBU 7f guiding catheter. Then two guidewires were passed through LAD and second diagonal branch (D2). After pre-dilation, using the double kissing crush technique, D2 was stented and crushed with an NC balloon and after rewiring, first kissing balloon inflation was performed. Afterward, LAD was stented and second kissing balloon inflation, post dilation and POT were done. Next step was saving the large diagonal branch, so its wiring was done and after pre-dilation with the jailed stent balloon technique, two stents were advanced through LAD and first diagonal branch. The diagonal stent was deployed and after deflation, the stent balloon was pulled back a little. Then LAD stent was inflated. After deflation of the LAD stent balloon, Jailed stent balloon of diagonal branch was reinflated and removed, and finally, LAD stent balloon was reinflated again. Afterward, rewiring of D1 was done and eventually post dilation,  kissing balloon inflation and POT were done with a nice final result.
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second bifurcation.MOV
final result.MOV

Case Summary

Saving the Coronary side branch is a mandatory step in saving the myocardium, especially if it is a large side branch.In this particular case both diagonal branches supplied a large myocardial territory, and that is why saving it was of great importance.Double kissing crush technique for both bifurcation lesions needed more time.The use of jailed stent balloon technique, in this case, has good short and medium-term results.The jailed stent balloon technique is especially useful in acute coronary syndrome for shortening the procedural time.

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TCTAP 2021 Virtual Apr 12, 2021
It’s very well organized. Thanks for sharing!