JACC

Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don¡¯t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP C-031

Bifurcation Stenting Using DK Crush Method

By Benjamin Tao Xiung Lim, Tze Ming Chan, Hazleena Mohamed Hasnan, Ramachandran Sathappan, Nor Hanim Mohd Amin

Presenter

Benjamin Tao Xiung Lim

Authors

Benjamin Tao Xiung Lim1, Tze Ming Chan2, Hazleena Mohamed Hasnan3, Ramachandran Sathappan4, Nor Hanim Mohd Amin3

Affiliation

Hospital Serdang, Malaysia1, Columbja Asia petaling Jaya, Malaysia2, Hospital Raja Permaisuri Bainun, Malaysia3, Hrpb Ipoh, Malaysia4,
View Study Report
TCTAP C-031
CORONARY - Bifurcation/Left Main Diseases and Intervention

Bifurcation Stenting Using DK Crush Method

Benjamin Tao Xiung Lim1, Tze Ming Chan2, Hazleena Mohamed Hasnan3, Ramachandran Sathappan4, Nor Hanim Mohd Amin3

Hospital Serdang, Malaysia1, Columbja Asia petaling Jaya, Malaysia2, Hospital Raja Permaisuri Bainun, Malaysia3, Hrpb Ipoh, Malaysia4,

Clinical Information

Patient initials or Identifier Number

ZBAH

Relevant Clinical History and Physical Exam

A 62-year-old female, with underlying hypertension, paroxysmal atrial fibrillation, end-stage renal disease on regular hemodialysis, presented with chest pain and shortness of breath. She was diagnosed with a NSTEMI with troponin I 80 ng/L. ECHO showing EF 59%. ECG sinus rhythm with T inversions over the anterior leads. Vital signs were stable and clinical examination was unremarkable. 

Relevant Test Results Prior to Catheterization

Relevant Catheterization Findings

Initial COROS showed 2 vessel disease with a smooth left main stem, LAD proximal to mid showing 50-70% stenosis, Dg1 ostial 80% ( Medina 1/1/1), LCx proximal 60% stenosis, RCA dominant and smooth. 
1ST KBT.mp4
2ND KBT.mp4
2ND POT.mp4

Interventional Management

Procedural Step

Right Femoral Approach with 6Fr femoral sheath, EBU 3.5 6Fr guide catheter, BMW and Sion blue coronary wires with total 200mls of Omnipaque contrast.The BMW was wired into the LAD and Sion blue wired to the Dg1. The Dg1 was predilated with NC Sapphire balloon 2.5 mm x 15 mm at 14 to 20 atmospheres (ATM). Subsequently, predilatation of LAD was done with a NC Sapphire balloon 3.0 mm x 15 mm at 8 to 26 ATM. The Dg1 was stented using Drug eluting stent (DES) XIENCE Xpedition 2.5 mm x 18 mm deployed at 12 ATM. Next, the stent balloon was removed and Dg1 stent was crushed using a NC Sapphire balloon 3.0 mm x 15 mm at 26 ATM. Then rewiring of Dg1 performed at proximal cells.1st Kissing Balloon Technique (KBT) done with a NC Sapphire balloon 3.0 mm x 15 mm at 16 ATM in LAD and NC LAXA balloon 2.0 mm x 15 mm at 12 ATM in Dg1. Ostial to proximal LAD was stented with DES XIENCE Xpedition 3.5 mm x 48 mm deployed at 9 ATM. Post dilatation of LAD stent with stent balloon at 18 ATM.1st POT of LAD stent done with NC Trek balloon 4.0 mm x 15 mm at 18 ATM followed by rewiring of the Dg1 with Sion blue wire. Final KBT done using a NC Sapphire 3.5 mm x 15 mm at 14 ATM in LAD with NC Sapphire 2.5 mm x 15 mm at 14 ATM in Dg1. Final POT of LAD stent done with NC Trek 4.0 mm x 15 mm at 18 ATM and concluded procedure.
FINAL RAO CRANIAL.mp4
FINAL LAO CRANIAL.mp4
FINAL LAO CAUDAL.mp4

Case Summary

Good results were seen on final angiography. Procedure ended with successful PCI to LAD & Dg1 using DK Crush method with patient being discharged from hospital the following day and remaining well on clinic follow up.