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-029
Balloon Embedded DK Crush Technique
By Praveen Velappan
Presenter
Praveen Velappan
Authors
Praveen Velappan1
Affiliation
Government Medical College Kollam, India1,
View Study Report
TCTAP C-029
CORONARY - Bifurcation/Left Main Diseases and Intervention
Balloon Embedded DK Crush Technique
Praveen Velappan1
Government Medical College Kollam, India1,
Clinical Information
Patient initials or Identifier Number
A S
Relevant Clinical History and Physical Exam
51-year-old gentleman admitted with acute anterior wall myocardial infarction. He was taken up for a coronary angiogram and revascularization.
HR - 86/min regular, BP - 130/80 mmHg, O2 saturation 96%. Cardiovascular system examination was unremarkable.
Other systems were within normal limits.
Relevant Test Results Prior to Catheterization
ECG Showed acute AWMI.
Echo showed RWMA in LAD territory with mild LV systolic dysfunction.
Blood reports revealed elevated cardiac biomarkers, normal Hb and renal function.
Relevant Catheterization Findings
Coronary angiogram showed discrete 80% lesion in proximal LAD followed by a tandem 80% LAD - diagonal bifurcation lesion (medina 1,1,1). The diagonal bifurcates after its origin from LAD and has significant bifurcation stenosis (medina 0,1,1). RCA - no significant lesions.
MOVIE-0006.mp4
MOVIE-0008.mp4
MOVIE-0009.mp4
MOVIE-0006.mp4 MOVIE-0008.mp4 MOVIE-0009.mp4Interventional Management
Procedural Step
Plan was to go ahead with a DK crush strategy protecting the lower branch of diagonal with an embedded balloon.
All three branches were wired.
After predilatation, stent placed in diagonal with a balloon embedded in the lower branch of diagonal.
Stent deployed with the embedded balloon in lower branch. Balloon embedding led to TIMI III flow in both diagonal branches with no dissection.
First crush and a first kiss was given.
Now the main branch stent was deployed after removing the side branch wire.
Second kiss given.
Pot was done.
Final result - TIMI III flow in all branches.
MOVIE-0017.mp4
MOVIE-0037.mp4
MOVIE-0049.mp4
All three branches were wired.
After predilatation, stent placed in diagonal with a balloon embedded in the lower branch of diagonal.
Stent deployed with the embedded balloon in lower branch. Balloon embedding led to TIMI III flow in both diagonal branches with no dissection.
First crush and a first kiss was given.
Now the main branch stent was deployed after removing the side branch wire.
Second kiss given.
Pot was done.
Final result - TIMI III flow in all branches.
MOVIE-0017.mp4 MOVIE-0037.mp4 MOVIE-0049.mp4Case Summary
Two stent strategy is a viable option when there are significant side branches.
Here we selected a DK crush strategy considering the acute angle between the main and side branch.
Balloon embedded angioplasty helps to save branches even if they are small. (No branch is insignificant - save them if possible)
Follow the basic steps of any selected strategy and success will be yours.
Here we selected a DK crush strategy considering the acute angle between the main and side branch.
Balloon embedded angioplasty helps to save branches even if they are small. (No branch is insignificant - save them if possible)
Follow the basic steps of any selected strategy and success will be yours.