LMCA DK-Crush Technique
In case of LMCA bifurcation, LMCA and LAD are considered MV and LCX is considered SB.
Wire MV and SB.
Pretreat MV with NC balloon (1:1).
Pretreat SB with NC balloon (1:1).
Advance stent Into SB and place 1-2 mm retracted into MV; advance 1:1 NC balloon in distal MV.
Deploy the SB stent.
Remove the SB stent balloon. Take an angiogram to rule out distal edge dissection. Inflate the MV balloon crushing the SB stent.
Remove the MV balloon. Rewire the SB through the crushed SB stent struts.
Advance NC balloon (1:1 with distal vessel) through the crushed stent struts into SB; may use compliant balloon if NC balloon doesn’t pass. Advance NC balloon (1:1) into MV.
Perform KBI (1st kiss).
Remove balloons from MV and SB. Remove SB wire.
Advance stent in MV.
Deploy MV stent.
Remove MV stent balloon. Rewire SB through the crushed MV and SB stent struts.
Perform POT. Balloon size according to LM size (short balloon – do not extend into LAD or LCx) for optimal LM stent apposition. Consider POT before rewiring if you have concerns of the wire entering behind the stent.
Advance NC balloon (1:1 with distal vessel) into SB; may use compliant balloon if NC balloon doesn’t pass. Advance NC balloon (1:1) into MV.
Perform KBI (2nd).
Perform low magnification angiogram to rule of stent edge dissection; if the result is satisfactory, conclude the procedure
