Racing Against Time: Simultaneous Anterior and Inferior ST-Elevation Myocardial Infarction Managed With the Nano-Crush Bifurcation Stenting Technique

Figures

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  Fig. 1. The electrocardiogram obtained during chest pain demonstrated ST-segment elevation in the inferior and anterior leads.

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  Fig. 2. Diagnostic coronary angiography revealed a 100 % occlusion of the LAD.

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  Fig. 3. A: RCA was also found to be 100 % occluded. B: Following predilatation with a 2.0 × 15 mm semi-compliant balloon, optimal flow was achieved after the implantation of 3.5 × 15 mm and 3.5 × 19 mm EES.

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  Fig. 4. A: When re-accessing the LAD, it was observed that the previously total occlusion had spontaneously reperfused, revealing a bifurcation lesion involving the LAD and the diagonal branch. B: A 3.0 × 16 mm everolimus-eluting stent was positioned in the diagonal branch and inflated at nominal pressure, followed by inflation of a 2.5 × 15 mm semi-compliant balloon in the LAD, resulting in the crushed appearance of the side-branch stent. C: Moment of implantation of a 3.0 × 16 mm everolimus-eluting stent in the LAD. D: Both branches were postdilated using 3.0 × 12 mm non-compliant balloons in a kissing balloon fashion. E: Proximal optimization technique performed with a 3.5 × 12 mm non-compliant balloon. F: Optimal luminal expansion was achieved.

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  Fig. 5. A: From a different angiographic view, a distal lesion of the LAD stent was observed. B: Optimal angiographic appearance following implantation of a 3.0 × 16 mm EES.