A Novel Modified Mini-Crush Technique for Complex Coronary Bifurcation Lesions: Controlled Balloon-Crush

Figure 1. (a) Critical stenosis of the LAD-D1 bifurcation. (b) IVUS showing severe calcification in the LAD artery. (c-e) Wiring and predilatation of the LAD and D1 arteries. (f) Implantation of a 2.5 × 31 mm DES in the D1 artery using the minicrush approach. DES, drug-eluting stent; D1, first diagonal artery; IVUS, intravascular ultrasound; LAD, left anterior descending artery; LCx, left circumflex artery; LM, left main coronary artery; NCB, non-compliant balloon.

Figure 2. (a) Proximal side-branch optimization technique for balloon stenting. (b) Kissing balloon inflation (D1: stent balloon, LAD: 3.0 × 12 mm NCB). (c) The D1 stent balloon was slowly deflated, and the D1 stent was crushed in a controlled manner. (d, e) IVUS and ClearStent images showing optimal coverage of the D1 artery and appropriate crushing of the D1 stent. (f) A 3.0 × 38 mm DES was implantated in the LAD. DES, drug-eluting stent; D1, first diagonal artery; IVUS, intravascular ultrasound; KBI, kissing balloon inflation; LAD, left anterior descending artery; NCB, non-compliant balloon.

Figure 3. (a-d) POT, final KBI, and re-POT. (e, f) ClearStent and IVUS images showing adequate stent apposition and metallic neo-carina. (g) Final result. DES, drug-eluting stent; D1, first diagonal artery; IVUS, intravascular ultrasound; KBI: kissing balloon inflation; LAD, left anterior descending artery; LCx, left circumflex artery; LM, left main coronary artery; NCB, non-compliant balloon; POT, proximal optimization technique.