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Patient background
59 year old male with known history of hypertension and hyperlipidemia
 

Presentation
RCA-distal 99% stenosis, LADTotal occlusion, LCX-mid 87% stenosis, LM Bifurcation Lesion.
 

PCI procedure
  • Treating RCA stenosis with Xience Prime 4.0*23mmand Non-­compliant PTCA balloonfor post-­‐dilatation (fig.1)
  • Treating LAD (fig 2, fig 3, fig 4, fig 5)
  • Treating LCx-­‐mid (fig 6 and fig 7)
  • Treating LM Bifurcation lesion ( Medina Classification 1,1,1) (fig 8, fig 9, fig 10, fig 11)
     
Fig 1 Fig 2 Fig 3 Fig 4
       
   
Fig 5 Fig 6    


Discussion
Treatment strategies for LM PCI include Crushing technique、Tstenting、Culottetechnique、Simultaneous kissing stenting, depending on the site and severity of the lesion. T stentingis more likely to form dead spaceand results in higher re-steosis rate.
We used Culotte stentingand placed in LM-­ LCX(4.0*23mm) and LM-­LAD(3.5*18mm) with Xience Primes. Simultaneous kissing balloon dilatation was used with optimal efficacy.

 
Fig 7 Fig 8 Fig 9 Fig 10
       
     
Fig 11