DKC2 stenting - “Double”, double kissing crushing stenting to LM-LCx & LAD-1st diag

#CardioTwitterCase originally published on Twitter

A step-by-step simultaneous double kissing crushing stenting for a LM-LCX-LAD & 1st Diagonal branch double bifurcation PCI.

This case was originally published on Twitter by @omendiz

Case description

The relevance of following and step-by-step procedure in a complex PCI for a high surgical risk patient after a CABG failure.

We present the case of a 73-year-old male with previous complicated CABG, all graft occluded, a complex LM-LCx, and LAD-Diagonal heavily calcified bifurcation lesions.

We used a 7Fr femoral access with 3 conventional .014” guidewires. A “high” pressure cutting balloon predilatation was performed.

LCx stenting, then crushing and kissing followed by the same sequence for 1st diagonal branch to proceed with LM-LAD stenting and final kissing for each bifurcation and POT for LM were done.

Excellent angiographic (showed in the video) and IVUS (unfortunately, due to a technical issue, we don't have access to these videos) results were achieved. Patient was discharged overnight under DPT.

Videos

3.0 Cutting Balloon predilatation (14 atm)
3.0 Cutting Balloon predilatation (14 atm)
3.0x24mm DES
3.0x18 mm DES (18 atm)
LCx Stent Crushing
LCx Stent 1st Kissing (2.5 &3.5mm balloons)
1st Diag predilatation (2.5mm)
1st Diag Stent (2.5x18 mm)
1st Diag Stent Crushing
After Crushing 1st Diag Stent
1st Kissing After Crushing LAD-Diag
LM-LAD Stent (3.5x30mm)
After LM-LAD Stenting
LAD-1st Diag Final Kissing (2.5 & 3.0mm)
LM-LCx Final Kissing (3.0 & 3.5mm)

POT was performed into the LM with a 4.5 short balloon

Final Angio
Final Angio

Final remarks

In conclusion, a double simultaneous DKC stenting was useful to solve these two bifurcation lesions.

Original tweet and Twitter discussion

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This case report does not reflect the opinion of PCR or PCRonline, nor does it engage their responsibility.