The patient was a 50-year-old gentleman with no prior history of coronary artery disease. He was admitted to the hospital after a new onset of chest pain. Physical examination did not show any significant findings. ST segment elevation and T-wave inversion in anterior leads were detected in the electrocardiogram. He received loading doses of aspirin and clopidogrel and was referred to cardiac catheterization laboratory for primary percutaneous intervention (PCI).
After coronary angiogram, LCA was engaged with EBU 7f guiding catheter. Then two guidewires were passed through LAD and second diagonal branch (D2). After pre-dilation, using the double kissing crush technique, D2 was stented and crushed with an NC balloon and after rewiring, first kissing balloon inflation was performed. Afterward, LAD was stented and second kissing balloon inflation, post dilation and POT were done. Next step was saving the large diagonal branch, so its wiring was done and after pre-dilation with the jailed stent balloon technique, two stents were advanced through LAD and first diagonal branch. The diagonal stent was deployed and after deflation, the stent balloon was pulled back a little. Then LAD stent was inflated. After deflation of the LAD stent balloon, Jailed stent balloon of diagonal branch was reinflated and removed, and finally, LAD stent balloon was reinflated again. Afterward, rewiring of D1 was done and eventually post dilation, kissing balloon inflation and POT were done with a nice final result. first bifurcation.mov second bifurcation.MOV final result.MOV
Saving the Coronary side branch is a mandatory step in saving the myocardium, especially if it is a large side branch.In this particular case both diagonal branches supplied a large myocardial territory, and that is why saving it was of great importance.Double kissing crush technique for both bifurcation lesions needed more time.The use of jailed stent balloon technique, in this case, has good short and medium-term results.The jailed stent balloon technique is especially useful in acute coronary syndrome for shortening the procedural time.