PCI of LAD-D1 and LAD-D2 Bifurcation using Double Mini-Crush Technique

Case and Plan:
75-year-old male with CCS Class III angina, negative SPECT MPI, but CTA with significant 2 V CAD. A Cardiac Cath on January 19, 2024 revealed 2 V CAD and anonmalous LCx: 95% proximal RCA, 80% mid RCA, long 80-90% moderately calcified LAD lesion with large size 80% D1 & moderate size 90% D2 bifurcation lesions, SYNTAX Score of 22 and LVEF 60%. Patient underwent successful interventions of RCA using two DES and did well. Patient is now planned for staged PCI of LAD-D1 and LAD-D2 bifurcation using double mini-crush technique.

[@jwilson3985]

Distal LAD deserves IVUS or IFR/FFR evaluation.

[@bilalalam1]

good case -- from ohio - i probably would have fixed the mid-distal LAD as well

[@tom11298]

DCB with kissing DCB for D2-LAD Stenting D1-LAD

[@jwilson3985]

I really think “hammering” the ostial SB by retracting the SB balloon back into the MV a few mm helps w re-crossing. Mid to distal cell crossing is fine.

[@MuhammadYasir-jl2fm]

When Ivus catheter is already open why don't you measure the length with that

[@gudalarajesh6249]

Is d2 stenting required sir?

[@areenal-taie6836]

Congratulations on your new Cath lab Thanks a lot for sharing the great knowledge! Very much appreciated ❤ Areen Al Taie

[@tom11298]

sometimes calcium can be underestimated with simple fluro.