Case Report: LMCA Bifurcation PCI Using Minicrush Technique with IVUS Guidance

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Case Report: LMCA Bifurcation PCI Using Minicrush Technique with IVUS Guidance

Case Report: LMCA Bifurcation PCI Using Minicrush Technique with IVUS Guidance

Author: Dr. Gyana Ranjan Nayak
Institution: SUM Hospital, Bhubaneswar, India

Introduction

Left Main Coronary Artery (LMCA) bifurcation lesions represent complex coronary anatomy, with CABG traditionally recommended as the first-line therapy. Percutaneous coronary intervention (PCI) using dedicated bifurcation techniques is a viable alternative in selected patients who decline surgery or are high surgical risk. We report a case of successful LMCA bifurcation PCI using the minicrush technique under IVUS guidance.

Case Presentation

A 65-year-old male with a history of angina uncontrolled on medical therapy presented with non-ST-segment elevation myocardial infarction (NSTEMI ACS).

Investigations:

  • Echocardiography: Normal left ventricular ejection fraction (LVEF)
  • Laboratory Findings: Non-diabetic
  • Coronary Angiography: Triple vessel disease with a critical ostial left circumflex (LCx) lesion and significant diffuse disease in the left anterior descending (LAD) artery

Management Decision:

  • CABG was recommended as the first-line option.
  • The patient opted for PCI and declined surgery.

Procedural Technique

  • Access: 7F femoral artery
  • Guidance: IVUS used for lesion assessment and stent optimization
  • Stenting Technique: Dedicated LMCA bifurcation PCI using minicrush technique
  • Stent Deployment and Optimization:
    • Ostial LAD minimum stent area (MSA): 12 mm²
    • LCX MSA: 10 mm²
    • Polygon of Confluence (POC) MSA: 13 mm²
    • LMCA MSA: 14.5 mm²
  • Procedure Outcome: Optimal stent expansion and apposition confirmed with IVUS

Outcome

  • Angiographic Result: TIMI 3 flow achieved in both LAD and LCx
  • Clinical Outcome: Hemodynamically stable, no peri-procedural complications
  • Follow-Up: Standard post-PCI care with dual antiplatelet therapy, secondary prevention, and lifestyle counseling

Discussion

LMCA bifurcation PCI remains technically challenging. While CABG is the gold standard for distal LMCA disease, PCI is an appropriate alternative in patients who refuse surgery or have high surgical risk.

Critical factors for success include:

  • Proper access (7F femoral in this case)
  • Advanced imaging guidance (IVUS)
  • Precision bifurcation techniques (minicrush, POC, final kissing balloon inflation)

This case underscores the importance of meticulous planning, effective team coordination, and specialized technical expertise in achieving optimal outcomes.

Conclusion

This procedure demonstrates that minicrush PCI with IVUS guidance for LMCA bifurcation can be performed safely with excellent stent expansion in selected patients.

Keywords: LMCA bifurcation, PCI, minicrush technique, IVUS guidance, NSTEMI, coronary intervention, interventional cardiology, cardiologist in Bhubaneswar, complex coronary procedures

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