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How should I treat this mini-crush stenting complication?

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology(2017)

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Abstract
BACKGROUND: A 62-year-old male was admitted with an acute non-ST-elevation myocardial infarction. Coronary angiography revealed a severe left anterior descending (LAD)-first diagonal (D1) bifurcation lesion, Medina type 1,1,1. Percutaneous revascularisation was performed, using a mini-crush bifurcation technique, with a good angiographic result. Optical coherence tomography (OCT) control was undertaken.INVESTIGATION: Coronary angiography, OCT.DIAGNOSIS: D1 stent deformation with severe malapposition caused by a post-dilating balloon, over a guidewire with a course partly outside the stent, resulting in a gap of scaffolding and drug delivery, as well as in a large edge dissection.MANAGEMENT: Implantation of an additional stent on the proximal D1, by an internal mini-crush technique, sealing the dissection and properly scaffolding the arterial wall, but resulting in an asymmetrical double lumen, separated by a stent neocarina.
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Key words
complication,coronary bifurcation,edge dissection,malapposition,mini-crush technique,neocarina
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