Crush2

A 76 years old male patient was admitted to our department with "NSTEMI" diagnosis from ED. Cardiovascular risk factors: hypertension, dislypidemia, former smoker. Echo: inferolateral wall hypokinesia. Lab: hsTPN I 580 mcg/L. Scheduled for cathlab on the next day. 6 Fr righ radial approach: Right coronary artery: proximal CTO. Left coronary artery: Left main: no remarkable lesions; LAD: middle segment moderate stenosis (iFR 0.88, haemodinamically significant); LCX: calcific, CTO after OM1 takeoff; OM1: three subocclusive tandem lesions. Rentrop 2 left to right collaterals. Patient was proposed CABG, but he refused. So he was scheduled on next day for OM1 PCI. Theraphy: ASA 100 mg, Ticagrelor 90 mx bid, Bisoprolole 1.25 mg, Atorvastatin 80 mg.

7 Fr right femoral approach. EBU 4.0/7.0 Fr. Sodic Heparin 5000 IU. OM1 wiring with Whisper ES 0.014" and Sion Blue 0.014". Multiple predilations with semicompliant balloons 1.5x15 and 2.0x15 mm. Failed attempt of stent delivery and stent got stucked in left main-LCX axis. Failed attempts to recover stent inflating its own balloon, then inflating a new balloon on a parallel wire, that caused stent deformation. Failed attempt to recover stent using handmade snares. So we perform initial crush of dislodged stent by inflating 3.0x20 mm semicompliant balloon, then PCI of left main-LAD-LCX with 2 DES 4.0x23 and 3.0x15 mm using minicrush technique to crush dislodged stent definitely, with POT of left main and final kissing ballon technique. PCI of midLAD was then performed. Staged OM1 PCI using Rotablator was eventually done in a subsequent hospitalization.