Unexpected complication during left main bifurcation PCI

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Left main bifurcation PCI using the D-Crush technique requires precise balloon sizing and careful crush balloon position. In the present case, PCI was performed for a complex left main bifurcation lesion using the D-Crush technique. Careful wiring of both the left anterior descending (LAD) and left circumflex (LCx) arteries was achieved, followed by stent deployment in the LCx. During the crush step, a non-compliant balloon was positioned in the left main to crush the protruding segment of the left main.
However, during balloon inflation, an unexpected complication occurred. The left main coronary artery developed a rupture (perforation).

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Authors

Malik F.¹, Uddin M. M.¹

1. National Heart Foundation Hospital & Research Institute, Dhaka, BANGLADESH