How should I treat this mini-crush stenting complication?

EuroIntervention Journal

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.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.

Read case