SS–14 Nanocrush Technique for Distal Left Main Coronary Artery Bifurcation PCI in a Patient with Occluded Saphenous Vein Grafts

Abstract

Introduction and Aim: Graft occlusion following coronary artery bypass grafting (CABG) represents a challenging clinical scenario that may require complex percutaneous coronary intervention (PCI). Distal left main coronary artery (LMCA) bifurcation lesions are technically demanding, and the selection of an appropriate bifurcation stenting strategy is critical for procedural success. We present a case of successful PCI of a distal LMCA bifurcation lesion using the Nanocrush technique in a patient with a history of CABG and total occlusion of all saphenous vein grafts.

Case Report: A patient with a previous history of CABG underwent follow-up coronary angiography, which demonstrated total occlusion of the left anterior descending (LAD) artery, left circumflex (LCx) artery, and all saphenous vein grafts. Further angiographic assessment revealed a critical lesion involving the distal LMCA bifurcation. Given the absence of patent bypass grafts and the significant distal LMCA disease, PCI was planned. Following appropriate lesion preparation, successful bifurcation stenting of the distal LMCA was performed using the Nanocrush technique. Final angiography demonstrated TIMI grade 3 flow in both the main and side branches without significant residual stenosis. No periprocedural complications occurred, and the patient was discharged in a clinically stable condition.

Conclusion: Distal LMCA bifurcation lesions in patients with previous CABG and total occlusion of bypass grafts represent highly complex coronary interventions requiring substantial technical expertise. In appropriately selected patients and lesions, the Nanocrush technique may provide an effective and safe bifurcation stenting strategy, allowing optimal stent apposition and reconstruction of the bifurcation anatomy.