Intravascular Imaging in Bifurcation Stenting

An 84-year-old male presented with a non-ST-segment elevation myocardial infarction. Coronary angiogram demonstrated severe left main coronary artery bifurcation stenosis. Left main coronary artery bifurcation stenting was performed using a double kiss crush technique. The patient represented 4 days later with a further non-ST-segment elevation myocardial infarction.

Repeat angiogram demonstrated a hazy opacity at the ostium of the circumflex (Cx). Intravascular imaging demonstrated deformation of the ostial Cx stent with associated thrombus.

The mechanism of deformation was abluminal wire recrossing into the Cx. Unintentional stent deformation is an underrecognized problem. This case highlights the importance of optimal wire recross when performing bifurcation stenting with the double kiss crush technique.

Unintentional stent deformation is an underrecognized problem. Intravascular imaging should be used in bifurcation stenting to: 1) ensure side-branch stent optimization; 2) confirm recross wire position; and 3) ensure there is no unintentional stent deformation.