Case1: Restenosis at the bifurcation treated by crush stenting, 60 year old male


Chief complaint: recurrence of angina
Crush stenting was performed 6 months ago. The first stent was implanted at the high lateral branch, which was crushed by the second stent implanted at left main to proximal LAD.
No restenosis was observed at the left main. However, the ostial circumflex had restenosis.
Strong backup force is necessary to pass a stent through 3 metal layers formed by the crush stenting.
We used 6 Fr Ikari L 4.0 via right radial access.

Angiography showed tight stenosis at the ostial circumflex

Caudal view

LAO Caudal view

ステント通過 Power position

It failed to pass a stent in standard position through 3 metal layers.
However, making power position of Ikari L, it was successful to pass a stent. As shown in the movie, the distal tip of the guiding catheter is outside of the left main. We can still push a stent stably because it is the power position.

Stent implantation

Post dilatation with kissing balloon technique

Final angiography

The third stent was implanted. The stent was T stent to the left main stent and culotte stent to the high lateral stent.


Strong backup force was necessary to pass a stent through 3 metal layers formed by crush stenting.
It failed to pass in the standard position of Ikari L. However, power position of Ikari L generated sufficient backup.
There was no restenosis in follow-up angiography 8 months later.