Bifurcation Stenting with Internal Crush (Reverse Crush) technique as a bailout in Acute coronary Syndrome


  • Hasan Sohail Tabba Heart Institute, Karachi-Pakistan.
  • Khursheed Hassan Tabba Heart Institute, Karachi-Pakistan.
  • Salman Ishaq Tabba Heart Institute, Karachi-Pakistan.
  • Muhammad Amin Tabba Heart Institute, Karachi-Pakistan.


NSTEMI, Bifurcation Stenting, Percutaneous Coronary Intervention, Reverse Crush/Internal Crush, No Reflow.


Introduction: Percutaneous coronary intervention (PCI) during acute coronary syndrome (ACS) involving bifurcation stenting presents heightened complications and intricacy. This case report showcases a 66-year-old woman with high-risk ACS and extensive coronary artery disease, featuring a total left anterior descending artery (LAD) occlusion. The case highlights the complexity of PCI in ACS, especially with bifurcation stenting.

Case Presentation: The patient, a 66-year-old woman, exhibited high-risk ACS with triple vessel coronary artery disease and complete LAD occlusion on angiography. The initial strategy aimed to restore LAD flow, followed by Coronary artery bypass grafting (CABG). However, her condition deteriorated due to severe no-reflow unresponsive to intracoronary vasodilators. In response, a left main (LM) to LAD PCI was performed to stabilize the patient. The case further elaborates on the internal crush bifurcation stenting technique and subsequent PCI of the right coronary artery (RCA), all undertaken within the same hospitalization for comprehensive revascularization.

Results: The patient's critical ACS necessitated swift decision-making. Severe no-reflow in the LAD, resistant to vasodilators, prompted a LM-LAD PCI to stabilize the situation. The report discusses the internal crush bifurcation stenting method used, providing insights into its technical aspects and implications. Furthermore, the PCI of the RCA during the index hospitalization for full revascularization is detailed, highlighting the comprehensive approach employed.

Conclusion: This case underscores the dynamic and critical nature of ACS management, requiring prompt decisions and adaptability. The successful execution of internal crush bifurcation stenting as a bailout strategy in this context demonstrates the potential for this technique in specific clinical scenarios. Timely interventions, such as LM-LAD PCI, are crucial to stabilizing patients in high-risk ACS situations, ultimately contributing to improved outcomes. The case emphasizes the importance of considering multifaceted strategies and techniques when managing complex ACS cases with bifurcation stenting challenges.


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How to Cite

Sohail, H., Hassan, K., Ishaq , S., & Amin , M. (2023). Bifurcation Stenting with Internal Crush (Reverse Crush) technique as a bailout in Acute coronary Syndrome. Cathalogue, 1(1), 01–06. Retrieved from