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Unprotected LM Trifurcation Lesion treated as two sequential bifurcations

EBC - ON DEMAND

European Bifurcation Club 2019, EBC 2019 – Barcelona, Spain

AWARD CASE SESSION – VOTING

Unprotected LM Trifurcation lesion treated as Two sequential Bifurcations using two different stenting techniques

Author: Parminder Singh, MD, DM, PGI Chandigarh, India

 

CASE OBJECTIVE

To discuss and learn: Management of LM trifurcation lesion in ACS – simplifying a multiple stent strategy

CASE PRESENTATION

Patient Demographics:

  • 27 year old
  • Male , a cab driver

Clinical History:

  • Recent onset angina class III , one episode of rest angina
  • Dyspnoea on exertion both for last – 25 days

Risk Factors:

  • Hypertension
  • Family History of CAD : Father, Paternal Uncle, Paternal Grandfather

Diagnostic Tests:    

  • ECG revealed ST depression in V3-V6
  • 2D Echo – Normal LV FuncDon , No RWMA ,Normal valves
  • TROPONIN – Elevated

LEARNING POINTS

  • Distil left main trifurcation is a complex lesion – Op2mal PCI strategy – not well defined
  • Basic rules of bifurcation lesions can be applied to trifurcation.
  • Keep it simple:  Single stent > 2 stent > 3 stent strategy preferred.
  • Simplified by treating trifurcation as two sequential bifurcations, especially if three stent strategy is planned .
  • By combining two stenting techniques for LM trifurcation ,good result can be achieved quickly and safely ,esp. in ACS.
  • IVUS guidance is helpful in optimising procedure results as in other left main lesions.

 

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