Unprotected LM Trifurcation Lesion treated as two sequential bifurcations
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.