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.