EBC - ON DEMAND
A left main distal trifurcation lesion: what did I do
European Bifurcation Club 2019, EBC 2019 – Barcelona, Spain
AWARD CASE SESSION – VOTING
A left main distal trifurcation lesion: what did I do
Author: Shih Hung Chan, MD, PhD, National Cheng Kung University Hospital, Taiwan
PATIENT CHARACTERISTICS
A 49-year-old male had hypertension and hyperlipidemia. He had already received percutaneous coronary intervention twice for non-ST elevation myocardial infarction and unstable angina pectoris in the past few years. This Ame, he presented with crescendo angina for 1 month. Renal function was normal.
TREATMENT STRATEGIES
- LV assistance device: nil
- Debulking/plaque modification:
- No marked calcification: not needed in the beginning
- In case needed, considering cutting balloon, scoring balloon,or rotational atherectomy
- Intravascular image:
- Definitely needed
- IVUS
- Antithrombotic: aspirin, clopidogel, and heparin
- Stenting strategy
TAKE HOME MESSAGES
- Percutaneous coronary intervention (PCI) for left main trifurcation lesion is challenging. No one-size-fits-all strategy is available
- The choice of treatment strategy is depended on the discrepancy between vessel size, extent of calcification, angle between vessels, etc.
- To be familial with various PCI techniques, including provisional one stent and two-stent technique as well as the way to protection side branch, is the key to successful PCI for leI main trifurcation lesion