Case 101: PCI Manual - Left main trifurcation

A patient was referred for PCI of a distal left main trifurcation lesion (LAD, ramus, dominant circumflex) as well as a mid LAD lesion. IVUS demonstrated that the left main was not significantly narrowed. After wiring the LAD, ramus and circumflex using workhorse guidewires, we first treated the mid LAD lesion, followed by provisional stenting of the left main trifurcation, stenting from the left main into the LAD. After performing POT (proximal optimization technique), the circumflex was wired with a pressure wire showing an iFR of 1.0, hence no additional PCI was performed.

[@matheuscsmed]

Thank you, Matheus Silva

[@shangz0216]

Thanks for your educative presentation.

[@salahuddinsalahuddin3210]

Thanks. Great case!! Very useful!

[@oussamabenrejeb2535]

Great case Tanks

[@TheMic0584]

We always open struts by kissing at least the dominant cx in lm cases. I'm a big fan, could you explain why not please

[@manosbrilakis]

Great point - this is an area of controversy: opening the side struts facilitates accessing the vessel if needed and may reduce restenosis. At the same time it can deform the main vessel stent and may lead to dissection necessitating stenting the circumflex. My usual approach is to not balloon the side branch, but you should always decide what is best for each patient and each lesion.

[@pers7175]

@@manosbrilakis great job

[@dobryi_chel]

@@manosbrilakis if do not to do kissing baloon technique in LM PCI, DAPT must be prolonged?

[@oussamabenrejeb2535]

In our cath labs in Tunisia we haven’t IVUS or FFR techniques How to be sure that we don’t require the POT side REPOT technique? thank you

[@drsidiyengar]

Why don't you use different colour torquer for identification

[@manosbrilakis]

Great idea (if you have different color torquers)