Case 129: PCI Manual - Unprotected left main PCI

A patient presented with unstable angina and was found to have a 90% lesion in the body of the left main, without significant lesions in the LAD, circumflex, and RCA. After discussion about PCI vs. CABG the patient decided to proceed with left main PCI. After wiring into the LAD, the left main lesion was predilated with a 3.0 mm balloon, but the lesion did not fully expand. IVUS demonstrated 180° arc of calcium. A 4.0 mm NC balloon expanded the lesion but also caused a dissection extending from the left main into the LAD without compromising antegrade flow. The left main was stented with a 4.0x13 mm DES that was postdilated with a 4.5 mm balloon, but the LAD dissection persisted. After wiring the circumflex a 3.5 mm DES was placed from the left main into the LAD with an excellent final result.