Case 85: PCI Manual - Ostial left main/LAD bifurcation stenting

A patient was referred for PCI of unprotected ostial left main and ostial LAD coronary artery lesions. He had normal ejection fraction and was pretreated with ticagrelor. Using femoral access the left main was engaged with an 8 French EBU guide catheter that was intermittently disengaged to prevent dampening. Given no significant disease in the proximal circumflex, a provisional stenting strategy (stent from left main into the LAD jailing the circumflex) was selected. IVUS was performed showed moderate calcification. A non-flow limiting dissection occurred after predilation with an Angiosculpt balloon. A stent was placed from the left main into the LAD and was postdilated at the left main ostium with an Ostial Flash balloon. Post stenting FFR in the LAD was 0.74 with an additional step-up in the mid LAD that was treated with implantation of another stent and a nice final result.

[@matheuscsmed]

Thank you, Matheus Silva

[@TheNEF11]

Thank you very much sir! great case!

[@andriigavrilishin7675]

Thank you for this case report and also for great channel. One question, why you did not perform side branch (Cx PTCA)?

[@naveedniazi3644]

Sorry for wrong pasting of comment/query! My question was about Case 84 of double stent thrombosis

[@tom11298]

the No-KBI strategy is non-inferior to KBI strategy when stenting the main vessel using provisional stenting. Also FFR confirmed good result on Cx. There are trails to confirm this. Hence no need to FKB in this case.

[@salahuddinsalahuddin3210]

Thanks.

[@Альбертини-51]

Thank you for are great Case! Why didn’t you do the final kissing with CX - LM-LAD?

[@joaoboscobastos6133]

In the case of a birfucation with a large lateral branch, why not do POT and Re-POT or KB to open the stent struts?

[@micger]

did you open the stent struts to LCx?

[@naveedniazi3644]

Prof Brilakis what was the initial stenting technique used? LAD, RAMUS &LCX all seemed to have ostioprox stents in situ.