Simple Technique in Complex Left Main Bifurcation Disease

Author : M. Puspitasari, R. Suryawan
Upload Date : 19-04-2018

Introduction: In spite of coronary artery bypass grafting, percutaneous coronary intervention (PCI) of complex left main (LM) bifurcation disease remain to be a promising strategy in context of stable coronary artery disease revascularization.

Case report: Coronary angiography of 61-years-old male stable angina and heavy active smoker patient revealed true LM disease (Medina 1-1-1) and triple vessel disease accompanied by anomaly origin of right coronary artery (RCA). There was also bifurcation disease (Medina 0-1-1) at distal left circumflex coronary artery (LCx) - obtuse marginal coronary artery (OM)-2. Provisional stenting was chosen at distal LCx and OM-2 bifurcation disease. The stent deployed at distal LCx while we keep OM-2 open. T and small protrusion (TAP) stenting was chosen as reperfusion method at LM disease. First stent deployed at distal LM to proximal left anterior descending coronary artery (LAD) followed by stent placement at LCx with small protrusion into LM bifurcation. Difficulty of guiding catheter (GC) engagement at RCA ostium was resolved by Amplatz Left-2 GC. Heavy calcification disease stenting at RCA was successfully done by buddy wire stenting technique. The result was good without any complication.

Discussion: PCI of complex LM bifurcation disease associated with complex technique and adverse event stent thrombosis. Anatomy and calcification of coronary artery, hemodynamic profile, and left ventricle function remain to be most important factors in stenting technique preference. TAP stenting in this case was chosen according near 90o bifurcation angle of LM and the advantage of side branch fully coverage. 

Conclusion: TAP stenting may be considered as simple stenting technique on left main bifurcation disease with main consideration focus on coronary anatomy and hemodynamic profile.

KEYWORDS : LM bifurcation disease, PCI, TAP stenting

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