Webinar 11 | LM Trifurcation-Case: Step-by-Step Approach of LM Trifurcation Stenting, Dr. Imad Sheiban

Case: Step-by-Step Approach of LM Trifurcation Stenting, Dr. Imad Sheiban

Video Transcription

Video Summary

The presentation discussed the complex challenges of percutaneous coronary intervention (PCI) in left main trifurcation disease, characterized by plaque distribution in three branches. Using an extended Medina classification, the speaker outlined strategies including single, double, or triple stenting based on lesion complexity and plaque location. Provisional single-stent approaches are preferred for simpler cases to minimize stent overlap and complications. For more extensive disease involving all branches, complex techniques like reverse TAP or culotte stenting are employed, emphasizing careful planification and vessel wiring with hydrophilic wires for tight lesions. The speaker highlighted using larger guiding catheters (7-8 French), intravascular imaging, and lesion preparation, while minimizing metal overlap to reduce restenosis risks. A detailed case of an 85-year-old with diffuse disease illustrated staged stenting with kissing and trypsis balloon inflations. The discussion concluded that no gold standard exists; procedural planning must be individualized considering patient condition and lesion anatomy, and drug-coated balloons may help reduce stent use in the future.

Keywords

Percutaneous Coronary Intervention

Left Main Trifurcation Disease

Extended Medina Classification

Single and Multiple Stenting Strategies

Intravascular Imaging

Drug-Coated Balloons