Webinar 5 | LM Stenting-LM Stenting

Video Transcription

Video Summary

The webinar focused on left main bifurcation PCI, beginning with guideline-based decision-making: assess anatomy, use a heart team approach, and choose CABG or PCI based on complexity and surgical candidacy. Speakers emphasized the importance of IVUS/OCT and physiology to evaluate intermediate lesions, plan calcium modification, guide stent sizing, and confirm optimal post-PCI expansion and apposition.<br /><br />Several cases illustrated practical strategy. For simple distal left main bifurcations, provisional stenting was favored, with POT and kissing balloon inflation used selectively. For complex disease, especially heavily calcified lesions or difficult circumflex access, upfront two-stent strategies such as DK crush or culotte were discussed. Hemodynamic support was not routine; it was reserved for patients with poor hemodynamics, instability, or extreme complexity, and right heart cath was highlighted as useful for assessing filling pressures and cardiac index.<br /><br />A major theme was that procedural planning is essential, but operators must remain flexible when anatomy or intraprocedural findings change. The panel also debated ostial stenting versus extending into the left main, the role of drug-coated balloons, and when to use kissing balloon inflations. The session ended with practical advice: image the lesion, keep procedures simple when possible, and treat left main PCI as a team effort.

Asset Subtitle

Yiannis S. Chatzizisis, MD, PhD, FSCAI; Binita Shah, MD, FSCAI; Adhir R. Shroff, MD, MPH, FSCAI; Mariem Sawan, MD; Bryan Kindya, MD

Asset Caption

closed captions are computer-generated

Keywords

left main bifurcation PCI

heart team decision-making

IVUS OCT

provisional stenting

DK crush

culotte stenting

calcium modification

hemodynamic support

right heart catheterization