Webinar 8 | Bifurcation Badness - Cases from South Asia-Case presentation, Dr. Fazila T. N. Malik

Video Transcription

Video Summary

The case involves a 57-year-old man with multiple risk factors—hypertension, diabetes, dyslipidemia, smoking, and family history—presenting with non-ST elevation myocardial infarction and 40% ejection fraction. After cardiac arrest and resuscitation, angiography revealed severe trifurcation left main disease, with total occlusion of the LAD and critical stenoses in LCX and ramus branches. Due to complexity and lack of bypass options, a multi-bifurcation stenting approach was employed using the ping-pong technique (dual femoral and radial guide catheters) enabling simultaneous wire access. Techniques included DK crush, T-stenting, and mini crush, optimized with IVUS guidance. The patient has remained asymptomatic and stable for over five years post-procedure. The discussion emphasized chronic versus acute lesion aspects, the importance of hemodynamic support, and modern strategies like drug-coated balloons that might alter contemporary treatment. Overall, the case illustrates sophisticated interventional strategies tackling complex trifurcation left main lesions with great long-term success.

Keywords

non-ST elevation myocardial infarction

trifurcation left main disease

multi-bifurcation stenting

ping-pong technique

IVUS guidance