Webinar 8 | Bifurcation Badness - Cases from South Asia-Dr. Malik case presentation slides

Dr. Malik case presentation slides

Pdf Summary

This case report by Prof. Dr. Fazila-Tun-Nesa Malik details the complex percutaneous coronary intervention (PCI) of a 57-year-old male patient presenting with a 4-hour history of chest pain (NSTEMI), ventricular tachycardia, and cardiac arrest. The patient, with multiple risk factors including hypertension, diabetes, hyperlipidemia, smoking, and a family history of ischemic heart disease, had a reduced ejection fraction (40%). Coronary angiography revealed a short left main stem with 80-90% stenosis at its trifurcation, 95% stenosis in the left circumflex artery (LCX), 99% stenosis in the ramus, and 100% occlusion of the left anterior descending artery (LAD). The right coronary artery was disease-free, providing collateral support.<br /><br />The intervention involved complex wiring and multiple pre-dilatation steps targeting the LAD, LCX, and ramus arteries using microcatheters and various balloon sizes. A dual arterial access approach (femoral and radial) with the “Ping Pong” technique was utilized, allowing simultaneous catheter engagement and wire manipulation. Various stenting strategies were applied to the trifurcation lesion: double kissing (DK) crush stenting from left main to LAD and LCX, T-stenting of LCX and ramus, and mini-crush stenting between LAD and ramus. Post-stent balloon dilatations, including proximal optimization technique (POT) and triple balloon inflation (trising), were performed to optimize stent apposition. Intravascular ultrasound (IVUS) was employed to guide and confirm optimal stent deployment.<br /><br />The case highlights that multiple bifurcation PCI techniques and dual arterial access can successfully treat complex trifurcation left main coronary artery lesions when coronary artery bypass grafting (CABG) is not feasible. The “Ping Pong” technique enables flexible catheter manipulation, and IVUS guidance is essential to optimize outcomes. Effective left main PCI greatly impacts long-term prognosis in high-risk patients.

Keywords

Percutaneous Coronary Intervention

Left Main Coronary Artery

Trifurcation Lesion

Dual Arterial Access

Ping Pong Technique

Double Kissing Crush Stenting

Intravascular Ultrasound

Non-ST Elevation Myocardial Infarction

Complex Bifurcation PCI

Proximal Optimization Technique