Webinar 9 | Women in Interventional Cardiology: Complex Bifurcation Cases-Case presentation, Dr. Megha Prasad

Video Transcription

Video Summary

The webinar featured Dr. Prasad discussing a complex left main trifurcation PCI case involving an 82-year-old frail man with multi-vessel coronary artery disease, complicated by hypotension and a large pericardial effusion. Initial stabilization with pericardiocentesis and hemodynamic monitoring was crucial before proceeding. Despite high-risk factors including kidney impairment and prior CABG denial, a staged approach including right heart cath, orbital atherectomy for lesion preparation, and a culotte stenting strategy was employed via radial access. IVUS guided lesion assessment and balloon sizing helped optimize calcium fracture and stent placement while avoiding excessive metal in the ramus. The patient’s creatinine improved with careful hydration, and no mechanical complications were found. The case underscored the importance of comprehensive pre-procedural planning, multidisciplinary heart team discussion, and tailored hemodynamic support decisions. Six months post-procedure, the patient was asymptomatic with stable renal function, reflecting successful complex PCI management. European experts discussed alternative strategies like drug-coated balloons for non-stented branches.

Keywords

left main trifurcation PCI

pericardiocentesis

orbital atherectomy

culotte stenting

multidisciplinary heart team