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

Video Transcription

Video Summary

Valeria presented a complex case of a 72-year-old woman with hypertension and diabetes, presenting with STEMI and multivessel coronary disease. Initial treatment included thrombus aspiration and DES implantation in the mid-RCA. Multiple lesions in small-caliber vessels and a challenging bifurcation lesion in the LAD involving the second diagonal branch (Medina 1,1,1) were evaluated. The team discussed strategies weighing angiographic severity, vessel size, and low body weight (55 kg) that increased bleeding risk. OCT imaging guided decision-making, revealing mild calcium and lipid-rich plaques, aiding lesion assessment and stent optimization. The bifurcation was managed by a two-stent culotte technique due to a <70° angle and comparable branch sizes, after provisional main branch stenting showed ostial pinching and underexpansion. The team debated alternatives like DCB but favored complete coverage of the side branch ostium. They emphasized individualizing treatment considering bleeding risk, especially in low-weight female patients, tailoring antiplatelet therapy and procedural complexity accordingly.

Keywords

STEMI

multivessel coronary disease

bifurcation lesion

OCT imaging

two-stent culotte technique