Another Technique for Reverse Wiring in the Acute Bend of Left Main Coronary Artery Trifurcation

Area of Science:

• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Complex left main (LM) trifurcation lesions pose significant challenges in percutaneous coronary intervention.
• Conventional wiring techniques often fail due to severe vessel angulation and equipment manipulation difficulties.

Observation:

• A 51-year-old man with unstable angina presented with significant stenoses in a left main trifurcation anatomy.
• Standard wiring methods failed to cross the distal LM and proximal LAD lesions due to extreme angulation.
• A balloon-assisted reverse wiring technique using a 0.3 wire (BARWAS) was employed to overcome these challenges.

Findings:

• The BARWAS technique successfully navigated the complex trifurcation anatomy without causing trauma to adjacent vessels.
• Two stents were implanted from the mid-left anterior descending (LAD) artery to the LM under intravascular ultrasound guidance.
• BARWAS proved effective and safe for managing extremely angulated branches in complex LM trifurcations.

Implications:

• BARWAS offers a valuable alternative for complex coronary interventions involving challenging trifurcation anatomy.
• This technique enhances procedural success rates and patient safety in high-risk PCI cases.
• Further studies may validate BARWAS in a broader range of complex coronary anatomies.