"Less Metal" in a Complex Left Main Trifurcation Lesion.

Area of Science:

• Interventional Cardiology
• Vascular Medicine

Background:

• Complex left main (LM) coronary artery trifurcation lesions pose significant management challenges.
• Optimal revascularization strategies for these lesions are still evolving.

Purpose of the Study:

• To report a case of successful management of a distal LM trifurcation lesion.
• To evaluate a hybrid interventional approach combining provisional stenting and drug-coated balloon (DCB) therapy.

Main Methods:

• A provisional stenting strategy was employed for a distal LM trifurcation lesion involving the left anterior descending (LAD), left circumflex (LCx), and ramus intermedius (RI) arteries.
• A single drug-eluting stent (DES) was deployed into the LAD, while the LCx was treated with a DCB. The RI was managed conservatively.
• Intravascular ultrasound (IVUS) was used for procedural guidance, including lesion assessment and stent placement verification.

Main Results:

• Post-procedural IVUS confirmed excellent stent deployment without malapposition or edge dissection.
• The hybrid approach demonstrated successful revascularization with no residual significant disease.
• The patient tolerated the procedure well, highlighting the safety of the technique.

Conclusions:

• A hybrid approach integrating provisional stenting and DCB therapy is a feasible and safe option for selected complex LM trifurcation lesions.
• Intravascular ultrasound (IVUS) guidance is crucial for optimizing procedural outcomes in these challenging anatomies.