Successful Management of a Complex Coronary Bifurcation Lesion in Acute Coronary Syndrome Using a Free-Metal Approach

We present the case of a 56-year-old male with non-ST elevation myocardial infarction (NSTEMI) and a complex thrombotic lesion at the ostial left circumflex artery (LCX), extending into bifurcating marginal branches. Due to the high risk of side branch occlusion, a stentless strategy using thrombus aspiration, the reverse wire technique, and sequential plaque modification with a cutting balloon (Rodin-CUT technique) was employed. Following optimal lesion preparation, a drug-coated balloon (DCB) was deployed, achieving excellent angiographic and intravascular ultrasound (IVUS) results, with sustained vessel patency at 6-month follow-up. This case highlights the efficacy of a free-metal strategy in managing challenging bifurcation lesions while preserving side branches and avoiding the risks associated with permanent metallic implants.