11 Oct 2025
Complex non left main bifurcation - LIVE Case
Culotte stent strategy + DCB for distal side branch
Summary
A 55-year-old male with no risk factors presented with an anterior STEMI treated by primary PCI of the LAD. Coronary angiography revealed triple-vessel disease. The RCA was treated one month later with a DCB, and the bifurcation LCX/OM (Medina 1,1,1) was treated during the live procedure. Left ventricular function was mildly reduced (LVEF 48%).
After extensive lesion preparation with non-compliant balloons, two stents were implanted in the LCX and OM using a culotte technique, with a DCB applied to the distal OM under OCT guidance. 3D OCT was used to ensure correct wiring of the distal cell during the culotte procedure and to guide final kissing with stent enhancement.
LIVE Educational Case from Apollo Hospitals - Chennai, India
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Key moments
- 05:22–09:43 – OCT analysis
- 53:43–57:47 – DCB dilatation
- 59:03–1:05:00 – Culotte technique step by step
- 01:06:28–01:09:25 – 3D OCT
Keywords: Non left main bifurcation, Culotte technique, OCT, 3D OCT, DCB, stent enhancement
Learning Objectives
- To understand the anatomy and complexity of bifurcation lesions using intracoronary imaging for optimal treatment planning
- To learn the selection of the optimal stenting strategy in a large non–left main bifurcation
- To demonstrate the step-by-step provisional stenting strategy
