10 Oct 2025
Left main PCI - LIVE Case
Distal left main provisional stenting and DCB on LCX and LAD in stent restenosis
Summary
A 78-year-old male with a history of LAD PCI in 1997 presented with an NSTEMI three months earlier due to diffuse three-vessel calcified disease, including: distal LM stenosis, severe mid and distal disease of a dominant RCA, and LAD in-stent restenosis. LV function was normal. He underwent RCA PCI two months ago.
During the following procedure, a new stent was implanted in the LAD beyond the previous stent, a DCB was used to treat the in-stent restenosis and the proximal LCX, and a stent was placed from the ostial LM to the proximal LAD (within the proximal segment of the prior stent). Lesion preparation included a 1.75 mm rotablation burr and a cutting balloon for the LAD, and IVL for the left main. The PCI was guided by OCT.
LIVE Educational Case from National University Heart Centre - Singapore
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Key moments
- 08:50–13:53 – Imaging analysis
- 21:54–32:26 – OCT analysis at the different steps of PCI
- 36:50–49:30 – IVL procedure
Keywords: Left main distal stenosis, provisional stenting, Rotablator, IVL, OCT
Learning Objectives
- To learn how to devise strategies for complex distal left main bifurcation PCI
- To learn the usefulness of intravascular imaging in optimising outcomes
- To learn how to treat left main in-stent restenosis from under-expansion
