23 May 2025
PCI for complex left main disease - LIVE Case
Distal calcified left main PCI with provisional stenting after lesion preparation
Summary
An 82-year-old male patient with a history of STEMI and diagonal PCI (2004) presented with stable angina (CCS 2). CT imaging revealed 2 severe LAD stenoses (at the ostium and mid part), and a severe bifurcation stenosis at the Cx/OM1 confirmed by angiography. A staged PCI was performed: a provisional stent PCI of the Cx/OM1 2 days prior, and then a LAD PCI.
After lesion preparation with cutting and non-compliant (NC) balloons, a long stent was implanted in the mid-LAD. The procedure continued with provisional stenting of the calcified LM/LAD following lesion preparation using cutting balloon, intravascular lithotripsy (IVL), and NC balloon. All steps were guided by IVUS.
LIVE Educational Case from Sant'Andrea University Hospital - Rome, Italy
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Key moments
- 07:08-11:20 - Imaging analysis
- 24:40-27:38, 37:04-39:10, 45:11-48:14, 1:06:34-1:06:53 - IVUS-guided steps
- 32:42-35:30, 40:13-43:56 - Calcified lesion preparation
- 48:50-59:30 - Step-by-step IVL
- 1:07:58-1:15:42 - Step-by-step left main provisional stenting
Keywords: Distal left main PCI, provisional stenting, IVL, cutting balloon, IVUS
Learning Objectives
- To share experience on treatment strategies in left main stenosis with associated coronary lesions in daughter branches
- To highlight the pivotal role of intra-coronary imaging in procedural planning and device selection
