Calcified left main distal trifurcation PCI - LIVE Case

A 48‑year‑old man with hypertension and diabetes mellitus presented with a recent history of thrombolysed anterior acute MI and preserved left ventricular function. Coronary angiography revealed a severely calcified ostial LAD and ostial ramus lesion, along with diffuse disease of the RCA.

The ramus was treated with a DCB. Following preparation of the LAD ostium with rotational atherectomy (1.5‑mm burr) and IVL, a long stent (3.5 × 40 mm) was implanted from the left main ostium to the proximal LAD, just proximal to the first diagonal branch. The PCI was guided by IVUS and without kissing.

LIVE Case from Groote Schuur Hospital Cape Town

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Key moments

• 07:10–12:16 – Procedural analysis
• 17:49–27:47 – IVUS runs before PCI
• 27:49–28:27 – DCB in the Ramus
• 29:50–38:13 – LAD rotablator
• 38:13–41:07 – Changing wire after rotablator
• 45:00–51:56 – LAD IVL
• 58:30–01:33:40 – IVUS runs after PCI

Keywords: Left main trifurcation, Provisional stenting, Rotablator, IVL, IVUS, DCB