Author + information
Patient initials or identifier number
55 year-old lady
Relevant clinical history and physical exam
A 55 years old ex-parliamentarian referred to our center for CAG. One month earlier,she admitted in a tertiary non-PCI capable hospital with NSTEMI and managed conservatively. She was non-hypertensive, non-diabetic, non-smoker, and non-alcoholic. Her ECG revealed T-inversion in anterior leads, Anterior wall hypokinesia and 50% LVEF on echo. Her CAG done through trans-radial route and found trifurcated left main disease with significant LAD ostial involvement with normal RCA.
Relevant test results prior to catheterization
ECG: T-inversion in anterior leads
Echo: Anterior wall hypokinesia
Relevant catheterization findings
Trifurcated left main disease with significant LAD ostial involvement with normal RCA
Wired down LM to LAD. Another wire passed to LCX. Balloon dilated quickly from LM to LAD. A 4.5/30 mm Onyx Resolute stent deployed from LM to LAD. Wires exchanged from LAD to LCX and from LCX to LAD. Post dilated with non-compliant balloon with proximal optimization. IVUS checked and found the stent apposition was adequate and the LCX ostial was clear. As the IVUS revealed Good LCX ostial, single stent strategy taken. She tolerated the procedure with some pain in the right arm due to spasm of the radial artery.
PCI in left main disease even though with trifurcation can be done by radial route. IVUS check is mandatory to estimate the size of the vessel, extent of plaque burden, and optimizing the stent size for best possible outcome single stent strategy is the best when feasible.