A distal LM bifurcation PCI
with IVUS guidance
Jun-Jie Zhang, MD, FSCAI
Nanjing First Hospital
Nanjing Medical University
How to treat?
LM bifurcation lesion (Medina 1,1,1)
• Provisional stenting vs.2-stent?
• If PS, how to protect LCX?
• If 2-stent,which one?
Definition of Complex Bifurcation Lesions
Chen SL, et al. JACC Interv 2014
My strategy
• Clinical presentation:
• Unstable Angina
• Lesion complexity:
• SYNTAX Score 28
• Simple BL
• Strategy:
• Provisional Stenting with jailed wire
IVUS Finding before Predilatation
↑ 点击查看大图
Cutting Balloon dilatation of LM-LAD and LCX
LM-LAD: 3.5/10 Flextome@14atm
LCX: 3.5/10 Flextome@14atm
Stenting LM-LAD with jailed wire
LM-LAD: 3.5/30 Resolute @ 10atm
POT Followed by Kissing Inflation
LM: 5.0/08 Quantum @ 20atm
LAD: 4.0/12 NC sprinter@8atm
LCX: 3.5/20 NC sprinter@8atm
Kissing Inflation Result
Re-POT
LM: 5.0/08 Quantum@ 20atm
Final Results
IVUS Final Results
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Take Home Message
• PCI for the treatment of LM bifurcation lesion with SYNTAX score lower than 28 was associated with good mid term result.
• Definition criteria can be used to distinguish simple LM BL from complex LM BL
• Provisional SB stenting with IVUS guidance was the preferred approach for simple LM BL.
