2019 Scientific Sessions

Title: An Obligatory Trifurcation LM Intervention Treated by The Novel "Inverted Single Strut V and Protrusion VAP Technique" Introduction: LM interventions are increasingly met in our practice, this is related to the progression and aggressiveness of the atherosclerosis pathology and is helped by the progress and feasibility of the technology of imaging and intervention tools. Trifurcating LM still remains as a challenge with no specific technique or recommendation to tackle this particular subset. Clinical Case: 60 years old, male patient.Hypertensive for 15 years. Patient had an acute coronary syndrome (7/2017) and PCI was done to ostial ramus intermedius lesion. 5 months later, the patient presented by repeated attacks of unstable angina increasing gradually to angina at rest on the day of admission to our CCU. Coronary angiography showed: ostial tight ramus ISR, Ostial 99% LCX stenosis, and 80% ostial LAD stenosis for surgical revascularization. The patient refused CABG, he was resent for PCI after 48 hours. We decided to do our described procedure, an inverted single strut protrusion VAP technique, suitable for 90 degerees anle between LAD and LCX with the ramus nearly exactly in the middle, V stenting between the LCX and the Ramus, where a DES was put in the LCX and a DEB in the Ramus, this was associated with a single strut protrusion from the LCX stent into the LM due to marked size discrepancy (6mm vs 3.5 mm), them an inverted TAP through the LM-LCX with the LAD, no space within the LM to kiss or POT. Discussion: -It's always difficult to decide about ostial lesions. - Sometimes it's better to leave an ostial diagonal, ostial OM or ostial ramus for medical treatment. - Trifurcating distal LM interventions still remains as a challenge. -The described "inverted single strut protrusion VAP technique" maybe a reasonable option for such cases.