SS–17 Rotablation-Assisted Complex Left Main Coronary Trifurcation Intervention in Severe Calcification: A Successful IVUS-Guided Complex Percutaneous Coronary Intervention

Abstract

Introduction and Aim: Left main coronary artery (LMCA) trifurcation lesions, particularly in the presence of severe calcification, represent some of the most complex interventions in interventional cardiology. In patients who are unsuitable for surgical revascularization or decline surgery, rotational atherectomy-assisted percutaneous coronary intervention may provide a successful alternative.

Case Report: A 69-year-old man was admitted with non-ST-segment elevation myocardial infarction and acute decompensated heart failure. Coronary angiography revealed a severely calcified Medina 0,1,1 LMCA trifurcation lesion, accompanied by a chronic total occlusion of the distal right coronary artery. Although surgical revascularization was recommended by the Heart Team, the patient declined surgery, and a high-risk percutaneous intervention was planned. For lesion preparation, rotational atherectomy was performed using a 1.5-mm burr, followed by implantation of a drug-eluting stent from the LMCA into the circumflex artery. During the procedure, impairment of LAD flow developed and was successfully managed using the T and small protrusion (TAP) technique, followed by final kissing balloon inflation and proximal optimization technique. Intravascular ultrasound confirmed adequate stent expansion and complete apposition. The procedure was completed without complications, with restoration of TIMI grade 3 flow on final angiography. Follow-up angiography demonstrated patent stents, while the patient showed a marked improvement in functional capacity and an increase in left ventricular ejection fraction during follow-up.

Conclusion: This case demonstrates that, in patients with severely calcified LMCA trifurcation lesions, a strategy combining rotational atherectomy, an appropriate bifurcation technique, and IVUS-guided stent optimization may provide a safe and successful treatment option for high-risk patients.