Successful Percutaneous Coronary Intervention With Two-Stent Technique for Unprotected True Left Main Bifurcation Lesion Via Left Snuffbox Approach

J INVASIVE CARDIOL 2019;31(3):E55.

Key words: bifurcation lesion, left main disease, snuffbox approach, two-stent technique

A 67-year-old man was referred to our clinic suffering from worsening exertional chest pain. After loading of aspirin 300 mg and clopidogrel 300 mg, coronary angiography (CAG) was performed via left snuffbox approach using a 5 Fr radial sheath (Radifocus Introducer II; Terumo Corporation). CAG demonstrated true left main bifurcation lesion (Medina classification: 1,1,1), with severe stenosis in the distal unprotected left main coronary artery (ULMCA) involving the proximal left anterior descending artery (LAD) and left circumflex artery (LCX) (Figure 1A). Thus, percutaneous coronary intervention (PCI) with a two-stent technique using a 7 Fr Judkins-type catheter (Vistal Brite Tip; Cordis) was planned, which led to a change to a 7 Fr sheath (Figure 1B). Predilation was done with a 2.5 x 15 mm compliant balloon from distal ULMCA to proximal LAD (Figure 1C); two everolimus-eluting stents (Xience Sierra; Abbott Vascular) were then simultaneously deployed from the distal ULMCA into the proximal LAD (2.75 x 18 mm) and the proximal LCX (3.0 x 23 mm) at 12 atm (Figure 1D). Final CAG showed good distal flow without residual stenosis (Figure 1E) and there was no puncture-site bleeding complication after 3 hours of hemostasis (Figure 1F).

There are few data regarding complex PCIs, such as this PCI for ULMCA and two-stent technique for a bifurcation lesion, via snuffbox approach. This case illustrates the potential feasibility of complex PCI and the benefits of hemostasis via snuffbox approach.

From the Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted October 25, 2018.

Address for correspondence: Myung Ho Jeong, MD, PhD, Cardiovascular Convergence Research Center of Chonnam National University Hospital, 671 Jaebongro, Dong-gu, Gwangju 501-757, Republic of Korea. Email: myungho@chollian.net