Left Main Trifurcation Disease Research Articles

Procedural characteristics and clinical outcomes in patients undergoing percutaneous coronary intervention for left main trifurcation disease: the EXCEL trial.

Limited data exist regarding procedural and clinical outcomes of percutaneous coronary intervention (PCI) in patients with trifurcation disease of the distal left main (LM) coronary artery. We therefore aimed to examine the procedural methods and early and late outcomes among patients undergoing distal LM trifurcation versus bifurcation PCI in the EXCEL trial. Patients with distal LM bifurcation disease randomised to PCI with everolimus-eluting stents in the EXCEL trial were categorised into those with and without trifurcation involvement. Angiographic and procedural characteristics in addition to clinical events up to five-year follow-up after PCI were compared. Among 605 patients with site-reported distal LM disease, 61 patients (10.1%) were identified with trifurcation anatomy. The five-year primary composite endpoint of death, myocardial infarction, or stroke occurred in 16.6% of patients with trifurcation disease compared with 22.5% of patients with distal bifurcation disease only (p=0.32). Ischaemia-driven target lesion revascularisation rates were also similar (11.9% vs 12.0%, p=0.94). No significant differences in definite or probable stent thrombosis were observed between treatment groups (1.7% vs 2.3%, p=0.76). Despite the greater inherent complexity, procedural and long-term clinical outcomes following PCI of distal LM trifurcations with everolimus-eluting stents in a modest-sized cohort from the EXCEL trial were similar compared with treatment of distal LM bifurcation disease without trifurcations. These findings support PCI as a treatment strategy for selected patients with distal LM trifurcation disease. ClinicalTrials.gov Identifier: NCT01205776.

TCTAP C-042 Critical Left Main Trifurcation Disease - How to Approach This Very Challenging Case?

### Patient Initials or Identifier Number XYZ ### Relevant Clinical History and Physical Exam Patient XYZ, 45-year-old male chronic smoker, admitted to our hospital with a complaint of recent onset chest pain. No history of shortness of breathlessness, no syncope. His blood pressure (systolic

TCT-84 Procedural Strategy and Clinical Outcomes in Patients Undergoing PCI for Left Main Trifurcation Disease: The EXCEL trial

TCT-84 Procedural Strategy and Clinical Outcomes in Patients Undergoing PCI for Left Main Trifurcation Disease: The EXCEL trial

Trifurcation Stenting of left anterior descending artery by “Kurdistan” Technique using Two Guide Catheters

Percutaneous coronary intervention of trifurcating lesion is a challenging and complex procedure. This has been reported for left main trifurcation disease but little is known about such substrate in left anterior descending artery. We herein report a case of 68-year-old male with chronic stable angina who was successfully treated with percutaneous coronary stent implantation for trifurcation lesion of left anterior descending artery. Bifurcation lesion was treated using culottes’ technique with 6F guide catheter. Balloon angioplasty of third side branch of the trifurcation lesion was performed with another 6F guide catheter. Here, first 6F catheter was pulled to dehook the left main when left main was being hooked with second 6F catheter. Fine tuning of both guide catheters needs to be exercised to make them stable, and to avoid injury of left main artery. This is the first case report to highlight the feasibility and efficacy of dual guiding catheter to treat a trifurcation lesion of left anterior descending artery by Kurdistan” Technique.

Modified T stenting for leftmain trifurcation stenosis in a patient with multiple co-morbidities through transradial route

A critical lesion in the left main coronary artery (LMCA) has been observed in 3%–5% of all the patients undergoing coronary angiography. Significant LMCA disease is considered as the lesion with the highest prognostic value in the coronary system because of the extent of jeopardised myocardium. Though CABG is considered as gold standard for treatment of left main stenosis, particularly distal left main, evidence is increasing to support the use of PCI with stenting in some cases . We report here a case of an elderly male with peripheral vascular disease and distal left main trifurcation disease with critical stenosis of ostial LAD and ostial LCX, who was treated by us with PCI of the distal left main trifurcation with a modified T stenting technique through the transradial route.

TCT-389 Clinical and Angiographic Outcomes of Percutaneous Coronary Intervention with Triple Kissing Balloon Technique After Drug-Eluting Stent Implantation for Left Main Trifurcation Disease: Comparison Between Single- and Two-Stent Techniques

TCT-389 Clinical and Angiographic Outcomes of Percutaneous Coronary Intervention with Triple Kissing Balloon Technique After Drug-Eluting Stent Implantation for Left Main Trifurcation Disease: Comparison Between Single- and Two-Stent Techniques

Early and long‐term results of percutaneous coronary intervention for unprotected left main trifurcation disease

We aimed to conduct a retrospective cohort study focusing on our 5-year experience in the percutaneous treatment of unprotected left main (ULM) trifurcation disease. Percutaneous treatment of ULM trifurcation remains a challenging and rare procedure for most interventional cardiologists. Moreover, data on long-term outcomes are lacking. We retrieved all patients with ULM trifurcation disease treated percutaneously at our Institution since 2002, and adjudicated baseline, procedural, and outcome data. The primary end point was the long-term rate of major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, bypass surgery, or target vessel revascularization). A total of 27 patients underwent percutaneous coronary intervention with stent implantation for ULM trifurcation disease, with 14 (52%) cases of true trifurcations, i.e., with concomitant significant stenoses of the distal ULM/ostial left anterior descending plus ostial ramus intermedius and ostial circumflex. Bare-metal stents were implanted in 8 (29%) patients and drug-eluting stents (DES) in 26 (96%), with a main branch stent only strategy in 11 (40%), T stenting in 9 (33%), and V stenting in 6 (27%). Procedural and clinical success occurred in 26 (96%), with one postprocedural death. Angiographic follow-up was obtained in 22 patients (81%), and clinical follow-up was completed in all subjects after a median of 28 +/- 17 months, showing overall MACE in 9 (33%), with cardiac death in 4 (15%), myocardial infarction in 1 (4%), coronary artery bypass grafting (CABG) in 4 (15%), and percutaneous target vessel revascularization in 5 (19%). Definite stent thrombosis was adjudicated in 1 (3%) patient. Treatment of a true trifurcation lesion and recurrence of angina during follow-up were significantly associated with an increased risk of MACE (P = 0.029 and P = 0.050, respectively). Percutaneous treatment of ULM trifurcation disease is feasible, associated with favorable mid-term results, and may be considered given its low invasiveness in patients at high surgical risk or with multiple comorbidities.