case_images: PMC6158926_01
case_images: Left coronary angiogram of the (a) right anterior oblique caudal view and (b) left anterior oblique cranial view revealed a significant distal left main trifurcation lesion (yellow arrows).
case_images: CRIC2018-6852946.001.jpg
case_images: PMC6158926_01_CRIC2018-6852946.001.jpg
case_images: fig1
case_images: Diagnostic coronary angiography revealed distal left main trifurcation disease including significant stenosis in the distal left main trunk (LMT), ostial left anterior descending artery (LAD), and ostial left circumflex artery (LCX) (modified Medina classification 1-1-1-0) (Figure 1).
case_images: Stent implantation using the simultaneous jailed balloon and jailed Corsair technique. (a) Left coronary angiogram of the left anterior oblique caudal view before stent implantation. (b) The side branch balloon in the intermediate branch was initially inflated. (c) The main branch stent balloon was inflated, which jailed the side branch semi-inflated balloon in the intermediate branch and the Corsair Pro microcatheter in the left circumflex artery. (d) Blood flow was preserved in both side branches after stenting. (e, f) Final kissing balloon inflations were performed.
case_images: CRIC2018-6852946.002.jpg
case_images: PMC6158926_01_CRIC2018-6852946.002.jpg
case_images: fig2
case_images: To protect the two large side branches, a Balance Middleweight Universal II guide wire (Abbott Vascular Japan, Tokyo, Japan) and a SION Blue guide wire (Asahi Intecc) with a Corsair Pro microcatheter (Asahi Intecc) were introduced into the intermediate branch and LCX, respectively (Figure 2(a)). The side branch balloon in the intermediate branch was initially inflated at low pressure (3 atm) (Figure 2(b)). The main branch stent balloon in the LMT to LAD was then inflated three times at nominal pressure (11 atm), which simultaneously jailed the side branch semi-inflated balloon in the intermediate branch and the Corsair Pro microcatheter in the LCX (Figure 2(c)). Blood flow was preserved in both the intermediate branch and the LCX after main vessel stenting, and there were no signs of plaque or carina shift into the side branches (Figure 2(d)). After reinsertion of a SION Black guide wire (Asahi Intecc) into the jailed intermediate branch via stent struts using a double-lumen catheter (Crusade K; Kaneka Medix, Osaka, Japan), kissing balloon inflation was performed with a 3.0 x 16 mm stent balloon in the LAD and a 2.5 x 15 mm canPass balloon in the intermediate branch (Figure 2(e)). Final kissing balloon angioplasty was then performed with a 3.0 x 16 mm stent balloon in the LAD and a 2.5 x 15 mm canPass balloon in the LCX (Figure 2(f)).
case_images: Final coronary angiogram of the (a) right anterior oblique caudal view and (b) left anterior oblique cranial view showed excellent results without any complications including side branch narrowing or occlusion (green arrows).
case_images: CRIC2018-6852946.003.jpg
case_images: PMC6158926_01_CRIC2018-6852946.003.jpg
case_images: fig3
case_images: A final coronary angiogram showed excellent results without any complications, including side branch narrowing or occlusion (Figure 3).