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European Heart Journal Advance Access originally published online on February 9, 2006
European Heart Journal 2006 27(16):1897; doi:10.1093/eurheartj/ehi791
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Simultaneous triple kissing stenting in an unprotected left main coronary artery

Christophe L. Dubois*, Peter R. Sinnaeve and Walter J. Desmet

Department of Cardiology, U.H. Gasthuisberg, Herestraat 49, Leuven, Belgium

* Corresponding author. E-mail address: christophe.dubois{at}uz.kuleuven.ac.be

A 76-year-old hypertensive male smoker with diabetes mellitus and a family history of coronary artery disease was urgently referred to the cardiac catheterization laboratory after a prolonged episode of chest discomfort, soon progressing to cardiogenic shock. Electrocardiogram showed a new left bundle branch block.

Coronary angiogram was performed using an 8 French guiding catheter and revealed an ostial thrombotic occlusion of the left anterior descending artery (LAD) in the left anterior oblique caudal projection (Panel A). A small circumflex artery (Cx) showed only moderate disease at the ostium.

A thrombus aspiration was performed in the LAD using an EXPORT catheter (Medtronic), restoring flow in the LAD and a very early originating diagonal branch (Dx). In an attempt to maintain patency in this trifurcation, three PRO-Kinetic stents (Biotronik) were positioned (Panel B) in the unprotected left main coronary artery (LMCA) to LAD (2.5/22 mm), Dx (2.5/22 mm), and Cx (2.5/15 mm) and simultaneously deployed at 10 atm (Panel C). Although TIMI 3 flow was restored through a widely patent LMCA trifurcation (Panel D), progressive deterioration to profound cardiogenic shock could not be prevented. The patient expired 24 h after recanalization.

Although long-term outcome of simultaneous kissing stenting technique for the treatment of bifurcation lesions is unknown, this case shows that even triple kissing stenting technique using newer generation stents is feasible through 8 French guiding catheters with good immediate angiographic success. Nevertheless, this approach should be reserved for bailout situations, as in the case presented.

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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
27/16/1897    most recent
ehi791v1
Right arrow E-letters: Submit a response
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Right arrow Articles by Dubois, C. L.
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Right arrow Articles by Dubois, C. L.
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