Around 15-20% coronary lesions include bifurcation, and among which left main (LM) bifurcation lesions are critical and complex to manage. Though two-stent strategy is preferred option for complex LM bifurcation lesion, provisional strategy should be considered if side branch is disease free to avoid peri- and post-procedural complications. Thus, precise anatomical and physiological assessment of LM lesion should be made using intravascular imaging techniques for appropriate decision making. Here, we report three case of successfully managed LM bifurcation lesions using provisional stenting technique with a guidance of intravascular ultrasound, fractional fl ow reserve and heart team. All three patients were doing well and were ischemia free on stress echocardiography at three months follow-up.
Despite considerable progress in the ????field of interventional cardiology, percutaneous coronary intervention (PCI) of coronary bifurcations continues to be associated with a lower procedural success rate and higher incidence of adverse events [1]. The provisional stenting has been considered as a gold standard approach for most bifurcations, however, 15-30% bifurcation lesions require two-stent strategy from the beginning of the procedure [2]. However, in few instances implantation of second stent in provisional stenting is required due to complexity of side branch. Thus, the management of bifurcation lesions, especially left main (LM) bifurcation lesions emphasizes on an integrated approach involving tailored techniques, adjunctive physiological and morphologic evaluation using multi-modalities, hemodynamic devices, and pharmacological agents to improve procedural and clinical outcomes [2, 3]. Here, we report three cases of LM bifurcation successfully managed with provisional stenting using intravascular ultrasound (IVUS) and fractional ????low reserve (FFR) in decision making.