How to Do It?: Percutaneous Treatment of a Severely Stenosed and Calcified Left Main Stem Bifurcation

Case SummaryA frail 87 year-old lady presented with rest angina associated with widespread ECG change and troponin release. She failed attempts at medical therapy and therefore was referred for coronary intervention on the basis that she was not a surgical candidate.InvestigationCoronary angiography demonstrated heavily calcified coronary arteries with critical disease at the distal left main stem bifurcation extending into the proximal segments of both LAD and circumflex.DiagnosisAcute coronary syndrome with extensive calcific coronary artery disease in the left main stem bifurcation.ManagementSequential rotational atherectomy of the left main stem bifurcation followed by ‘Y’-stenting using three Xience Prime drug eluting stents.