Mr UR

A 67 year-old man presented with acute chest pain for 4 hours, he came to our hospital. His cardiovascular risk factor was smoker. Baseline ECG showed ST elevation at anterior extensive lead. His physical examination was unremarkable.

Troponin was elevated

LM was normal. There was total thrombotic occlusion at proximal LAD. There were severe diffuse stenosis proximal to distal LCX with thrombus. RCA was normal.

A 6 Fr BL 3.5 guiding catheter was engaged into LCA ostium through right radial artery. After successfully inserting intermediate wire to distal LAD,  thrombosuction  was performed using  a APT3 V Extra suction catheter followed by administration of bolus eptifibatide intracoronary. Predilation was done using 2.5 x 20 mm semi compliance balloon (SCB) in LAD. Contrast injection  revealed a  true bifurcation lesion  of LAD and D1 (medina 1-1-1). We decided  to dilate  D1 using 2.5 x 15 mm SCB. We performed modified jailed balloon technique to settle the bifurcation lesion. A 3.0 x 38 mm EES was placed at proximal LAD and 1.5 x 12 mm SCB  in D1. The Stent and balloon were inflated simultaneously at 12 atm. OCT evaluation post stenting showed malapposition and under expansion stent. Optimization was performed using 3.5 x 15 mm Non Compliance Balloon (NCB). Final OCT evaluation showed well apposed and expanded stents without stent edge dissections. Intervention continued to LCx. A 2.5 x 38 mm EES was placed and inflated. Final angiogram showed no residual stenosis with TIMI 3 Flow.

Modified jailed balloon techniques proved to provides reliable patency of the side branch during provisional stenting in Primary PCI with bifurcation lesion. Optical Coherence Tomography guided  jailed balloon technique  in Primary PCI with bifurcation lesion  could be considered to optimize the result.