Impella-Supported Optical Coherence Tomography-Guided Aggressive Rotational Atherectomy for Heavily Calcified Lesions in Left Main Trunk Bifurcation in a Patient with Severe Left Ventricular Systolic Dysfunction

Figure 3

Double-kissing culotte stenting for LMT bifurcation lesion. After dilation with a 3.0-mm high-pressure balloon from the proximal LCx to the LMT (a), a 3.0-mm × 28-mm Ultimaster Tansei™ stent was implanted from the LMT to the proximal LCx (b). KBI was performed with 3.5- and 3.0-mm balloons (c). A 3.5-mm × 24-mm Ultimaster Tansei™ stent was implanted from the proximal LAD to the LMT (d), followed by a proximal optimization technique with a 4.5-mm balloon in the LMT (e), and KBI was performed with 3.5- and 3.0-mm balloons (f). A 3.5-mm × 18-mm stent of Ultimaster Tansei™ was implanted in the distal portion of proximal LAD (g). Coronary angiography (h and i) and OFDI images (j–l) confirmed good flow and good dilatation of lesions.

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