Case Report: Trissing balloon inflation and percutaneous coronary intervention with drug-coated balloons for the treatment of restenosis of a left main trifurcation lesion
We report the case of a 62-year-old male with multiple cardiovascular risk factors and comorbidities who presented to our institution due to unstable angina. One year earlier, he underwent percutaneous coronary intervention (PCI) to unprotected left main trifurcation lesion involving the ostial left...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1558491/full |
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| author | Francesco Amata Francesco Amata Francesco Paolo Gioia Francesco Paolo Gioia Gaetano Liccardo Gaetano Liccardo Giancarlo Barberis Giuseppe Ferrante Giuseppe Ferrante |
| author_facet | Francesco Amata Francesco Amata Francesco Paolo Gioia Francesco Paolo Gioia Gaetano Liccardo Gaetano Liccardo Giancarlo Barberis Giuseppe Ferrante Giuseppe Ferrante |
| author_sort | Francesco Amata |
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| description | We report the case of a 62-year-old male with multiple cardiovascular risk factors and comorbidities who presented to our institution due to unstable angina. One year earlier, he underwent percutaneous coronary intervention (PCI) to unprotected left main trifurcation lesion involving the ostial left anterior descending artery (LAD) (Medina classification 0-0-1-0) with provisional stenting technique with single drug-eluting stent (DES) implantation from left main to LAD and PCI to LAD with single DES implantation from LAD in crossover with D1 for the treatment of LAD-D1 bifurcation lesion (Medina 1-1-0). Coronary angiography by radial approach found sub-occlusive restenosis of both jailed ostial ramus intermediate (RI) and left circumflex (LCX), with patency of DES to left main LAD and a significant in-stent restenosis (ISR) of DES to LAD at the bifurcation with D1. LAD ISR was treated with PCI with single DES implantation with optimal angiographic results. The left main trifurcation restenosis was treated by radial approach PCI with simultaneous trissing balloon inflation to left main, RI, and LCX, followed by kissing balloon with drug-coated balloons with sirolimus elution to RI and LCX, subsequent trissing balloon inflation, and final proximal optimization technique to the left main achieving an optimal angiographic result. Planned follow-up angiography at 1 year showed persistence of optimal angiographic results. |
| format | Article |
| id | doaj-art-db1d6813d64342708fe01092ce5e4efa |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-db1d6813d64342708fe01092ce5e4efa2025-08-20T03:53:13ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-05-011210.3389/fcvm.2025.15584911558491Case Report: Trissing balloon inflation and percutaneous coronary intervention with drug-coated balloons for the treatment of restenosis of a left main trifurcation lesionFrancesco Amata0Francesco Amata1Francesco Paolo Gioia2Francesco Paolo Gioia3Gaetano Liccardo4Gaetano Liccardo5Giancarlo Barberis6Giuseppe Ferrante7Giuseppe Ferrante8Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Milan, ItalyDepartment of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Milan, ItalyDepartment of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Milan, ItalyDepartment of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Milan, ItalyDepartment of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Milan, ItalyWe report the case of a 62-year-old male with multiple cardiovascular risk factors and comorbidities who presented to our institution due to unstable angina. One year earlier, he underwent percutaneous coronary intervention (PCI) to unprotected left main trifurcation lesion involving the ostial left anterior descending artery (LAD) (Medina classification 0-0-1-0) with provisional stenting technique with single drug-eluting stent (DES) implantation from left main to LAD and PCI to LAD with single DES implantation from LAD in crossover with D1 for the treatment of LAD-D1 bifurcation lesion (Medina 1-1-0). Coronary angiography by radial approach found sub-occlusive restenosis of both jailed ostial ramus intermediate (RI) and left circumflex (LCX), with patency of DES to left main LAD and a significant in-stent restenosis (ISR) of DES to LAD at the bifurcation with D1. LAD ISR was treated with PCI with single DES implantation with optimal angiographic results. The left main trifurcation restenosis was treated by radial approach PCI with simultaneous trissing balloon inflation to left main, RI, and LCX, followed by kissing balloon with drug-coated balloons with sirolimus elution to RI and LCX, subsequent trissing balloon inflation, and final proximal optimization technique to the left main achieving an optimal angiographic result. Planned follow-up angiography at 1 year showed persistence of optimal angiographic results.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1558491/fullleft main trifurcationleft main restenosisleft main angioplastyin-stent restenosiscomplex PCI |
| spellingShingle | Francesco Amata Francesco Amata Francesco Paolo Gioia Francesco Paolo Gioia Gaetano Liccardo Gaetano Liccardo Giancarlo Barberis Giuseppe Ferrante Giuseppe Ferrante Case Report: Trissing balloon inflation and percutaneous coronary intervention with drug-coated balloons for the treatment of restenosis of a left main trifurcation lesion Frontiers in Cardiovascular Medicine left main trifurcation left main restenosis left main angioplasty in-stent restenosis complex PCI |
| title | Case Report: Trissing balloon inflation and percutaneous coronary intervention with drug-coated balloons for the treatment of restenosis of a left main trifurcation lesion |
| title_full | Case Report: Trissing balloon inflation and percutaneous coronary intervention with drug-coated balloons for the treatment of restenosis of a left main trifurcation lesion |
| title_fullStr | Case Report: Trissing balloon inflation and percutaneous coronary intervention with drug-coated balloons for the treatment of restenosis of a left main trifurcation lesion |
| title_full_unstemmed | Case Report: Trissing balloon inflation and percutaneous coronary intervention with drug-coated balloons for the treatment of restenosis of a left main trifurcation lesion |
| title_short | Case Report: Trissing balloon inflation and percutaneous coronary intervention with drug-coated balloons for the treatment of restenosis of a left main trifurcation lesion |
| title_sort | case report trissing balloon inflation and percutaneous coronary intervention with drug coated balloons for the treatment of restenosis of a left main trifurcation lesion |
| topic | left main trifurcation left main restenosis left main angioplasty in-stent restenosis complex PCI |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1558491/full |
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