Optimizing Multivessel PCI with Limited Stents: Successful Revascularization Without Left Main Intervention
DOI:
https://doi.org/10.24252/alami.v10i1.56340Keywords:
Acute Coronary Syndrome, Left Main Disease, Multivessel Coronary Artery Disease, Percutaneous Coronary Intervention, Chronic Total OcclusionAbstract
Background: Acute coronary syndrome (ACS) is a major cause of hospitalization and
mortality. Patients with multivessel disease (MVD), especially with left main (LM)
involvement, face higher risks of complications and adverse outcomes.
Objective: A 55-year-old male with uncontrolled hypertension and diabetes presented
with 16-hour chest pain. The ECG showed T-wave inversion in leads I and aVL, with
a high-sensitivity troponin level of 59,480 ng/dL. He was diagnosed with high-risk
lateral NSTEMI.
Methods: This is a case report. Coronary angiography (CAG) revealed 70% distal LM
stenosis, 80% ostial stenosis with chronic total occlusion (CTO) in the proximal left
anterior descending (LAD) artery, and 80% subtotal occlusion in the left circumflex
(LCx) artery. PCI was performed using drug-eluting stents in the LAD and LCx.
Results: TIMI 3 flow was achieved without major complications. LM PCI was deferred
due to strategic stenting in the LAD and LCx, which improved perfusion and
potentially reduced the functional significance of LM stenosis.
Conclusion: This case highlights the complexity of MVD PCI and demonstrates that
targeted stenting can optimize revascularization while minimizing procedural risks.
Careful post-PCI assessment is essential for long-term management.
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