“Less Metal” in a Complex Left Main Trifurcation Lesion

Management of complex left main (LM) coronary artery trifurcation lesions remains a significant challenge. Herein, we report a case where a provisional stenting strategy was employed in a patient with distal LM trifurcation lesion involving left anterior descending artery (LAD), left circumflex artery (LCx) and ramus intermedius (RI). A single drug‐eluting stent (DES) was deployed from the LM into the LAD, while the LCx managed with a drug‐coated balloon (DCB) and RI conservatively as already had a previous ostial stent. Intravascular ultrasound (IVUS) was utilized throughout the procedure to assess coronary anatomy, lesion morphology and guiding stent sizing and placement. Post‐procedural IVUS imaging demonstrated good stent deployment without malapposition, edge dissection, or residual disease. This case underscores the feasibility and safety of a hybrid approach incorporating provisional stenting and DCB therapy in selected LM trifurcation lesions, with IVUS guidance playing a critical role in procedural success.