VA-ECMO and IABP Supported CHIP-PCI for Left Main Bifurcation and CTO After Failed CABG

Figure 1. Baseline Coronary Anatomy and Graft Assessment (A and B) Severe left main coronary artery (LMCA) disease involving the ostial and proximal left anterior descending (LAD) artery, with concomitant chronic total occlusion (CTO) of the left circumflex (LCx). (C) Severe stenosis at the distal anastomosis of the saphenous vein graft to the obtuse marginal branch, with the absence of retrograde collateral flow from the obtuse marginal territory to the LCx. (D) Occluded left internal mammary artery graft. (E) Severe LMCA and proximal LAD disease in a spider view, associated with CTO of the LCx. (F) Chronic total occlusion of the right coronary artery, consistent with advanced multivessel coronary artery disease.

Figure 2. Complex Percutaneous Coronary Intervention Strategy With Calcium Modification and Bifurcation Stenting (A) Dual wiring of the left anterior descending artery and left circumflex (LCx) with attempted chronic total occlusion crossing of the LCx. (B) Rotational atherectomy performed for calcium modification of the left main bifurcation. (C) Stent positioning according to a planned mini-crush technique at the left main coronary artery bifurcation.

Figure 3. IVUS Assessment and Final Results (A) IVUS demonstrating an intermediate lesion in the mid–left anterior descending (LAD) artery, which was deferred and managed conservatively. (B) In-stent minimal luminal area of the LAD, confirming adequate stent expansion, with the corresponding final angiographic result. (C) IVUS assessment of the left circumflex ostium showing the luminal area and diameter after intervention. (D) Final IVUS of the left main coronary artery demonstrating satisfactory in-stent expansion and the optimal procedural result. IVUS = intravascular ultrasound.