Another Technique for Reverse Wiring in the Acute Bend of Left Main Coronary Artery Trifurcation

Figure 1. EKG Electrocardiography revealed normal sinus rhythm and left anterior fascicular block without significant ST-T changes.

Figure 2. Diagnostic Angiograms Coronary angiography showed significant stenosis at the distal left main and proximal left anterior descending (LAD) arteries, with a trident shape. Minor disease was present in the ramus and left circumflex branches (Medina 1-1-0-0), and significant stenosis at the mid-LAD. In addition, there were moderate lesions at the proximal and distal right coronary artery.

Figure 3. Multislice Computed Tomography Multislice computed tomography revealed a complex trifurcation involving the left main, proximal left anterior descending, ramus, and left circumflex arteries.

Figure 4. Technique Demonstration (A) A 2.0 × 15–mm inflated balloon was placed at the proximal segment of the ramus branch. (B) A Suoh 0.3 wire was pushed toward the stop balloon in the ramus and then reversed direction to the very tight ostial left anterior descending lesion. (C) The Suoh 0.3 wire was then pulled back, and the microcatheter was advanced to support the wire in moving further down.

Figure 5. Technique Animation Illustration of the anatomy and balloon-assisted reverse wiring with active Suoh wire.

Figure 6. Final Angiograms Final coronary angiography results after stenting in the left main and left anterior descending arteries.