Provisional Technique for Bifurcation Left Main In-Stent Restenosis Lesion: A Case Report

Krishna Ari Nugraha, Sasmojo Widito, Budi Satrijo, Novi Kurnianingsih



Percutaneous coronary intervention for bifurcation lesions remains challenging because of its complexity and the lack of trials to guide decision-making. Interventional cardiologists are forced to make decisions based on their own judgment and experience rather than the results of rigorously randomized trials.

Case Summary

A 64-year-old male with some coronary risk factors of hypertension, passive smoker, and family history of CAD presented with recurring exertional chest pain for the last 4 months. He was hospitalized to undergo DCA-Adhoc after the ECG stress test revealed a positive result. The coronary angiography revealed a 95% ISR in the osteal LAD and 20% ISR of the proximal LCx. Since the patient refused to undergo coronary bypass surgery, the team decided to perform catheter intervention to the LM bifurcation of LAD-LCx. The procedure begins with the insertion of IABP through the access of the left femoral artery. We performed a provisional approach with the main vessel stenting of LM-LAD. At the end of the procedure, we performed simultaneous kissing balloon inflation of LAD-LCx followed by POT in LM stent as the post-dilation procedure.


When considering intervention on a bifurcation lesion, there are two general strategies i.e the more conservative or provisional technique that intent to only use one stent and the two-stent approach. The provisional technique is considered to offer advantages in terms of reducing procedure complexity, reducing fluoroscopic time, requiring less contrast volume, and reducing resource (stent) use compared by 2 stent strategy.


bifurcation lesion, provisional technique, kissing balloon inflation

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