Severe Calcified Stenoses in Distal LM With Ostial and Diffuse Disease in LAD and LCX
(A) Severe and calcified stenoses in distal left main (LM), with ostial and diffuse disease in left anterior descending (LAD) and left circumflex (LCX) arteries (Medina classification: 1-1-1) (arrows). (B) Intravascular ultrasound–guided percutaneous coronary intervention with evidence of severe concentric calcification with an arc >270º (arrows). (C, D) Intravascular lithotripsy was performed in LM to LCX with 3.5-mm balloon (arrows) in staged pulses fashion with successful result. (E) A 4 × 28 mm drug-eluting stent was implanted in LM to LCX (arrows). (F) Proximal optimization technique with 4.0 × 10 mm noncompliant balloon was performed (arrows). (G) TAP technique with 2.75 × 12 mm drug-eluting stent to LAD and 4.0 × 10 mm noncompliant balloon (arrows). (H) Angiogram post-stenting with good final result (arrows).