Stenting coronary trifurcation lesions: Is “ménage à trois” the solution?

Abstract

Percutaneous treatment of coronary stenoses involving important side branches remains a challenge to the interventionist. We describe two cases of stent deployment in coronary trifurcation lesions. Triple kissing balloon inflation appears important for achieving an optimal angiographic and clinical result.

Utility of simultaneous triple balloon inflation technique through a single 6-French sheath in treating pulmonary vein stenosis

“…The triple kissing balloon technique, initially designed for treating trifurcation left main coronary artery lesions, has not been investigated for pulmonary vein application lesions. [5][6][7] However, when 0.014" guide wires are employed for trifurcation coronary artery lesions, it typically necessitates the use of a large 9-French guide catheter. In smaller children, utilising a 9-French sheath can be challenging due to their petite anatomy.…”

“…Interventional cardiologists frequently accept some degree of narrowing in one vein to maintain the patency of others. Although the "triple kissing balloon technique" has been reported in the literature for treating complex coronary artery lesions, [5][6][7] its application in the context of pulmonary vein stenosis was only described by one of the oral presentations in the 2022 SCAI Scientific Session. 8 Nevertheless, a few programmes likely utilised this technique before.…”

Trifurcation stenting using two guide catheters

“…This applies even more to a trifurcation lesion, wherein it is not possible to use smaller guide catheters. Furthermore a “ménage à trois”, or simultaneous triple kissing has been described in a few case reports as the solution to achieve ostial scaffolding and stent apposition [4–6]. Here, we overcame this difficulty by using two simultaneous access sites and using two routine left coronary guide catheters to engage the coronary ostia alternately, while leaving the other parked beside the ostia and completed a successful procedure signing of the procedure with a “ménage à trois”.…”

Bifurcation Stenting: Unnecessary Challenge or a Last Frontier in Intervention

“…Guides of 7 Fr (0.08″) or 8 Fr (0.09″) are required for two‐stent techniques. These will also allow adequate KB postdilatation: up to three balloon shafts can be delivered through an 8‐Fr guide catheter 13 …”