Trifurcation triple balloon angioplasty in a dual left anterior descending coronary artery: The “Ménage à trois” revisited

Abstract

We describe a case of simultaneous triple balloon angioplasty of a trifurcation stenosis in a dual left anterior descending coronary artery variant using over‐the‐wire and monorail balloon catheters and a single guide catheter. © 1996 Wiley‐Liss, Inc.

Dual left anterior descending artery: Case series based on novel classification and its therapeutic implications

“…3 ; Panel IIIc V 2 0.6 Group III (N = 11; 3.2%) III-PA Common origin of LAD 2 and LMCA from the RCS wherein LMCA divides into LAD 1 and LCX which takes retro aortic course while LAD 2 continues epicardially. Barbaryan et al 41 ; Lee et al 42 ; Vora 43 ; Bozlar et al 2 Fig. 3 ; Panel IIId VIII 4 1.2 III-AB LMCA originated from the RCS, had interarterial course, which divided into LCX and LAD, and LAD divided into LAD 1 in AIVS and LAD 2 which ran epicardially on LV surface.…”

“… 2 Intramyocardial course of the LAD 1 . 43 III Group I-AS A challenging revascularization due to its higher position in the anterior interventricular groove makes it more difficult to graft. Knowledge about the dual LAD variant allows for more accurate placement of arteriotomies during revascularization.…”

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”.…”

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

“…Simultaneous triple balloon angioplasty has been previously described (“ménage à trois”) for treatment of trifurcation lesions [15, 16]. To our knowledge, these are the first reported cases using current stenting techniques.…”