Unprotected Distal LMCA Angioplasty with Simulataneous Kissing Stent (SKS) Technique in Left Dominant Coronary Circulation: A Nightmare for Interventionist

Left main coronary artery stenosis is the most challenging lesion in patients with acute coronary syndromes. Since the amount of myocardium at risk is very high, the patient is often in cardiogenic shock, and the risk of death is high and even more so in left dominant coronary system. Left main stenosis is a Class I indication for CABG -ACC/AHA guidelines and has been a relative contraindication to PCI. We report an elderly patient presenting with ACS with ECG showing ST elevation in lead a VR. Coronary angiogram revealed left dominant system with left main stenosis and ostioproximal LAD and LCX disease. Double stenting of the unprotected left main with bifurcation disease done with SKS technique with simultaneous stenting and post balloon dilatation was done with good results. Current guidelines still indicate CABG as optimal treatment for LMCA lesions. The choice of stenting technique for LMCA bifurcations should be based on bifurcation morphology