Case 172: Manual of PCI - Double bifurcation

A patient was referred for PCI of a double bifurcation lesion: (a) LAD diagonal bifurcation and (b) bifurcation of the diagonal into a superior and an inferior branch. Coronary physiology with a pressure wire and AngioFFR was performed showing a long lesion in the LAD and a more focal lesion in the diagonal. The superior diagonal branch did not have significant stenosis, hence provisional stenting was chosen for the diagonal bifurcation. DK crush was chosen for the LAD/diagonal bifurcation. After predilatation the diagonal lesion was stented covering the ostium of the superior branch and protruding the stent into the LAD. DK crush was successfully used in the LAD/diagonal bifurcation with an excellent final angiographic result. Post PCI FFR and FFRangio in the LAD were 0.92 and 0.93, respectively. The diagonal could not be crossed with the pressure wire after LAD/diagonal stenting but FFRangio was 0.93.