The R stent with its double helix configuration provides high radial support and excellent side branch access. These characteristics make it the stent of choice for complex coronary anatomy involving side branches, bifurcation, and even trifurcation said Dr. Sianos.

Trifurcation Stenting by Dr. Sianos

Case Details :

The patient was a 51-year-old man, ex smoker, with no previous cardiac history. He had an acute anterior infarction and underwent primary angioplasty. A subtotal occlusion of the LAD after the take-off of the first and second diagonal branches (Fig 1a) was seen. After direct stent implantation (R stent 3.0 x 18mm) in the LAD over the trifurcation with the diagonal branches (Fig 1b) and dilatation of the second diagonal (D2) branch with a 2.5 mm balloon (Fig 1c), a good final angiographic result was achieved. The first diagonal branch (D1) covered by the stent remained with normal flow and no intervention was necessary (Fig 1d).

The patient remained asymptomatic for two months. Afterwards he developed angina class III. Repeat coronary angiography revealed good patency of the stent in the LAD, but a severe lesion at the ostium of the D2 (Fig 2a). The D1 remained patent. Repeat angioplasty was decided. After kissing balloon predilatation (3.5 mm in the LAD and 2.5 mm in D2) (Fig 2b), stent placement in the D2 (R stent 2.5 x 9 mm) was performed with simultaneous balloon inflation in the LAD (Fig 2c - 2g). Prophylactically, a third wire was places in the D1. After stent placement in the D2, severe ostial stenosis in the D1 was noticed (Fig 2h).

After kissing balloon dilatation in the D1 and D2 through the struts of the R stent in the

LAD (Fig 3a and 3b), a good angiographic result was obtained in all three branches (Fig 3c). The patient remained asymptomatic and six month angiographic control showed a well preserved result in all branches (Fig 4).