Double-barrel stenting of distal left main stenosis in a patient with acute coronary syndrome: intravascular ultrasound and optical coherence tomography follow-up at six months.

A 58-year-old man presented with frequent episodes of angina at rest. A diagnosis of anterior non-ST elevation myocardial infarction was made. Coronary angiography performed on the day of admission revealed a significant stenosis (50% to 60%) of the distal left main stem (LMS) extending to the ostia of the left anterior descending and left circumflex arteries. Coronary artery bypass graft surgery was advised; however, the patient consistently declined this option. Kissing balloon predilation was performed at the LMS bifurcation, and two stents of the same diameter and length (4.0 mm × 18 mm) were simultaneously deployed at the same high pressure (18 atm) spanning the entire length of the LMS, and extending into the left anterior descending and left circumflex arteries beyond the bifurcation lesion. Six months later, intravascular ultrasound and optical coherence tomography revealed neointimal hyperplasia, especially in the artificial septum.