How should I treat a coronary "traffic jam"? A triple kissing balloon in distal left main trifurcation.

BACKGROUND: A 60-year-old man with relapsing unstable angina a year aftger an anterior acute myocardial infarction treated with PCI to proximal left anterior descending (LAD) and proximal intermediate branch (IB), resulting in a severely impaired LV function. INVESTIGATION: Physical examination, laboratorytest, transthoracic echocardiogram, rest ECG, coronary angiography. DIAGNOSIS: Severe in-stent restenosis to IB, with a bulky plaque involving distal left main, obtuse marginal and proximal circumflex. MANAGEMENT: Percutaneous coronary intervention/coronary artery bypass grafting.