Left main and coronary bifurcation angioplasty

The left main is the first segment of the left coronary artery: it supplies a large part of the heart before dividing into two main branches. A bifurcation is a point where an artery splits in two. A narrowing at these sites is delicate to treat, because the main artery must be reopened without closing off the branch that arises from it. The angioplasty is performed through a catheter, most often via the wrist. Depending on the anatomy, the cardiologist uses either a single-stent strategy in the main vessel, protecting the side branch with a guidewire, or a two-stent technique when both branches are diseased. Simultaneous balloon inflations in both branches ("kissing") help to fine-tune the result. Intracoronary imaging (intravascular ultrasound or OCT) is particularly useful here to measure the artery and confirm that the stents are well expanded. For a left main narrowing, angioplasty and coronary bypass surgery are both valid options; the choice is made jointly by cardiologists and cardiac surgeons (the "heart team"), according to the complexity of the lesions, the other arteries involved, diabetes and the patient's general health, and the patient is involved in the decision. At Clinique Pasteur Tunis, these procedures are performed in a latest-generation catheterisation laboratory, with a cardiac surgery team and a cardiac intensive care unit on site.