Effective Interventional Strategies for Bifurcating Lesions in Acute coronary syndrome (ACS): Insights into the Jailed ballon stent kissing technique (J-BSKT) Approach

Abstract

Background: Percutaneous coronary intervention (PCI) for bifurcation lesions is a challenging aspect of coronary intervention. The Jailed Balloon Stent Kissing Technique (J-BSKT) is one approach for managing bifurcation lesions, though it remains a controversial technique with limited data, particularly in the context of Acute Coronary Syndrome (ACS). This case discusses the use of J-BSKT in a Non-ST Elevation Myocardial Infarction (NSTEMI) and highlights its complications.

Case Presentation: A patient with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) presented with echocardiographic findings of an ejection fraction of 50%, along with hypokinesia of the apex and anterior wall. Coronary angiography revealed triple-vessel coronary artery disease, including a bifurcation lesion in the left anterior descending artery (LAD) involving the diagonal branch.

Results: Following a successful PCI to the LAD, the patient developed chest pain. An immediate relook angiogram demonstrated occlusion of the side branch at the ostium. Subsequent intervention to the side branch was performed, but it resulted in thrombus propagation within the main vessel. The main vessel was then reintervened, while the branch vessel was managed medically. On a follow-up angiogram, both the main vessel and side branch showed patent flow, with TIMI III flow in both.

Conclusion: Bifurcation lesions in coronary arteries pose a significant challenge for interventional cardiologists. The Jailed Balloon Stent Kissing Technique (J-BSKT) can be an effective strategy for managing such lesions, though complications such as side branch thrombosis may occur, necessitating careful patient monitoring and management.