Ultra-Low Contrast Balloon-Embedded PCI for Acute LMCA Occlusion With Quadrifurcation Anatomy in a Resource-Constrained Setting.

Abstract

Acute thrombotic occlusion of the left main coronary artery with quadrifurcation anatomy is exceptionally rare, confers a high risk of early mortality, and poses substantial management challenges. We describe a case of acute left main coronary artery occlusion, successfully treated using an ultra-low contrast (25 mL) provisional single-stent strategy with a balloon-embedded technique. Six-month follow-up angiography confirmed a patent stent in the left main coronary artery, with angiographically unchanged lesions in the diagonal branch, left circumflex artery, and obtuse marginal branch. The patient demonstrated improved left ventricular function and sustained clinical stability, highlighting the feasibility of provisional stenting in quadrifurcation lesions even in resource-constrained settings.