1. IVUS evaluation TAP technology for unprotected left main bifurcation lesions interventional therapy Yong-Sheng Ke. MD Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001

2. Brief history  Male, 66yaer old,  Spontaneous chest pain 2 days  Past medical history: no hypertension no DM no lipid abnormal Smoking history:20 yrs, 20 cigarettes/d

3. ECG after first chest pain attack

4. ECG after 3 days

5. Biochemistry examination

6. cTnI

7. Admission diagnosis  Coronary heart disease Acute coronary syndrome

8. CAG

10. Syntax score 39 LM 5*2=10 Bifurcation=1 Calcification=2 13 LCX 1.5*2=3 Bifurcation 1 Calcification 2 Long lesion 1 7 pLAD 3.5*2=7 Bifurcation 1 Calcification 2 Long lesion 1 11 mLAD 2.5*2=5 D1 1 D2 1 Long lesion 1 8

11. 7F JL3.5 Runthrough BMW

12. Maverick-2 2.0*15mm 12-14atm

13. IVUS

14. LAD-LM LCX-LM

15. ostial lesion of LM ostial lesion of LAD ostial lesion of LCXmiddle lesion of LCX

16. mLAD

17. Resolute 3.5*30mm 12atm

18. Stent balloon 14atm Resolute 4.0*24mm

20. 16atm Exchange guide wire LM-LCX Maverick-2 2.0*15mm LM-LAD Quantum 3.5*12mm

22. LM-LCX 16atm LM-LAD 18atm

23. Kissing balloon dilatation 12atm

24. LM-LAD Quantum 3.5*12mm LM-LCX Resolute 2.75*30mm

25. LCX stent 12atm

26. Retracement of the stent balloon 14atm Kissing balloon dilatation

27. LCX-LM Quantum 3.0*12mm 16-18atm

28. Non-compliant balloon dilatation （ 18atm,respectively)

29. Final kissing dilatation 12atm

31. LAD-LM LCX-LM

32. mLAD Two stents no overlap region But, no dissection

33. Two layer stents Ostial of LM Ostial of LCX Distal LM-ostial LAD

34. ECG after PCI

35. Myocardial enzymes after PCI

36. ECG after 1 month

37. ECG after 2 month

38. Discuss  IVUS is helpful for judgment Lesion and guidance of stent implantation.  Two stents of the left anterior descending artery were not completely overlap （ 2mm gap ）.  IVUS had not found intimal dissection of stents exposed area,lumen diameter was large enough, we didn't need immediatly suppling a stent, waiting for further follow-up.