Percutaneous treatment of coronary bifurcation is a typical area where controversy regarding stenting techniques is still there. While provisional stenting (PS) of the side branch is a practical and effective technique, there is a number of cases where two stent techniques are needed. We present here a case of a 69-year-old gentleman presenting with Acute coronary syndrome (ACS) with ongoing chest pain was subsequently diagnosed to have right coronary artery (RCA) bifurcation lesion (Medina 0,1,1) where a change of stenting strategy from V-stenting to mini crush enabled us to tide over the complications. A 69-year-old gentleman, non-diabetic, nonsmoker normal body mass index (BMI), with a past history of coronary artery disease (CAD), with ACS was transferred to our catheterization lab in view of recurrent chest pain and dynamic ST-T changes. Electrocardiogram (ECG) showed ST-T changes in inferior leads and Echocardiography (ECHO) showed regional wall motion abnormalities (RWMA) in RCA territory. A diagnosis of CAD, non-Q myocardial infarction (MI) was made. Coronary angiography (CAG) revealed triple vessel disease with culprit vessel was identified as distal RCA with bifurcation into posterior descending artery (PDA) and posterolateral vessel (PLV) with thrombolysis in myocardial infarction (TIMI) grade - 3 clot. Two stent strategy with V-stenting was contemplated due to ongoing chest pain and dynamic ST-T changes. Two Drug-eluting stents (DES) from distal RCA to PLV and PDA in a V fashion were implanted simultaneously. However, it resulted in edge dissection at the proximal edge of overlapping stents. Hence, another long stent 3 x 33mm DES was deployed from PLV to distal RCA crushing the PDA stent which was then recrossed and sequentially balloon dilated and final kissing balloon dilatation was performed with the excellent final result. V-stenting can be an attractive two-stent strategy in patients of bifurcation where clinically there is an acute situation and PCI must be completed in the shortest possible time with minimal complicity. In case of complication of proximal edge dissection in V-stenting technique, the strategy can be changed to mini crush to bail out the complications.

PCI, Bifurcation stenting, unstable angina, V stenting, Mini crush, Myocardial Infarction