This is a prospective, randomized, controlled trial comparing two strategies for optimizing stent implantation during bifurcation stenting of the left main coronary artery (LM): an intravascular ultrasound (IVUS)-guided approach versus a "IVUS-trained eye" approach based on angiographic assessment and operator experience. All patients receive the same stent brand and procedure steps to minimize variability. The primary objective is to compare the planimetric stent appearance between two strategies.
De novo lesion in an unprotected left main coronary artery, indicated for bifurcational stenting (provisional or 2-stent)
Patient referred for elective or delayed (non-emergency) stenting
Technical feasibility of performing IVUS
Signed informed consent
ST-elevation myocardial infarction (STEMI) within the preceding 72 hours
Cardiogenic shock
Isolated (non-bifurcation) left main lesion
Prior PCI in the target segment