Disease of the left main stem (LMS) coronary artery has traditionally been regarded as an indication for coronary artery bypass surgery rather than angioplasty. When the disease involves the bifurcation into the left anterior descending (LAD) and circumflex (Cx) branches, the technical difficulties of implanting stents, with the accompanying risks of subacute thrombosis and restenosis, have made this almost exclusively a surgical preserve.

A new technique of stent implantation, known as “shotgun” stenting (a variant of “V-stenting”) has made this …