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Primary angioplasty of the left main coronary artery with culotte skenting in non-ST elevation acute coronary syndrome.

Treatment of non-ST elevation acute coronary syndrome has long been the subject of debate and study, particularly with regard to the timing of coronary angiography and angioplasty. According to the latest European guidelines, an emergent strategy should be adopted in certain patients (estimated at 5%) with hemodynamic instability, malignant arrhythmias or angina refractory to optimal medical therapy. The authors report a case illustrating this situation in which the lesion severity and anatomy required a complex procedure of dilation of the left main coronary artery ending with a double-stent technique.