A 82 year old man who presented with acute chest pain for 12 hours was admitted to our coronary care unit. He had no previous cardiac history. There was significant elevation of the troponin T level. There were ST segment elevation, pathological Q waves and T wave inversions on precordial derivations on electrocardiogram. The patient was diagnosed to have a subacute anterolateral ST-elevation myocardial infarction(STEMI). The patient was transferred to the catheter laboratory. Dual anti-platelet therapy(acetylsalicylic acid and ticagrelor) was initiated. Invasive coronary angiography showed a recanalized severe stenosis of the left anterior descending artery(LAD), severe lesion on circumflex artery and nonsignificant stenosis on intermediate artery. His logistic Euroscore II was 14,86% and STS score was 35.5%. LVEF was 20% and global hypokinesia was detected on transthoracic echocardiography. The patient didn’t accept surgical intervention and because of the refractory angina and hypotension, we decided to perform percutaneous intervention. Three o.o14 inches floopy wires were inserted to LAD, CX and intermediate artery. Next, three balloons were parked to the these vessels. Three balloons were inflated simultaneously. During this pocedure the 0.014 inches wire in the intermediate artery was broken and it remained in the vessel. An another wire was inserted to this vessel and we continued to the procedure. 2.5×15 drug eluting stent was implanted while two balloons was inflating in the CX and intermediate artery. Adequate flows were obtained in the three vessels. Heparin infusion was started for 24 hours. Medical therapy was applied. After one day, coronary angiography was done again and the flow was better. In this patient, three ballons were inflated simultaneously and there is no complication except broken and remained o.o14 inches floopy wire in the distal part of the intermediate artery. The wire in the distal artery did not obstruct the coronary flow.
