**Introduction/Hypothesis:**
Iatrogenic ostial coronary stenosis, a rare complication post coronary reimplantation, poses unique challenges. Specifically, ostial left main stenosis can present with acute pulmonary edema, cardiac arrhythmias,
coronary syndromes, or cardiac arrest.

**Methods**
Computed tomography coronary angiography is an excellent imaging modality to confirm the diagnosis, as well as plan the subsequent intravascular ultrasound-guided intervention.

**Results**
We report the first case utilizing the Synergy Megatron drug-eluting stent (Boston Scientific) for this rare complication with computed tomography coronary angiography/intravascular ultrasound-guided percutaneous coronary intervention at a center without on-site cardiac surgery.

**Conclusion**
The stent selection was based on the CTCA, and the Synergy Megatron’s high radial strength and overexpansion capabilities were crucial for treatment at the location of this stenosis. IVUS is essential for LMCA PCI to confirm optimal stent expansion and geographical coverage. Utilizing all the information derived from the CTCA and IVUS allowed this procedure to be completed safely and efficiently at an outreach facility without surgical backup.



Post Bentall CT/IVUS guided LMCA PCI