Download - Bifurcation stenting strategies.ppt
Bifurcation Lesions Stenting strategies And
Newer Advancements.
Dr Gopi Krishna
PROVISIONAL M.B.S. E.D.S
Stent thrombosis incidence in clinical trials comparing 1-stent (1S) with 2-stent (2S) strategies in treating
coronary bifurcations
Major adverse cardiac event (MACE) and TLR incidence in randomized trials comparing 1-stent (1S) with
2-stent (2S) strategies.
Provisional stenting of Bifurcations:technique
Avoid Pre - dilation of SB
False bifurcation-possibility of proximal cross is more
- ? Possible proximal crossUtility of very short over sized baloon to discover proximal cross
Role of final kissing baloon.
ELECTIVE DOUBLE VESSEL STENTINT
E.D.S.for non left main bifurcations.
• Pt selection– D.E.S. is considered default strategy for
E.D.S.technique.– Should undergo at least 12 mnth antiplatelet
treatment.– So avoided in pts non comliant with medications
and at high risk for bleeding.
Techniques E.D.S
Step crush
Sleeve technique
Potential failure modes of crush and suggested solutions
1. Inability to wire the SB.» Make Sure That The Wire Is Directed Towards The Distal
Part But Not The Proximal Part.» If The Primery Guide Wire Failes Try Hydrophilic Wires.
If They Also Fail Consider Tapered Tip Wires(MIRACLE).
2. INABILITY TO PASS BALOON IN TO SB.» USE COMPLIANT MONORAIL 1.5 MM BALOON.» IF FAILS REWIRE SB THROUGH A DIFFERENT SITE AND
RE ATTEMT BALOON CROSSING.» IF FAILS THEN USE FIXED WIRE BALOON SYSTEMS.
• Advantages• all angles of bifurcations• provides near-perfect
coverage of the SB ostium• disadvantage• technique is that rewiring
both branches through the stent struts can be difficult and time consuming.
L.M.C.A. BIFURCATION STENTING
L.M.C.A. BIFURCATION STENTING
• Double confirm about compiance of antiplatelts.
• 7/8 fr sheath.• Elective I.A.B.P PUMP if required
» Low E.F» HEMODYNAMIC SHOCK» OLD AGE.
• FEMORAL ROUTE PREFFERED.
• WHY WE NEED DEDICATED STENT.• PROVISIONAL ASSOCIATED WITH S.B CLOSURE• E.D.S . Is complex, time consuming, need one more
stent
• What are desired features• Low profile• Less cost • Easy trouble
QCA OF BIFURCATIONS