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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.
Potential failure modes of crush and suggested solutions1. 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.
• 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