Bifurcation stenting strategies.ppt

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  • 1. Bifurcation Lesions Stenting strategies And Newer Advancements. Dr Gopi Krishna
  • 2. PROVISIONAL M.B.S. E.D.S
  • 3. Stent thrombosis incidence in clinical trials comparing 1-stent (1S) with 2-stent (2S) strategies in treating coronary bifurcations
  • 4. Major adverse cardiac event (MACE) and TLR incidence in randomized trials comparing 1-stent (1S) with 2-stent (2S) strategies.
  • 5. Provisional stenting of Bifurcations: technique
  • 6. Avoid Pre - dilation of SB
  • 7. False bifurcation-possibility of proximal cross is more Utility of very short over sized- ? Possible proximal cross baloon to discover proximal cross
  • 8. Role of final kissing baloon.
  • 9. ELECTIVE DOUBLE VESSEL STENTINT
  • 10. 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.
  • 11. Techniques E.D.S
  • 12. Step crush
  • 13. Sleeve technique
  • 14. 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.
  • 15. • 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.
  • 16. L.M.C.A. BIFURCATION STENTING
  • 17. L.M.C.A. BIFURCATION STENTING
  • 18. • 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.
  • 19. • 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
  • 20. QCA OF BIFURCATIONS