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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 tre...
Major adverse cardiac event (MACE) and TLR incidence in randomized                 trials comparing 1-stent (1S) with     ...
Provisional stenting of Bifurcations:             technique
Avoid   Pre - dilation of SB
False bifurcation-possibility of           proximal cross is more                              Utility of very short over ...
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.  – Sh...
Techniques E.D.S
Step crush
Sleeve technique
Potential failure modes of crush and suggested solutions1. Inability to wire the SB.           »   Make Sure That The Wire...
• Advantages• all angles of bifurcations• provides near-perfect  coverage of the SB ostium• disadvantage• technique is tha...
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  ...
• WHY WE NEED DEDICATED STENT.     • PROVISIONAL ASSOCIATED WITH S.B CLOSURE     • E.D.S . Is complex, time consuming, nee...
QCA OF BIFURCATIONS
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
Bifurcation stenting strategies.ppt
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Transcript of "Bifurcation stenting strategies.ppt"

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