A coronary bifurcation consists of a flow divider (carina) and three vessel segments:
The proximal main vessel (PMV)
The distal main vessel (DMV) and
The side branch (SB).
A bifurcation lesion is a major epicardial coronary artery stenosis next to and/or including the ostium of a significant side branch
A significant SB is a branch whose severe narrowing or acute occlusion before or during intervention can cause considerable ischemia or a new infarction area that will worsen the clinical course of a particular patient.
Other important elements to consider that are not inherent in the bifurcation classifications include:
Extent of disease on the SB (limited to the ostium or involving the vessel beyond the ostium)
Its size (over 2.5mm in reference diameter)
Bifurcation angle, and
Disease distribution
CALCIUM MODIFICATION TECHNIQUES IN COMPLEX PCIThieu Minh Son
Coronary artery calcification represents a major challenge associated with adverse outcomes after PCI
To avoid stent failure, optimal plaque preparation of calcified coronary lesions is required
Intracoronary imaging and determination of coronary calcification severity and characteristics are the keys to guiding further treatment decisions.
Available modification techniques includes: Balloon-Based Devices (Non-Compliant Balloons, High-Pressure Non-Compliant Balloons, Cutting Balloons, Scoring Balloons, Intravascular Lithotripsy) and Coronary Atherectomy (Rotational Atherectomy, Orbital Atherectomy, Laser Atherectomy)
The decision relating to which modification technique to use is based on numerous anatomic and technical factors, including the location of the lesion, the concentricity of the calcium pool, operator familiarity/expertise, and local device availability.
Significant unprotected left main (LM) coronary artery disease is present in <10% of patients undergoing coronary angiography. In autopsy research, a mean LM length of 10.8 mm ± 5.2 mm (range 2–23 mm), mean LM diameter 4.9 mm ± 0.8 mm and mean angle between the left anterior descending (LAD) and left circumflex (LCx) of 86.7° ± 28.8° has been described. This angle value positively correlated with LM length.2 Further studies showed that long LM developed stenoses more frequently near the distal bifurcation compared to near the ostium (77% versus 18%).7 It is also worth emphasising that LM bifurcation disease is rarely focal and that both sides of the carina are almost never disease-free. Furthermore, continuous plaque from the LM into the proximal LAD artery has been reported in 90% of cases.8 Summarised below are the most crucial LM peculiarities (in comparison with non-LM bifurcations), which should be taken into consideration when distal LM stenosis PCI is planned:
A coronary bifurcation consists of a flow divider (carina) and three vessel segments:
The proximal main vessel (PMV)
The distal main vessel (DMV) and
The side branch (SB).
A bifurcation lesion is a major epicardial coronary artery stenosis next to and/or including the ostium of a significant side branch
A significant SB is a branch whose severe narrowing or acute occlusion before or during intervention can cause considerable ischemia or a new infarction area that will worsen the clinical course of a particular patient.
Other important elements to consider that are not inherent in the bifurcation classifications include:
Extent of disease on the SB (limited to the ostium or involving the vessel beyond the ostium)
Its size (over 2.5mm in reference diameter)
Bifurcation angle, and
Disease distribution
CALCIUM MODIFICATION TECHNIQUES IN COMPLEX PCIThieu Minh Son
Coronary artery calcification represents a major challenge associated with adverse outcomes after PCI
To avoid stent failure, optimal plaque preparation of calcified coronary lesions is required
Intracoronary imaging and determination of coronary calcification severity and characteristics are the keys to guiding further treatment decisions.
Available modification techniques includes: Balloon-Based Devices (Non-Compliant Balloons, High-Pressure Non-Compliant Balloons, Cutting Balloons, Scoring Balloons, Intravascular Lithotripsy) and Coronary Atherectomy (Rotational Atherectomy, Orbital Atherectomy, Laser Atherectomy)
The decision relating to which modification technique to use is based on numerous anatomic and technical factors, including the location of the lesion, the concentricity of the calcium pool, operator familiarity/expertise, and local device availability.
Significant unprotected left main (LM) coronary artery disease is present in <10% of patients undergoing coronary angiography. In autopsy research, a mean LM length of 10.8 mm ± 5.2 mm (range 2–23 mm), mean LM diameter 4.9 mm ± 0.8 mm and mean angle between the left anterior descending (LAD) and left circumflex (LCx) of 86.7° ± 28.8° has been described. This angle value positively correlated with LM length.2 Further studies showed that long LM developed stenoses more frequently near the distal bifurcation compared to near the ostium (77% versus 18%).7 It is also worth emphasising that LM bifurcation disease is rarely focal and that both sides of the carina are almost never disease-free. Furthermore, continuous plaque from the LM into the proximal LAD artery has been reported in 90% of cases.8 Summarised below are the most crucial LM peculiarities (in comparison with non-LM bifurcations), which should be taken into consideration when distal LM stenosis PCI is planned:
Digitális, hálózatalapú óravázlat
Elektronikus médiumok és tananyagok - 3. beadandó feladat
Oktató: Dr. Forgó Sándor
Készítette: Facskó Anett - GS412I
mozgóképkultúra és médiaismeret tanár - tehetségfejlesztő tanár MA
II. évfolyam
levelező tagozat
Bertalan Székely the romanticism and the academism mixing one of the largest representatives of Hungarian historical painting.
Székely Bertalan a romantikát és az akadémizmust elegyítő magyar történelmi festészet egyik legnagyobb képviselője.
1. MŰV-390
Magyar művészet a 19. században
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