Bifurcation stenting

CASES OF BIFURCATION STENTING LAST WEEK

WASIQ 47YRS/M R/O DELHI

Chief c/o- 1-AOE NYHA class II for 2yrsh/o HTN, No h/o DMchronic bidi smoker

ECG- T wave inversion in V1-V62D ECHO- No RWMA,LVEF 60%

BIFURCATION STENTING

True bifurcation- MB & SB are both significantly narrowed (>50% diameter stenosis).

Non true bifurcations- all other lesions

Strategy of stenting the MV with provisional SB stenting is the current favored approach.

Two stents strategy may be preferred, such as in the presence of a large SB that supplies a significant area of myocardium especially when side branch arises at a shallow angle.

CLASSIFICATION OF BIFURCATION

Copyright ©2008 American College of Cardiology Foundation. Restrictions may apply.

Latib, A. et al. J Am Coll Cardiol Intv 2008;1:218-226

Medina Classification of Bifurcation Lesions

GENERAL APPROACH OF BIFURCATION LESION

SECOND STENT IN SIDE BRANCH AFTER PROVISIONAL APPROACH

T technique Modified T technique—SB

stent first, when angle between MB & SB is near 90 degrees

CRUSH TECHNIQUE

T STENTING & SMALL PROTRUSION(TAP)

T stenting & crush technique

REVERSE CRUSH TECHNIQUE

Minimize any possible gap b/w MB & SB

CULOTTE TECHNIQUE

SKS TECHNIQUE

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