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 treating

coronary bifurcations

Major adverse cardiac event (MACE) and TLR incidence in randomized trials comparing 1-stent (1S) with

2-stent (2S) strategies.

Provisional stenting of Bifurcations:technique

Avoid Pre - dilation of SB

False bifurcation-possibility of proximal cross is more

- ? Possible proximal crossUtility of very short over sized baloon to discover proximal cross

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.– Should undergo at least 12 mnth antiplatelet

treatment.– So avoided in pts non comliant with medications

and at high risk for bleeding.

Techniques E.D.S

Step crush

Sleeve technique

Potential failure modes of crush and suggested solutions

1. 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.

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» 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

QCA OF BIFURCATIONS