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dr awadhesh
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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
THANK YOU