dr awadhesh

1. CASES OF BIFURCATION
STENTING LAST WEEK

2. WASIQ 47YRS/M R/O DELHI
 Chief c/o-
1-AOE NYHA class II for 2yrs
h/o HTN, No h/o DM
chronic bidi smoker
ECG- T wave inversion in V1-V6
2D ECHO-
No RWMA,LVEF 60%

3. BIFURCATION STENTING

4.  True bifurcation- MB & SB are both
significantly narrowed (>50% diameter stenosis).
 Non true bifurcations- all other lesions

5. 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.

6. CLASSIFICATION OF BIFURCATION

9. Medina Classification of Bifurcation Lesions
Latib, A. et al. J Am Coll Cardiol Intv 2008;1:218-226
Copyright ©2008 American College of Cardiology Foundation. Restrictions may apply.

10. GENERAL APPROACH OF
BIFURCATION LESION

12. 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

13. CRUSH TECHNIQUE

14. T STENTING & SMALL
PROTRUSION(TAP)
 T stenting & crush technique

15. REVERSE
CRUSH
TECHNIQUE
 Minimize
any possible
gap b/w MB
& SB

16. CULOTTE TECHNIQUE

17. SKS TECHNIQUE

19. THANK YOU