Bifurcation coronary stenting: State 0f the Art

1. Bifurcation coronary stenting: State 0f the Art Mazhar M Khan Consultant Cardiologist Royal Victoria Hospital Belfast, N.Ireland

2. Percutaneous intervention of coronary bifurcation lesion, like marriage, is easy to do but difficult to get out David Holmes

3. Problems of Bifurcation Stenting • “Stent jail” of side branch • “Snow plough” effect • Stent deformity • Difficult re-crossing • Lower Success and higher complication rate • High Restenosis • Over all incidence of 15% of PCI

4. “ Stent Jail of the side branch is a low security prison” Caputo et al

6. The Problem • Bifurcation lesion location remains a predictor of adverse late outcomes in multiple (DES) trials • Controversies exist among differing strategies using standard stents: • Is long term efficacy improved when a SB stent is placed? • Is the SB compromised in provisional techniques? • When 2 stents are needed, what is the safety impacts of multiple stent layers and mechanical distortions in T-, crush, culotte, V-, or SKS? • Which technique is best?

8. Khan et al International J of Cardiovascular Intervent;2002 (1+1+1)* (1+1+0)* (1+0+1)* (0+1+1) (0+1+1)*

12. Need for stent?

18. Published in 2010 Circ.

21. PCI of Bifurcation coronary lesionOne stent or two stents* * Khan et al Int. Journal of cardiovascular intervention 2002

22. Stress MI Duration of PCI Contrast

23. And Keep it Safe Keep it Simple

26. And How

27. Khan et al Int J of Cardiovasc intervention:2001

34. p=0.26 p=0.12 p=0.47 p=0.34

43. Crush technique

44. (A) Crush stent SB stent first then main branch (B) final double balloon inflation

45. (A) Pre (B) Post crush