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Complex techniques in complex lesions : which one is the best ?

Complex techniques in complex lesions : which one is the best ?. EBC Annual Meeting Alexanderplatz, Berlin 2009. Leif Thuesen MD, DMSc, FESC Department of Cardiology Aarhus University Hospital, Skejby, Denmark. “Bifurcation treatment can only be understood backwards;

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Complex techniques in complex lesions : which one is the best ?

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  1. Complex techniques in complex lesions : which one is the best ? EBC Annual Meeting Alexanderplatz, Berlin 2009 Leif Thuesen MD, DMSc, FESC Department of Cardiology Aarhus University Hospital, Skejby, Denmark

  2. “Bifurcation treatment can only be understood backwards; ”but I prefer antegrade coronary flow." Jens Lassen Complex techniques in complex lesions : which one is the best ?

  3. Background 8 months binary restenosis Circulation. 2006;114:1955-1961

  4. Background

  5. Kissing balloon post dilatation

  6. Background

  7. Non-complex LAD/D1 bifurcation

  8. Complex LAD/D1 bifurcation

  9. Pre-dilatation and/or and/or X Undersized balloon Therapeutic dilatation Kissing balloon Side branch Main vessel

  10. Strategy of optional SB stenting Treatment principles • Stenting of main vessel • Side branch dilatation if TIMI flow <3 • Side branch stenting only if TIMI flow = 0 after side branch dilatation Circulation. 2006;114:1955-1961

  11. How to treat • Predilate side branch with significant stenosis • Dilate side branch, if reduced flow after main vessel stenting • Stent side branch if occlusion after main vessel stent

  12. 8-month rate of CCS 2-4 angina class in patients with and without post stent in lesion diameter stenosis >50% of side branch p=0.34

  13. Main Vessel Stented Patients Late-loss in Side Branch

  14. Provisional Sidebranch Stent Techniques

  15. Continue to a two-technique

  16. Continue to a two-technique Culotte-stenting

  17. Continue to a two-technique

  18. Internal Crush

  19. Complex techniques in complex lesions : which one is the best ? • Keep • It • Simple • S…

  20. “Bifurcation treatment without permanent implants” Future EBC nightmare

  21. Post Procedure 2 Years 24-Month Results – OCT Data Future EBC nightmare Case Example P.W. Serruys, TCT 2008

  22. Future bifurcation treatment Internal crush (Medina 1,1,1)

  23. Future bifurcation treatment Culotte (Medina 1,1,1)

  24. Complex techniques in complex lesions : which one is the best ? • It´s • All • The • Same • S…

  25. “Bifurcation treatment without permanent implants “No discussions on bifurcation techniques” Future EBC nightmare Thank you for your attention

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