18. False bifurcation-possibility of
proximal cross is more
Utility of very short over sized
- ? Possible proximal cross baloon to discover proximal cross
27. 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.
37. 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.
38.
39. • 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.
44. • 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.
45.
46.
47. • 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
