Case 172: Manual of PCI - Double bifurcation

Рет қаралды 2,402

Ай бұрын

A patient was referred for PCI of a double bifurcation lesion: (a) LAD diagonal bifurcation and (b) bifurcation of the diagonal into a superior and an inferior branch. Coronary physiology with a pressure wire and AngioFFR was performed showing a long lesion in the LAD and a more focal lesion in the diagonal. The superior diagonal branch did not have significant stenosis, hence provisional stenting was chosen for the diagonal bifurcation. DK crush was chosen for the LAD/diagonal bifurcation. After predilatation the diagonal lesion was stented covering the ostium of the superior branch and protruding the stent into the LAD. DK crush was successfully used in the LAD/diagonal bifurcation with an excellent final angiographic result. Post PCI FFR and FFRangio in the LAD were 0.92 and 0.93, respectively. The diagonal could not be crossed with the pressure wire after LAD/diagonal stenting but FFRangio was 0.93.

Пікірлер: 22

@CALMSCARDIO Ай бұрын

Great cases as usual Manos. My only point is about the LAD stent, you chose 2.25 mm diameter. POT with 3.5 will lead to over expansion . The ONYX 2.25 goes up 3.25. I would have used a larger diameter and deployed at lower pressures then post dilated accordingly.

@guozhuchen5511 Ай бұрын

I agree with your opinion about stent size and need IVUS or OCT to confirm the proximal stent is good apposition.

@dipaklenka9611 Ай бұрын

This looks like 2.75 stent. Not 2.25

@mahmoud_elrayes 25 күн бұрын

May be Onyx Frontier as Onyx Frontier 2.0--2.5 mm expand up to 3.5 mm

@manosbrilakis 25 күн бұрын

Great point!

@shangz0216 Ай бұрын

Thanks for the excellent case presentation.

@tom11298 Ай бұрын

Excellent job Caution is needed when pressure wires are advanced through MB stent to check pinched side branches, especially in some case of high calcium burden at bifurcation (even after stenting) these pressure wires can easily get stuck leading to unpleasant complications. I would always use FFR Angio after stenting as it was perfectly mentioned here

@dr.settapongpmk4374 15 күн бұрын

Could we use DCB in DG and only provisional stenting for LAD in this case ?

@ahmedzahran7016 27 күн бұрын

nice case , I have a couple of questions if I may: First: Would it be safer to avoid ballooning the superior diagonal branch beforehand? second:2.25 is too small a stent to put in LAD, isnt it?

@manosbrilakis 25 күн бұрын

Good points - Agree that not predilating the SB is preferable to minimize the risk of dissection. Also agree re:stent sizing but it is usually better to start with a smaller stent and postdilate to larger diameter than start with a larger stent that may cause distal edge dissection.

@uzunoglan.sezgin Ай бұрын

Do we have to see from another angle how much we protruding into lad when we implanting first stent?

@mahmoud_elrayes 25 күн бұрын

Excellent case.In case of severe lesion not moderate one, do you still relay on FFR for strategy planning? Thanks

@manosbrilakis 25 күн бұрын

If lesion is very severe angiographically I do not use FFR as it is almost always positive - post PCI FFR can be useful even in such cases though.

@TheCyclingCardio Ай бұрын

Many advocates the use of OCT for bifurcation stenting, especially for making sure the proper SB strut wiring before 2nd kissing balloon..what is your view on that? Thank you

@manosbrilakis 25 күн бұрын

Absolutely! Intravascular imaging is extremely useful in bifurcation PCI.