Maybe consider using guiding extension on first hand to deliver the 2’.75 mm in LAD Doing this « larga manu » in this kind of situation (recrossing long stent /calcification etc..) allowed us to loose very few stents this past years Thanks for your always very interesting cases ! Dr Ivan Carel /France
Thanks for the great educational case! I'm a bit twitchy about the LMS bifurcation stenting technique used. I appreciate decisions were made step by step, but we have no clue where the LAD stent landed proximally and there's a good chance distal LMS into ostial LAD was not covered by the stent. Was final IVUS LAD-LMS performed? Do you think different bifurcation strategies could have been used in the end? Many thanks!!
A lot of operators are hesitant to perform atherectomy after predilation for fear of presence of dissection and resultant perforation… what’s your opinion? and is there a certain atm beyond which atherectomy should be performed, some say below 4-6 atm it’s ok but if higher should wait 3-4 weeks and bring back for atherectomy… what’s your opinion Dr Brilakis please ?
Atherectomy can be performed ater predilation, even if there is an angiographic dissection (provided that there is a resons for atherectomy, such as balloon undilatable lesion). Would carefully monitor the ECG during atherectomy runs. The risk of deferring PCI for later is acute vessel closure.
Thanks for the educative case sharing.
Maybe consider using guiding extension on first hand to deliver the 2’.75 mm in LAD
Doing this « larga manu » in this kind of situation (recrossing long stent /calcification etc..) allowed us to loose very few stents this past years
Thanks for your always very interesting cases !
Dr Ivan Carel /France
Thanks for the great educational case!
I'm a bit twitchy about the LMS bifurcation stenting technique used. I appreciate decisions were made step by step, but we have no clue where the LAD stent landed proximally and there's a good chance distal LMS into ostial LAD was not covered by the stent. Was final IVUS LAD-LMS performed? Do you think different bifurcation strategies could have been used in the end? Many thanks!!
A lot of operators are hesitant to perform atherectomy after predilation for fear of presence of dissection and resultant perforation… what’s your opinion? and is there a certain atm beyond which atherectomy should be performed, some say below 4-6 atm it’s ok but if higher should wait 3-4 weeks and bring back for atherectomy… what’s your opinion Dr Brilakis please ?
Atherectomy can be performed ater predilation, even if there is an angiographic dissection (provided that there is a resons for atherectomy, such as balloon undilatable lesion). Would carefully monitor the ECG during atherectomy runs. The risk of deferring PCI for later is acute vessel closure.