For left main disease that involves the bifurcation but also the ostium, use the same bifurcation stenting strategies, except you have to also extend your left main stent to the ostium with a couple of mm in the aorta. When deploying your main LM-LAD stent in this case, use the view that shows the LM ostium, usually LAO cranial or LAO straight view, and make sure you cover the ostium's lower edge into the aorta. Review my Aorto-ostial stenting talk. The bigger issue in this case is guide ventricularization and left main ischemia that can happen if you fully engage the guide. For that, as explained in my Aorto-ostial talk, I recommend the "hit and run" maneuvering, meaning you keep your guide slightly disengaged throughout the case, making sure the guide is not ventricularized. You only engage during device positioning, which may cause intermittent transient left main ischemia. This may still translate into substantial LM ischemia if you are doing complex device positioning and steps. Hence, having to treat complex distal disease (requiring a lot of time) through a ventricularized LM guide is an additional push to use LV support and/or to use a simple distal strategy. It is one of the 6 additional features I consider in my decision to use LV support. I show that in the slide about LV support (Eg 48:22) and under my "LV support" talk.
Thanks for this lecture Dr. What is your position in KB predilatation in a Medina 1-1-1 (distal-DA-Cx / all critical) to preserve architecture and avoid shift before stenting? Do you recommend it? Or its the same than sequential prep at high pressures? Pd. I have the notifications on; waiting for your next lecture. Again, thanks a lot.
And, the second question Dr.: Sometimes after first POT, it is difficult to advance the side branch stent through struts; do you think I should re-POT (considering it was a suboptimal POT) with a wider balloon, or in this case, dilate directly the struts with a NCB prior to attempt advancing the stent.
I don't know how to tag you, sir, in my comment. In thankful to you for your insightful videos. Kindly consider uploading such videos on structural interventions too.
Thank you. You use the same bifurcation stenting strategies, except you have to also extend your left main stent to the ostium with a couple of mm in the aorta, . When deploying your main LM-LAD stent in this case, use the view that shows the ostium, usually LAO cranial or LAO straight view, and make sure you cover the ostium's lower edge into the aorta. Review my Aorto-ostial stenting talk. The bigger issue in this case is guide ventricularization and left main ischemia that can happen if you fully engage. For that, as explained in my Aorto-ostial talk, I recommend the "hit and run" maneuvering, meaning you keep your guide slightly disengaged throughout the case, making sure the guide is not ventricularized, and you only engage during device positioning, which may cause intermittent transient left main ischemia. That may still be substantial ischemia if you are doing complex device positioning and steps. Hence, having to treat complex distal disease (requiring a lot of time) through a ventricularized LM guide is an additional push to use LV support and/or to use simple strategy. It is one of the 6 additional features I consider in my decision to use LV support. I show that in the slide about LV support (Eg 48:22) and under my "LV support" talk.
@@eliashanna8248 Dr if crush technique predilatation ostial LM befor stienting distal LM?? If after pre dilatation It happened dissiction LM Turn to TAP technique quickly?? If TAP technique decidd long stient cx (ostial to mid) not difficult delvirance long stient from stien LM - LAD? Once again thank you very much
