EBC - ON DEMAND
Inverted provisional T-stenting for treatment of protected left main bifurcation
European Bifurcation Club 2010 – EBC 2010 – Budapest, Hungary
CD session 2: Stenting techniques
Inverted provisional T-stenting for treatment of protected left main bifurcation
Author: Imre Ungi, Szeged, Hungary
CASE HISTORY
- 50-year old ♂;
- Exertional angina for several months, progression from CCS 2 to 3.
- Remote history:
- CABG (1999): LIMA-LAD; sequential SVG to IM-OM.
- Risk factors:
- current smoker, diabetes and hyperlipidemia, PAD.
- Echocardiography:
- no wall motion abnormality, LVEF: 60%.
- Stress test:
- angina at 7 MET with 2 mm STD in II, III, aVL, V4-6.
- Medication:
- ASA, bisoprolol, trimetazidin, rosuvastatin, nitroglycerin
LESSONS FROM THE CASE
- From the CX-OM:
- Intention to treat the ostial stenosis of a small vessel may generate escalation of the procedure and significantly increase the cost;
- Tryton stent MUST be used with DES in the MB;vFrom the LM bifurcation:
- The whole diseased area should be covered with additional DES in case of a potential vessel injury during predilation;
- Sometimes the most expensive solution is a forced pursuit to decrease the expenses.