Modified TAP Technique Balloon Assisted SB Stenting OR Pull-Back Technique

European Bifurcation Club 2018 – EBC 2018 – Brussels, Belgium

Modified TAP Technique Balloon Assisted SB Stenting OR Pull-Back Technique

Author: Rajiv Bhagwat Bifurcation club of India Mumbai

MODIFIED BALLOON OCLUSSION TECHNIQUE

• Post stenting the main branch the main branch Balloon is used to occlude the SB ostium after the SB stent is in position for a T type deployment
• The MB balloon is inflated at 4 to 6 atm and the undeployed SB stent is then gently pulled to oppose against the Inflated MB balloon and the SB stent deployment started while maintaining the gentle pull on the SB stent balloon system under fluoroscopy
• Once the SB stent deployment has begun the MB balloon is inflated at higher pressures limiting the protrusion of the SB stent material in the MB
• Both stents can then be individually dilated with NC balloons at higher pressures if needed and KBD followed by POT could finish the procedure

The Modified Balloon Occlusion Technique

• More often than not gives you a perfect deployment at the SB ostium in a Two stent strategy
• Ease of reintervention, recrossing the SB and passage of balloons downstream into the MB is unhindered
• Maintains integrity of the Carina
• Laminar flow
• Leaves the bifurcation lesion with minimal metal burden at the carina ( multiple layers of crushed stent in DK crush and Double layer in the MB in culotte )
• The technique can be employed for all angles ( 15° to 90°& more)

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