Thank You very much for this case. What would Your treatment strategy be, if FFR in LCx was less than 0.8? Maybe TAP on LCx, final trissing and final POT in this situation, if You performed extended-V in left main-LAD-intermediate? Thank You.
Great case and perfect approach. I liked the Idea of separating the 3 wires with the towel as you demonstrated. Are you using the same impella access for the Guide catheter? or you using another site.
Beside technical part, planning is of utmost importance (Hemodynamic support, EUROSOCRE, Heart team discussion) that all contributed to success. Ad-hoc PCI for this case would result in failure.
I’m sorry I didn’t understand ... How could we be sure that the distal left main completely covered after v stenting with lAD and RI ? Or Did you overlap both LAD and RI stents into the distal left main stent ??
As I understood, there is overlapping between V stents and left main stent. So, there are 2 layers of stent at distal LM all around . If CX is physiologically significant, i would rewire through distal cell (in this case, the wire should pass through ramus stent)then Kissing (LCX, Ramus). Another issue is Kissing would shift the new carina made by V stenting towards LAD. Based on IVUS i would do extra step which is Trissing again.
saighi bouaouina Mehdi because the risk of dissection of LM would be high (it is diseased distally), That is why covering the LM first was the plan and then going for a V-stenting approach
saighi bouaouina Mehdi in case of dissection after a classical v-Stenting it would be technically difficult to place the LM stent having already 2 stents protruding into the MV
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Really great case, great result! very educating! Thank you very much!
Great job! Thank you for sharing!
Thank You very much for this case. What would Your treatment strategy be, if FFR in LCx was less than 0.8? Maybe TAP on LCx, final trissing and final POT in this situation, if You performed extended-V in left main-LAD-intermediate? Thank You.
Great case and perfect approach. I liked the Idea of separating the 3 wires with the towel as you demonstrated.
Are you using the same impella access for the Guide catheter? or you using another site.
Thanks for sharing the case. Did you overlap the stents in LAD/ramus with left main stent?
What would be your strategy if there was Medina 1,1,1,1 at the beginning
Beside technical part, planning is of utmost importance (Hemodynamic support, EUROSOCRE, Heart team discussion) that all contributed to success. Ad-hoc PCI for this case would result in failure.
why used or euroscore II to assess mortality?
Bravo
Which wire did you put the TCE Stent in? In that case, wouldn't it be a double TAP?
I’m sorry I didn’t understand ...
How could we be sure that the distal left main completely covered after v stenting with lAD and RI ? Or
Did you overlap both LAD and RI stents into the distal left main stent ??
What if there is significant pinching of LCX ostium? Or FFR of LCX is positive? What would be next strategy?
As I understood, there is overlapping between V stents and left main stent. So, there are 2 layers of stent at distal LM all around . If CX is physiologically significant, i would rewire through distal cell (in this case, the wire should pass through ramus stent)then Kissing (LCX, Ramus). Another issue is Kissing would shift the new carina made by V stenting towards LAD. Based on IVUS i would do extra step which is Trissing again.
could we have done a classic v stenting (LAD and ramus) then stent the left main ?
saighi bouaouina Mehdi because the risk of dissection of LM would be high (it is diseased distally), That is why covering the LM first was the plan and then going for a V-stenting approach
@@tom11298 thanks
But in all cases we plan to put a stent in the LM with or without dissection
saighi bouaouina Mehdi in case of dissection after a classical v-Stenting it would be technically difficult to place the LM stent having already 2 stents protruding into the MV
@@saighibouaouinamehdi3153
Beside dissection part, If u do V first then you had to stent LM. The Later would compress either one of previous 2 stents.