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Angiosoft.NET. BIFURCATION TREATMENT BY TR APPROACH – A CASE Operators: Dr. S. Rigattieri, Dr. A.S. Ghini “Sandro Pertini” Hospital Cath Lab Rome, Italy Cath Lab Director: Dr. P. Loschiavo. Angiosoft.NET.
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Angiosoft.NET BIFURCATION TREATMENT BY TR APPROACH – A CASEOperators: Dr. S. Rigattieri, Dr. A.S. Ghini“Sandro Pertini” Hospital Cath LabRome, ItalyCath Lab Director: Dr. P. Loschiavo
Angiosoft.NET • 71 years old woman with recent onset angina and T wave changes in V4-V6 leads. No troponin I elevation. • Procedure: right transradial approach with long Terumo Hydrophilic sheath. • Selective angiography with standard Judkins catheters show disease of LAD-D1 with bifurcation lesion (Fig. 1,2)
Angiosoft.NET Fig 1
Angiosoft.NET Fig.2
Angiosoft.NET • Guiding catheter XB 3.5 6F 0.070” i.d. • Biotronik Galeo 0.014” wire in diagonal branch • Guidant BMW Universal 0.014” wire in LAD • Direct stenting of the LAD with a Tsunami gold 3.5x20 mm deployed at nominal pressur • Direct stenting of the second lesion on the LAD with a Tsunami gold 3.5x10 mm. • Exchange of wires • PTCA of the mid-diagonale lesion with a 2.5 Maverick balloon. • Kissing balloon with a 3.5x15 mm (LAD) and 2.5x15 mm (D1). (Fig 3) • Final result (Fig.4)
Angiosoft.NET Fig.3
Angiosoft.NET Fig.4
Angiosoft.NET Final considerations • Bifurcation lesions represent a growing and challenging subset of cases • Provisional T stenting technique is associated with good immediate and long term results, although recently crushing technique with DES and dedicated stents have been proposed. • With adequate guiding catheters (6F large lumen) optimal back up can be obtained through the transradial approach, with the possibility to perform direct stenting and kissing balloon procedures.
