Bifurcation left main stenting- Elias Hanna

0:00 General approach to left main stenting: the 5+3 major questions
02:10 General approach to bifurcation left main. When to choose provisional strategy (EBC main and DK crush V trials) + cutoffs and data for provisional postdilatation, stenting, and predilatation.
11:57 4 planned 2-stent techniques, and 3 provisional stenting techniques.
13:19 Regular vs inverted TAP and Culotte: when and how. The one advantage of crush and perfect T
15:03 Data for 2-stent strategy techniques: EXCEL, NOBLE, EBC main, DK crush V and III
18:14 Vessel prep pre- and post-stent and careful technique (more important than the exact 2-stent strategy)
20:45 TAP steps, video animation, tips (+33:36). Difference with Crush and Culotte
29:24 Perfect T and nanocrush steps. Different from TAP and similarity to standard SK crush
33:36 Additional tips for TAP: how to reduce size of the protrusion, distal rewiring, future distal crossing past TAP neocarina. Advantages vs Crush and Culotte (eg, much less metal overlap)
41:50 Distal vs proximal rewiring with Crush and Culotte
43:47 LCx underexpansion is Achilles heel of LM PCI, esp with Crush
44:34 IVUS and angiographic sizing: the 8-7-6-5 rule
46:22 Radial access, 6Fr vs 7Fr, LV support

[eliashanna]

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.

[afsanehmohammadi]

Thank you for your comprehensive discussion

[samialazkany]

I wait impatiently for your lecture. Thank you very much dear Prof.

[abdelrahmanassal]

Thanks dear professor
Every lecture is extremely useful
Can't wait for the next one
God bless you ❤

[aroojzahid]

Thanks for such nice demonstration
Kindly upload data nd techniques for trifurcation LMS . Highly awaited

[Mohamed-czkc]

Thank you sir
We are all always waiting your teaching lectures ❤

[bhaskerjeyaraman]

Great sir .only you could explain it lucidly.our humble request (if you have the time)pleas do video on pci complications sir

[고티카-qg]

I always appreciate to your lecture
I really wonder, when i LM-LCX crossover stenting, should i opening the LAD ostium even if there is no stenosis at LAD os? or not?
And is there any research data which i can consult about this question?

[gyanpapisen]

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.

[m.abrill.]

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.

[aroojzahid]

Can u please upload lecture upon IAS puncture techniques and TAVR techniques . Waiting

[abuahmed]

Thanks a lot
Dr if ostial LM 90%+ complexe distal LM bifurcation
What the best strategie here ?