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Bifurcation Case What to next?? Bifurcation stenting: Questions to be answered Types of bifurcations Two stents or one? Should I have kissing stents? What is plaque shifting? What Technique IVUS/OCT…? What did we Why that??? Dedicated Devices: Pros: - Effective treatment of entire bifurcation anatomy - Minimal main branch impact Cons: - Cost (price and time) since stents required - More complex design than modified provisional Current Stent Design Options (Provisional) While simple in concept they fail to deal with the complexity of the anatomy Current Stent Design Options (Dedicated) Current Stent Design Inputs Their simplicity lies in their ability to treat the complexity of the anatomy in a repeatable and effective way Goal: Span Both Vessels     Cover the proximal lesion segment Cover the ostium of the side branch and distal parent vessel without compromising access to the side branch This is accomplished if markers are in branch and is in the other Provide a convenient placement marker for additional distal stents Angiographic Outcome Any in-bifurcation restenosis: 6.4% (9/140 at months) (DIVERGE Study) Location Analysis: Proximal edge: 2.8% SB stent: 4.8% (105 SB stents) Parent Vessel RS pts pts Both Side Branch RS pts Lowest restenosis rates ever reported in a bifurcation study of any kind AXXESS: 0.7% Distal PV Cypher: 2.1% Dr Grube, Bangkok 2012