Ca ghi hình can thiệp chỗ chia nhánh với kỹ thuật Cullotte

LIVE-IN-A-BOX BIFURCATION STENTING WITH CULOTTE TECHNIQUE LE THANH BINH, MD VIETNAM NATIONAL HEART INSTITUTE BACH MAI HOSPITAL HUI NGHI TIM MACH TOAN oua'c CASE STUDY 58’s y.o male Angina Pectoris (CCS class III) Stent in LCx year ago Coronary Risk Factor: Smoking ECG: normal Echo: EF: 69% HUI NGHI TIM MACH TOAN oua'c Stent in distal LCx is patent Proximal LAD lesion & Ostial LCx lesion, True Bifurcation Lesion: 0.1.1, α ≈ 75° SYNTAX Score: 21 HUI NGHI TIM MACH ' Trans right femoral artery 7-Fr EBU guiding catheter Placement of wires (LAD, LCx, Dig1) Predilatation in LMproximal LAD (2.5x20mm baloon) HUI NGHI TIM MACH TOAN oua'c Predilatation in the ostial LCx (2.5x20 baloon) HUI NGHI TIM MACH ' Stent the LM-LCx leaving wires in the LAD & Dig1 HUI NGHI TIM MACH ' Stent (3.5x23 mm) in the LM-LCx is deployed at 12 atm (leaving wires in the LAD & Dig1) HUI NGHI TIM MACH ' Remove the wire from the stented LCx & crossing into the LAD (Rewiring at the distal strut of the stent) HUI NGHI TIM MACH ' Rewiring at the distal strut of the stent HOI NGHI TIM MACH Crossing with a baloon into LAD & dilate (2.5x20 mm at 12atm) M HUI NGHI TI ' MACH Advance second stent into the LAD, but … HUI NGHI TIM MACH ' And remove the stent system (broken stent system) -~-' : 01 NGHI TIM ~ -yoAN aua'c MACH2016 Use NC baloons to capture the broken stent system HUI NGHI TIM MACH Crossing with a new baloon into LAD & dilate (2.75x15 mm at 12atm) HUI NGHI TIM MACH TOAN oua'c Advance stent into the LAD, remove the jailed wire in LAD & wire in LCx, deploy the stent in LAD HUI NGHI MA TIM TOAN CH oua'c Cross with a wire into the LCx stent (Rewiring at the distal strut of the stent) HUI NGHI TIM MACH 'c Crossing with a baloon into LCx & dilate HUI NGHI TIM MACH TOAN oua'c Perform final kising baloon inflation (2 NC baloons) HUI NGHI TIM MACH TOAN oua'c Final result HUI NGHI TIM MACH TOAN oua'c Conclusions The culotte technique uses stents & leads to full coverage of the bifurcation, probably gives the best coverage of the carina This technique is suitable for all angles of bifurcations & provides nearperfect coverage of the SB ostium The culotte technique leads to a high concentration of metal with a doublestent layer at the carina & in the proximal part of the bifurcation Other disadvantages of the technique include rewiring both branches through the stent strut, placement a second stent into the unstented branch, which can be difficult and time consuming HUI NGHI TIM MACH TOAN oua'c ... HUI NGHI TI ' MACH Advance second stent into the LAD, but … HUI NGHI TIM MACH ' And remove the stent system (broken stent system) -~-' : 01 NGHI TIM ~ -yoAN aua'c MACH2016 Use NC baloons to capture... (2.5x20mm baloon) HUI NGHI TIM MACH TOAN oua'c Predilatation in the ostial LCx (2.5x20 baloon) HUI NGHI TIM MACH ' Stent the LM-LCx leaving wires in the LAD & Dig1 HUI NGHI TIM MACH ' Stent (3.5x23... HUI NGHI TIM MACH ' Remove the wire from the stented LCx & crossing into the LAD (Rewiring at the distal strut of the stent) HUI NGHI TIM MACH ' Rewiring at the distal strut of the stent HOI NGHI