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

[@eliashanna8248]

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 <a href="#" class="seekto" data-time="2902">48:22</a>) and under my "LV support" talk.

[@aroojzahid3138]

Simply the best and perfect concepts

[@samialazkany6379]

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

[@eliashanna8248]

Thank you for the very kind words. It is my pleasure.

[@Mohamed-cz7kc]

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

[@abdelrahmanassal4933]

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

[@dinomikulic3356]

This is gold!

[@aroojzahid3138]

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

[@aroojzahid3138]

Simply the great

[@Nikesnipe]

Another Jewel

[@bhaskerjeyaraman879]

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

[@aroojzahid3138]

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

[@gyanpapisen7806]

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.

[@eliashanna8248]

Thank you for the kind words. Unfortunately, I don't do structural interventions.

[@m.abrill.7407]

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.

[@m.abrill.7407]

And, the second question Dr.: Sometimes after first POT, it is difficult to advance the side branch stent through struts; do you think I should re-POT (considering it was a suboptimal POT) with a wider balloon, or in this case, dilate directly the struts with a NCB prior to attempt advancing the stent.

[@abuahmed9026]

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

[@eliashanna8248]

Thank you. You 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 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. 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, and you only engage during device positioning, which may cause intermittent transient left main ischemia. That may still be substantial 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 simple 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.

[@abuahmed9026]

@@eliashanna8248 Dr if crush technique predilatation ostial LM befor stienting distal LM?? If after pre dilatation It happened dissiction LM Turn to TAP technique quickly?? If TAP technique decidd long stient cx (ostial to mid) not difficult delvirance long stient from stien LM - LAD? Once again thank you very much