ZEL

BFURKASYON STENTLER
Dedicated stents for bifurca@ons

Ylmaz Nianc

Dedicated Bifurca-on Devices


Bifurca-on Op-miza-on Stent System -
BIOSS

BIOSS Stent

Balon i-kten sonra,distal ve proksimal aplarna uyan, 2 blml stent.

(POT efek- gibi).
Karina kaymasn engelliyor.

 No dierence in clinical parametres with BIOSS vs DES

ABBOT DES, yan dal girili bifurkasyon sistemi (ABT Fron-er)

Aldnda yan dal os@umunu

tam kaplayacak. Kendi alr,
ni@nol, BMS

COBRA trial
Primer son nokta : OCT ile, bifurkasyonun kaplanmama derecesi: 9 ayda
CULOTTE TEKN DAHA Y GRLYOR.

COBRA trial

 self expandable, ni@nol, BMS ve DES (paclitaxel) li, stabil polimerli

6F e uygun tek telli (wire)
AYRILABLR STRUT lardan yan dala gei kolay.
SB Os@umunu kaplamas mkemmel

SONU
zel yan dal stentleri :
Bifurkasyon stentlerine ih@ya vardr.
lemi kolaylaarrlar, akut baar sonucunu
arbrrlar.
Uygun yaplm bifurkasyon stentleme
ynlemlerine stnln gsteren yeterli
uygulama ve veri yoktur.
Anakoroner bifurkasyonlarnda yarar daha
fazla olabilir.

Stent specica-ons for LM PCI

6. Keep it simple: And fast
BVS: 2 atm per 5 seconds + 30 sec at max
Pressure For 16 atm: 40 + 30 sec: 70

seconds.

BVS requires aggressive predilata@on with

increased risk of dissec@ons
BVS requires postdilata@on in calcied lesions

BVS in LM is possible
1. Anatomy suited for single scaold cross-over
2. Able to tolerate prolonged ina@on @mes :
. Absence of severe heart failure
3. Diameter <4.0 mm
4. LCX small
5. Absence of circular os@al calcica@on
6. Able to maintain DAPT for 12 months

BVS in bifurca-on
TAP technique is reasonable
BVS in MV and DES in side branch
Final kissing ?

DEB in Bifurca-ons
Conclusions
DEB only strategy is eec@ve in Medina 0-1-1 bifurca@ons
DEB only strategy is possible in the majority of such
lesions
Sten@ng might be avoidable in many pa@ents without an
increase in restenosis and MACE rate
The DEB only approach should be inves@gated in larger
series of pa@ents

IVUS-guided treatment of complex bifurca-on lesions is

associated with signicantly lower rates of adverse cardiac
events at late follow-up
Bifurca@on lesions, propensity score matching (n=247 / n=202)
ACS 61% and 89% of bifurca@ons lesions were Medina class 1,1,1
IVUS compared to no IVUS was associated with signicantly lower
rates of
death or MI (OR 0.38, 95% CI 0.20 to 0.74, p = 0.005),
death (OR 0.40, 95% CI 0.18 to 0.88, p = 0.02),
MI (OR 0.37, 95% CI 0.14 to 0.98, p = 0.04),
periprocedural MI (OR 0.45, 95% CI 0.20 to 0.97, p = 0.04),
TVR (OR 0.28, 95% CI 0.14 to 0.53, p <0.0001), and
TLR (OR 0.27, 95% CI 0.14 to 0.53, p = 0.0003)
Patel et al. Am J Cardiol, 2012

Bifurkasyon stentlemede 2 stent yerle-rme yaklam