17 May 2023
Complex bifurcation PCI - LIVE case
TAP strategy in complex non-left main bifurcation guided by FD-OCT
Summary
Study the case of this 69-year-old male patient with recent PCI on LAD presenting chronic coronary syndrome. Angiography showed calcified stenosis on bifurcation of proximal CX and large obtuse marginal 1, Medina 0-1-1.
The PCI strategy was an OCT-guided TAP technique:
7F guiding catheter, predilatation with semi-compliant and non-compliant balloons on CX and OM1, followed by Shockwave on the 2 vessels. Then, kissing balloon predilatation followed by implantation of the first long stent (CX-OM1), followed by a POT. Another kissing balloon before implantation of the second stent as TAP (CXprox-CX mid), followed by a final kissing balloon.
Good preparation of the lesions thus enabled the stents to be placed without any further support (guiding extension, etc.).
LIVE Case from Policlinico Universitario Fondazione Agostino Gemelli, Rome - Italy
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Key moments
- 32:29 - 35:38 - Shockwave OM
- 54:52 - 56:45 - Kissing balloon with one inflator
- 01:01:00 - 01:07:08 - TAP procedure, described step-by-step, with 3 kissing balloons
Keywords: Non-left main bifurcation, TAP stenting, FD-OCT, Lithotripsy, Calcified lesion
Learning Objectives
- To understand when bifurcation lesion characteristics can indicate the need of an upfront two stent strategy
- To learn how to select the optimal two stent strategy depending on lesion characteristics
- To learn how to use intracoronary imaging to optimise complex bifurcation stenting
