BIFURCATION TREATMENT BY TR APPROACH A CASE Operators: Dr' S' Rigattieri, Dr' A'S' Ghini Sandro Pert

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BIFURCATION TREATMENT BY TR APPROACH A
CASEOperators Dr. S. Rigattieri, Dr. A.S.
GhiniSandro Pertini Hospital Cath LabRome,
ItalyCath Lab Director Dr. P. Loschiavo
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• 71 years old woman with recent onset angina and T
  wave changes in V4-V6 leads. No troponin I
  elevation.
• Procedure right transradial approach with long
  Terumo Hydrophilic sheath.
• Selective angiography with standard Judkins
  catheters show disease of LAD-D1 with bifurcation
  lesion (Fig. 1,2)

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Fig 1
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Fig.2
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• Guiding catheter XB 3.5 6F 0.070 i.d.
• Biotronik Galeo 0.014 wire in diagonal branch
• Guidant BMW Universal 0.014 wire in LAD
• Direct stenting of the LAD with a Tsunami gold
  3.5x20 mm deployed at nominal pressur
• Direct stenting of the second lesion on the LAD
  with a Tsunami gold 3.5x10 mm.
• Exchange of wires
• PTCA of the mid-diagonale lesion with a 2.5
  Maverick balloon.
• Kissing balloon with a 3.5x15 mm (LAD) and 2.5x15
  mm (D1). (Fig 3)
• Final result (Fig.4)

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Fig.3
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Fig.4
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Final considerations
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• Bifurcation lesions represent a growing and
  challenging subset of cases
• Provisional T stenting technique is associated
  with good immediate and long term results,
  although recently crushing technique with DES and
  dedicated stents have been proposed.
• With adequate guiding catheters (6F large lumen)
  optimal back up can be obtained through the
  transradial approach, with the possibility to
  perform direct stenting and kissing balloon
  procedures.