Ostial side branch stenting (esp. ostial diagonal): algorithms and cases -Elias Hanna

0:00 Types of ostial side branch disease, cases where a perfect T can be done.
5:53 and 9:13 Algorithm for LAD-diagonal or LCx-OM with shallow angle: semi-culotte, re-cross into LAD and balloon, inverted TAP if needed
18:04 Cases
19:17 Two cases of crush stenting with pitfalls: difficult balloon recrossing through crushed stent.
20:45 The one caveat of semi-culotte
26:29 Inverted TAP case
30:46 Planned standard TAP case (vs provisional stenting). Technical comments about TAP
***Perfect T vs TAP:
T stenting: branch needs to be close to 90 degrees and a single stent can be done for isolated ostial SB disease
vs. TAP: can be done for narrower angles, even 40-60, but only after MB has been stented (TAP is part of 2-stent strategy, whether provisional or planned)

[@mohamedatef2584]

Thank you, Dr. Elias Hanna. Your videos and book are really amazing.

[@areenal-taie6836]

Thanks a lot !
please continue these great work and explanations

[@AhmedMohammed-jq1cp]

Great sir.
Thanks for your efforts.

[@m.s3815]

Hi dr hanna...
Passionately waiting your new presentation.

[@Nikesnipe]

Thank you Greatly

[@MrAymano1]

Thanks, great teaching and information

[@m.s3815]

Thank you. Nice.

[@BarrieLouis]

Thank you!

[@sheraligowani9029]

Excellent ❤

[@superwall81]

hi prof ellis, may i ask the half cullote will lead to neo carina formation right, and would you like to come to malaysia to give some lecture, your lectures are GOLD

[@eliashanna8248]

Half culotte would create neocarina if the stent is large and pinches the distal main vessel (the so-called carina shift). And when this happens, I rewire the distal MB and balloon it then do kissing balloon, in which case there should no longer be a neocarina.
Sizing the stent to the side branch and doing POT proximally reduces the likelihood of this carina shift.
And thank you! I would love to go to beautiful Malaysia someday, not in the near future though

[@aasaad007]

Great sir 9

[@mohamedkishkt3667]

A question came to my mind why the manufacturer of the stent make the proximal end tilted a little with double markers over that end?

[@trooperrex9972]

Why not Tap the D1?

[@eliashanna8248]

TAP can only be done after the other branch has been stented, in this case the LAD. So, TAP implies that you already stented the LAD across the Dg, then you rewire the Dg and do TAP stent in the diagonal with simultaneous inflation of the Dg stent (hanging in the LAD) and LAD balloon, preventing the TAP from becoming culotte (Alternatively, you can start by stenting the LAD into the Dg, then reverse TAP the distal LAD. Again, a stent has to be present in the other branch before you TAP). So, you may do TAP in the case of isolated diagonal if you choose to do 2-stent strategy.
-If you do TAP in the Dg without having stented the LAD, you will be inflating 1 stent+ 1 balloon simultaneously in that proximal LAD, causing significant injury; this is not advised. That is why semi-culotte is preferred, where you stent the prox LAD into the Dg and eventually only balloon the distal LAD through the LAD stent struts using an undersized balloon, limiting the risk of LAD injury.
If LAD distally is suboptimal, then I convert to full culotte or reverse TAP, as explained in the video.
-Only the perfect T at a close to 90 degrees angle can be done without any stent or balloon in the LAD. TAP: can be done for angles 60-90, even 40-60, but only after MB has been stented

[@amiralitrn-hu8np]

Uyu67