How to do DK crush: step-by-step in a bench model
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- čas přidán 14. 06. 2019
- Step-by-step description of the DK crush technique. After wiring and predilating both main vessel (MV) and side branch (SB), DK crush is done in 17 steps:
1. Insert MV balloon (sized 1:1 with the distal MV) in the MV at or distal to the SB origin
2. Deliver SB stent protruding 2-3 mm in the MV
3. Deploy SB stent
4. Remove SB balloon
5. Perform angiography to assess SB result
6. Crush SB stent by inflating MV balloon
7. Rewire SB through crushed stent, then remove jailed SB wire
8. Deliver balloon in SB
9. First kissing balloon inflation
10. Remove SB and MV balloon
11. Deliver and deploy MV stent
12. Assess MV stent result
13. POT
14. Rewire SB through MV stent then remove the SB wire
15. Second kissing balloon inflation
16. Final POT
17. Final angiography - Jak na to + styl
Very Concise and great presentation, Thanks a lot Dr Brilakis
Very nice demonstration. Every fellow of cardiology should subscribe you. Great teacher.
please your report for the attached film czcams.com/video/7_3a1rm7sAM/video.html
Thank you for your exellent demostration sir✌🏻
Geia sou Mano edo Antonis Kardiologos sti germania. Poly oraia ta video sou. Mpravo!
Thanks forthe nice case presentation .
Great demonstration. Curious as to whether the tubing you are using is readily available for purchase or if it is something you worked to have custom developed? Thanks!
nicely explained
which technique and how to know the wire has entered the proximal strut of side branch stent in step 7 and 14? I don't have OCT
Why do you have to cross the wire through the proximal strut rather than the middle or distal strut after the first crush? At the end you are pushing away the struts either way!
Did the first stent come back too much sir?
perfect as usual, where do you place the distal balloon‘s marker when performing a POT? and when performing KBI do you use NC Balloon for both vessels? Thank you
Distal balloon marker should be at the carina. Usually use NC balloons for both, but sometimes when NC balloon delivery is challenging will use regular balloons.
distal ballon markar should be kept before carina, for kbi NC ballons should be used
please your report for the attached film czcams.com/video/7_3a1rm7sAM/video.html
Finally here!! DK-Crush by Manos Brilakis!
Manos videos are amazing
i am sorry this might be a stupid question but i d like to know the purpose of rewiring the SB after crushing SB with MV baloon, and do we use the the third (another wire) to the SB? I noticed we still have on the SB then why rewiring it?
oh never mind i found the answer on your other video..thank you
Where does the second re wire (after MV stenting) cross? Through the proximal strut, like the first one? Or through the distal strut, like in provisional ?
Distal, similar to provisional.
The SB stent wasn't crushed, was it? Did the step 6 crush the SB ? Thank you for the video!
It was - it's just filmed at the weird angle.
Thank you for your demonstration. In the culotte stenting I asked "After kissing balloon , isn't final POT ( instead of second POT) necessary?", and you answered as " Another POT should be done if the kissing balloons did not come back enough into the MV. If kissing balloon are back enough in the MV and the MV is well expanded it may not be necessary.
"
However, now in the double kissing crush tecnique after second kissing balloons, final POT is the 16 th step. Why is there difference between culotte and DK crush techniques after kissing balloons about final POT?
Thank you for your answer!
Good point - same concept applies to both culotte and DK crush.
What your opinion adout two step crushing of side branch stent, when the first step is standart crushing in main vessel, and the second is crushing like POT?
I do not have experience with this technique, but it makes sense if there is big size mismatch between the proximal and distal main vessel.
@@manosbrilakis Thank You very much.
I advocate for this
Thank you sir.
I dont understand, how can you pull back main vessel balloon after SB stent was inflated, to crush SB stent? Once the SB stent is deployed, wire in the MV is automatically jailed, even if you pull back and inflate it would just push and crush the SB tent to one side, not dilating from the lumen of SB stent.
The wire in MV is unlikely to be jailed due to the smaller size of SB and therefore the SB stent. It is not difficult to pull back on MV balloon. This is something you have to do to know.