Isolated ostial LAD or ostial LCx stenting

0:00 2 major approaches
01:32 Nail the ostium strategy. Pitfalls
03:43 Troubleshooting
06:59 Crossover stenting into LM. Provisional steps
10:13 Ostial LCx compromise with LAD stenting. Risk factors and management
14:29 Same 2 strategies for isolated ostial LCx stenosis
16:55 Avoid touching uninvolved branch and kissing balloon if no compromise
20:27 Avoid Szabo technique
22:06 Data and cases

[@user-ug4lh5vu1s]

Brilliant as usual, thank you and hope to see CTO series from you , wish you the best and please keep up with this amazing work

[@Navjeet-nz8ch]

Great presentation, highly appreciated!

[@ahmedsabbar9049]

Thank u very much for sharing and your enthusiasm to illustrate for us.

[@Docsammy]

Once a brilliant lecture

[@aroojzahid3138]

Great talk just like u always do

[@Nikesnipe]

Thanks greatly !

[@drmot7955]

Thanks doctor 😊

[@ahmedsabbar9049]

جزاك الله خيرا في الدنيا والآخرة

[@denovo1148]

excellent !!

[@areenal-taie6836]

Brilliant 👌

[@Mohamed-cz7kc]

Great our prof we hope cto from you ❤

[@harmeetsingh6134]

Sir appreciate to all cases but in last case i have doubt about present last case in this video OSTEUM LCX STENT is short because land on the edge of OM1 acc to me stent is taken long 6mm to cross the OM1 due to in future if any disease occur in OM 1 if any operator treat this easily to treat in future i see your all caese excellent knowledge

[@shivaprasad9095]

Thank you sir

[@user-cf9sm6tx1v]

Dr.Hanna ,thanks so much, please tell us lecture about PCI Complication and management and Structural Intervention such as ASD closure,PTMC,....

[@Shadeslayer200593]

🙏

[@amangupta03]

Dr. Hanna, do you ever use a blocking balloon sized in the side branch to nail the ostium of the main branch?

[@eliashanna8248]

I do not, but it is one of the techniques that some operators use. One way of doing it consists of inflating balloon in the LM to LCx while positioning then deploying LAD stent (pull back on the LAD stent until it abuts the LCx balloon, this way you make sure you nail the ostium).
I don't like it because you risk injuring a healthy LM and LCx that do not require ballooning. Also, while it ensures nailing the ostium, it does not necessarily prevent landing the stent too much proximally, even landing in the left main (same reason I don't like Zsabo technique or the reliance on the LCx floating wire to position the LAD stent).

[@abuahmed9026]

Dr elias
If stenting ostial LAD with minimal protrusion in LM 1 or 2 strtus after dissection in cx and LM
Who to mange this situation ??
Go to inverted DK crush ?
Crush stent LAD by ballon size 1:1 cx
After stent LM -lCX ?
What your opinion dr ??

[@kam12379]

Dear Dr. Hanna,
Often when nailing the ostium and sometimes going 1-2 struts in the left main as u said . We do the OCT to controle the results and find ourselves underexpanded in the proximal portion as the reference is the left main. What do u recommend doing in those 1-2 struts? As going with an over sized balloon in the POC will put the proximal non stented ostium in danger of carinal shift.
Thank you

[@eliashanna8248]

With nail the ostium technique, the 1-2 struts in the left main are sized to the branch vessel; the branch vessel is the reference. They are not meant to be apposed or sized to the left main or to receive POT: doing so will create carina shift and defies the purpose of "nail the ostium". IF you're looking for a more elegant result in the left main, do the crossover strategy into the left main (6-8 mm) then POT proximal to the carina, as I explained. No definite data on which strategy is better, but I tried to show the pros and cons of each one.

[@abuahmed9026]

Thanks a lot
Dr. What about LM true bifurcation 1.1.1
Cx lesion 95% but just ostial pot
Kissing ballon for cover ostial cx by stent LM -LAD
Or in LM direct 02 stent technique beacouse cx is very sgnificant lesion 95%??

[@eliashanna8248]

-What you did is appropriate. You considered the bifurcation true but simple as it is short 75-90% or significant dissection>A that would require stenting. You would do provisional TAP in this case.
In the EBC main trial, which established provisional strategy as very appropriate for true LM bifurcation, the LCx stenosis was mostly 50-60% (52%+/-18%), not 95%.
-In reality, true LM bifurcation with 90% ostial LCx stenosis is likely complex true bifurcation. LCx likely has longer lesion, more calcium, and more MB plaque burden, all of which will make the bifurcation true and complex as per the algorithm and DK Crush V, especially if LCx has a large territory. So I would start with planned 2 stent strategy, using potentially the same steps and LCx TAP after LM-LAD stent but in a planned fashion. Alternatively, you may start with LCx stent in a nanocrush/perfect T fashion, or SK or DK minicrush fashion.

[@abuahmed9026]

Thanks a lot