Bifurcation
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The Treatment of Bifurcation Disease is a challenging area in interventional cardiology. It presents a challenge as interventional cardiology takes on increasingly complex coronary cases.
Load moreStudies report that when compared to non-bifurcation stenting, intervention to bifurcation disease is associated with lower rates of success, higher costs, longer hospitalisation and a higher rate of clinical and angiographic restenosis. Whilst the use of drug-eluting stents (DESs) has improved some outcomes, side branch ostial residual stenosis and long-term restenosis remain a problem.
Bifurcation stenting requires a diverse armamentarium of stenting strategies. Provisional stenting to the main vessel, tackling the side branch only if there is a poor angiographic result remains the prevailing approach. Other more complex two stent approaches include those that stent the main branch first, such as elective T-Stenting, the Culotte and TAP approaches. Other approaches include those that stent the side-branch first such as the various Crush approaches. Innovations such as dedicated bifurcation stents and improved stent and balloon technologies will mean bifurcation approaches will expand and evolve rapidly.
With so many different approaches, it can be seen that the most important question in bifurcation disease PCI is selecting the best possible strategy for an individual bifurcation and optimising the performance of this technique. Educating Interventional Cardiologists will be essential to keep up-to-date on the current data and help physicians choose the most relevant procedure for their patient.
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Videos
Key Bifurcation Guidelines from around the web
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Levine GN, Bates ER, Blankenship JC, et al. Circulation 2016;133:1135–47.
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Lassen JF, Holm NR, Banning AP, et al. EuroIntervention 2016;12:38– 46.
Key Bifurcation Presentations From Around The Web
Webinars
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Dr. Hakim BEN-AMER
Round Table Discussions
Live Streams
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Dr. Nicolas M. Van Mieghem
MedShr Cases
Simple Education Videos
Key Bifurcation Articles from around the web
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Hoo AS, Ryan L, Neville R, Mukherjee M. J Vasc Surg Cases Innov Tech 2018;4:278–82.
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Rhee TM, Park KW, Kim CH, et al. JACC Cardiovasc Interv 2018;11:2453–63.
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De Luca L. JACC Cardiovasc Interv 2018;11:2464–6
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Kandzari DE, Gershlick AH, Serruys PW, et al. Circ Cardiovasc Interv 2018;11:e007007.
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Maciej LesiakInterventional Cardiology Review 2016;11(2):124–7DOI: https://doi.org/10.15420/icr.2016:22:2
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Upul Wickramarachchi, Simon EccleshallInterventional Cardiology Review 2016;11(2):110–5DOI: https://doi.org/10.15420/icr.2016:17:3
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Sudheer Koganti, Tushar Kotecha, Roby D Rakhit, et alInterventional Cardiology Review, 2016;11(1):11–6DOI: http://dx.doi.org/10.15420/icr.2016:6:1
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John Rawlins, Jehangir Din, Suneel Talwar, et alInterventional Cardiology Review 2015;10(2):85–9DOI: https://doi.org/10.15420/icr.2015.10.2.85
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