Fellow, Complex Coronary Angioplasty, Japan
Fellow, Interventional Cardiology, Taiwan
Guest Professor of Cardiology, Tiantan Hospital, Beijing
Guest Professor Tan Tao Medical School, Vietnam
Vice Chairperson Coronary Intervention , Asia Pacific Heart Association
It is often useful to think of the heart arteries like a tree with branches. At the site where a side-branch vessel comes off of the main coronary artery, plaque and fatty build-up are more likely to develop because of forces related to changes in blood flow. Narrowing, located in a main coronary artery and an adjoining side-branch vessel is called a bifurcation blockage or bifurcation lesion. Bifurcation blockages are somewhat more challenging for cardiologist to treat than blockages that do not involve side-branch vessel.
Earlier coronary bifurcation blockages used to get treated by bypass surgery. However with the advent of various techniques and technology, angioplasty can be done with excellent long- term result. It should be done by experinced interventional cardiologist.
Experienced interventionalists have developed a specialized approach to individualize patient treatment for these blockages, but the treatment procedure is sometimes technically demanding.
Dr Dash’s approach for bifurcation blockages includes
Main branch stenting with provisional T stenting. One should avoid the use of more than one stent, if possible (except under certain situations). If more than one stent is used to treat the blockage, there is an increased risk of blood clot formation on the stents. Therefore, the patient’s blood thinning regimen (anticoagulant medication) often needs to be modified.
In addition to the usual guide wire that is placed in the main vessel, cardiologist places a second guide wire through the stent in the main vessel and performs a "kissing balloon" inflation after the first stent has been placed.
Whenever required two stenting techniques employed are TAP (T stenting and small protrusion), Cullotte, Mini-crush, V stenting. However, final result is more important than techniques used.
Stents, called Bifurcated stents specifically designed for placement at branch point stenoses are there for specific situation