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
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
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
It's huge pleasure to follow your videos and read your original book
Thank you, Dr. Elias Hanna. Your videos and book are really amazing.
Thanks a lot !
please continue these great work and explanations
Great sir.
Thanks for your efforts.
Thanks, great teaching and information
Hi dr hanna...
Passionately waiting your new presentation.
Thank you Greatly
Thank you. Nice.
Excellent ❤
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
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
Thank you!
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?
Great sir 9
Why not Tap the D1?
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
Uyu67