Bail-Out Strategies in Provisional Stenting

Dr. Ertan Ekici

Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

Stepwise provisional bifurcation stenting is the recommended approach for most of the bifurcation lesions. During the procedure side branches may be compromised. In order to take protective measurements, it is vital to detect a clinically relevant vessel and a side branch at risk for periprocedural occlusion. Despite the preventive techniques, side branch might still get occluded. There are suggested methods for regaining the side branch such as proximal optimization technique (POT), kissing baloon inflation, and POT-side-rePOT. After these steps, the necessity of a second stent depends on some criteria including low TIMI grade, ostial lesion longer than 5 mm, clinical signs of ischemia, type A or further dissection or hemodynamically relevant stenosis. If one or more of these criteria are met, bail-out stent implantation is indicated. The technique for deploying the bail-out stent is primarily chosen according to the bifurcation angle. While T or TAP stenting is suggested for wider angled lesions (>70º), culotte and reverse crush are the options for narrow angled (<70º) bifurcations. T/TAP and Reverse (internal) crush techniques will be discussed in this chapter.

Keywords: Percutaneous coronary intervention; Coronary artery disease; Coronary angiography; Coronary stenosis; Coronary disease; Provisional stenting; Bail-out strategies

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