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global_colors_info=&#8221;{}&#8221;]\n\t<div class=\"id3d-main-warp id3d-main-warp-single-screen\">\n\n\t\t<script id=\"screen-data-json\" type=\"text\/json\">{\"left\":\"<div id=\\\"id3d-video\\\"><div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><!--[if lt IE 9]><script>document.createElement('video');<\\\/script><![endif]-->\\n<video class=\\\"wp-video-shortcode\\\" id=\\\"video-260102-1\\\" width=\\\"1080\\\" height=\\\"729\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/bifurcaid3d.s3.us-east-2.amazonaws.com\\\/LM_Minicrush.mp4?_=1\\\" \\\/><a href=\\\"https:\\\/\\\/bifurcaid3d.s3.us-east-2.amazonaws.com\\\/LM_Minicrush.mp4\\\">https:\\\/\\\/bifurcaid3d.s3.us-east-2.amazonaws.com\\\/LM_Minicrush.mp4<\\\/a><\\\/video><\\\/div><\\\/div>\",\"right\":\"<div id=\\\"id3d-vid-conte\\\"><\\\/div> <div class=\\\"id3d-main-conte\\\"><\\\/div><div class=\\\"id3d-child-pages\\\"><\\\/div>\",\"video_type\":\"wpmedia\",\"video_content\":[{\"time\":\"00:00:00\",\"description\":\"<a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9108\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-1\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Wire<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-1\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Guidewire selection<\\\/strong><\\\/h2><ul><li>Main Branch: Work horse wires like BMW, Runthrough, ASAHI Scion, ASAHI Prowater<\\\/li><li>Side Branch: Polymer coated (can be jailed; easy to recross) like Fielder, Hi Torque Whisper<\\\/li><li>Wire the most difficult branch first<\\\/li><li>Shaping guidewire: Shaping the wire tip either with a rounded J-shape or with a sharp angle may be sufficient to start a procedure. However, in many cases the tip curve needs to be reshaped according to the side branch takeoff angle and tortuosity. Considering the variety of anatomical settings, our best recommendation is to adapt the length and angulation of the tip curve to the given anatomy. This may require long, sharp or even multiple angulations in the tip<\\\/li><li>According to the bifurcation angle, guidewires can be shaped in 3 ways [ see figure ]<\\\/li><\\\/ul><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/Less45.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9669\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9668\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third et_column_last'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/More90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9670\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><div class='clear'><\\\/div><\\\/p>            <\\\/div>        <\\\/div> MV and SB.\"},{\"time\":\"00:00:04\",\"description\":\"Pre-treat MV with 1:1 size NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-2\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-2\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:09\",\"description\":\"Consider <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8820\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-3\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Atherotomy<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-3\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Atherotomy<\\\/strong><\\\/h2><ul><li>Consider atherotomy of MV or SB if suboptimal results with NC \\\/ compliant balloon.<\\\/li><li>If SB has &gt;70% stenosis and atherotomy balloon is available, consider atherotomy as first line treatment.<\\\/li><li>Size of atherotomy balloon is usually 0.25 to 0.5 mm smaller than vessel size.<\\\/li><li>If initial attempt of atherotomy resulted in suboptimal lesion preparation, consider upgrading the atherotomy balloon to 1:1 sizing<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (0.25-0.5 mm smaller than vessel diameter) if suboptimal results with NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-4\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-4\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:15\",\"description\":\"Pre-treat SB with 1:1 size NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-5\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-5\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:18\",\"description\":\"Consider <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8820\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-6\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Atherotomy<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-6\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Atherotomy<\\\/strong><\\\/h2><ul><li>Consider atherotomy of MV or SB if suboptimal results with NC \\\/ compliant balloon.<\\\/li><li>If SB has &gt;70% stenosis and atherotomy balloon is available, consider atherotomy as first line treatment.<\\\/li><li>Size of atherotomy balloon is usually 0.25 to 0.5 mm smaller than vessel size.<\\\/li><li>If initial attempt of atherotomy resulted in suboptimal lesion preparation, consider upgrading the atherotomy balloon to 1:1 sizing<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (0.25-0.5 mm smaller than vessel diameter) if suboptimal results with NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-7\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-7\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:24\",\"description\":\"Advance SB <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-8\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-8\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> followed by MV stent.\"},{\"time\":\"00:00:27\",\"description\":\"SB <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-9\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-9\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> extending into MV by 1 mm.\"},{\"time\":\"00:00:30\",\"description\":\"Proximal end of MV <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-10\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-10\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> should be proximal to SB stent.\"},{\"time\":\"00:00:34\",\"description\":\"Deploy SB <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-11\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-11\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> first.\"},{\"time\":\"00:00:38\",\"description\":\"Remove SB <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-12\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-12\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> only.\"},{\"time\":\"00:00:40\",\"description\":\"Check SB results with angiogram.\"},{\"time\":\"00:00:42\",\"description\":\"Remove SB guidewire if no distal <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9690\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-13\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >dissection<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-13\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Dissection<\\\/strong><\\\/h2><p>Distal edge dissection or perforation: Caused by vessel over stretching or due to presence of large, calcified, or attenuated plaques at the edges of the stent<\\\/p>            <\\\/div>        <\\\/div> of SB noted.\"},{\"time\":\"00:00:46\",\"description\":\"Check MV <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-14\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-14\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> position and deploy MV stent.\"},{\"time\":\"00:00:50\",\"description\":\"Remove MV <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-15\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-15\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-16\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-16\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:52\",\"description\":\"<a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9688\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-17\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Rewire<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-17\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Difficult SB Rewiring after MV stenting<\\\/strong><\\\/h2><p>During SB rewiring, the wire that was used initially to cross the SB is pulled back into the guide prior to MV stenting but not all the way out of the body. The same wire is then used to recross in to SB. This is successful at most times but if facing difficulty to rewire-<\\\/p><ul><li>Try using a new hydrophilic wire like Fielder, Whisper, Sion<\\\/li><li>Use Balloon support to help redirect the wire<\\\/li><li>Reshape the wire and use pullback technique<\\\/li><li>Try swapping the wire from MV in to SB<\\\/li><li>Consider repeating POT at higher pressure or with a bigger balloon<\\\/li><li>Use angled tip microcatheters like Venture and Supercross if everything else fails<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> SB and perform <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9694\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-18\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >POT<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-18\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2>Proximal Optimization Technique (POT)<\\\/h2><ul><li>POT is the technique of post dilating the proximal portion of the stent in the main vessel. The post dilatation is done with a short balloon either 1:1 in size or 0.5 mm more than that of the main vessel stent. The balloon for proximal optimization is kept in such a way that the distal marker is at the level of the bifurcation (by using a short balloon).<\\\/li><li>This leads to:<\\\/li><\\\/ul><ol><li style=\\\"list-style-type: none;\\\"><ol><li style=\\\"list-style-type: none;\\\"><ol><li>Strut expansion and stent apposition in the proximal main vessel<\\\/li><li>Reconstruction of bifurcation anatomy and reducing the risk of side branch compromise related to shifting of the carina<\\\/li><li>Facilitates side branch access after main vessel stent implantation<\\\/li><\\\/ol><\\\/li><\\\/ol><\\\/li><\\\/ol>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:00\",\"description\":\"Advance 1:1 NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-19\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-19\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> through SB ostium.\"},{\"time\":\"00:01:03\",\"description\":\"Consider new compliant (0.5 mm smaller) <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-20\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-20\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> if unable to cross with NC balloon.\"},{\"time\":\"00:01:08\",\"description\":\"Advance non-compliant <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-21\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-21\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (1:1) in main vessel.\"},{\"time\":\"00:01:12\",\"description\":\"Serial post dilation: Side branch first. (16-18 atm).\"},{\"time\":\"00:01:17\",\"description\":\"Serial post dilation: Main vessel next (16-18 atm).\"},{\"time\":\"00:01:22\",\"description\":\"Perform <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9689\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-22\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >KBI<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-22\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Kissing Balloon Inflation (KBI)<\\\/strong><\\\/h2><ul><li>Left Main Bifurcation KBI<\\\/li><\\\/ul><p style=\\\"padding-left: 40px;\\\">Balloons in the MV and SB should be 1:1 in size<\\\/p><ul><li>Non Left Main Bifurcation KBI<\\\/li><\\\/ul><p style=\\\"padding-left: 40px;\\\">Balloon of 1:1 size should be used in the MV and SB balloon is 0.5mm smaller<\\\/p><p>These steps are common to both Left Main and Non Left Main Bifurcations<\\\/p><ul><li>If SB is difficult to recross, trying using a smaller size compliant balloon.<\\\/li><li>Short balloons are recommended over longer ones to due to the ease of recrossing.<\\\/li><li>Sequential inflations are performed at 16-18atm by inflating SB balloon first followed by MV balloon at the same high atmospheres. This is then followed by aligning the proximal dots of MV and SB balloons and performing simultaneous inflations and deflations of SB and MV balloons at lower atmospheres<\\\/li><li>If during inflation the balloon slips, then consider sequential inflations with low pressures in the SB and high pressures in the MV<\\\/li><li>Advantage of kissing balloon inflation is to reduce side branch thrombosis<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (at 12-14 atm each).\"},{\"time\":\"00:01:27\",\"description\":\"Final angiogram to rule out distal <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-23\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-23\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> edge <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9690\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-24\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >dissection<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-24\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Dissection<\\\/strong><\\\/h2><p>Distal edge dissection or perforation: Caused by vessel over stretching or due to presence of large, calcified, or attenuated plaques at the edges of the stent<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:34\",\"description\":\"If the results are good, the procedure is finished.\"}],\"video_arec\":\"<p>[video width=\\\"1600\\\" height=\\\"1080\\\" mp4=\\\"https:\\\/\\\/bifurcaid3d.s3.us-east-2.amazonaws.com\\\/LM_Minicrush.mp4\\\"][\\\/video]<\\\/p>\\n\",\"video_are\":\"<div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><!--[if lt IE 9]><script>document.createElement('video');<\\\/script><![endif]-->\\n<video class=\\\"wp-video-shortcode\\\" id=\\\"video-260102-1\\\" width=\\\"1080\\\" height=\\\"729\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/bifurcaid3d.s3.us-east-2.amazonaws.com\\\/LM_Minicrush.mp4?_=1\\\" \\\/><a href=\\\"https:\\\/\\\/bifurcaid3d.s3.us-east-2.amazonaws.com\\\/LM_Minicrush.mp4\\\">https:\\\/\\\/bifurcaid3d.s3.us-east-2.amazonaws.com\\\/LM_Minicrush.mp4<\\\/a><\\\/video><\\\/div>\"}<\/script> \n\n        <nav id=\"bifurcaid3d-nav\" style=\"display: none;\">\n            <li class='nav-ajax'>\n                <a class=\"active bifurca-id3d-page-link bifurca-link\" href=\"#\" data-page-id=\"0\">Home<\/a>\n            <\/li>\n        <\/nav>\n\n        <div class=\"id3d-left\">\n        \t<div id=\"id3d-video\"><div style=\"width: 1080px;\" class=\"wp-video\"><!--[if lt IE 9]><script>document.createElement('video');<\/script><![endif]-->\n<video class=\"wp-video-shortcode\" id=\"video-260102-1\" width=\"1080\" height=\"729\" preload=\"metadata\" controls=\"controls\"><source type=\"video\/mp4\" src=\"https:\/\/bifurcaid3d.s3.us-east-2.amazonaws.com\/LM_Minicrush.mp4?_=1\" \/><a href=\"https:\/\/bifurcaid3d.s3.us-east-2.amazonaws.com\/LM_Minicrush.mp4\" target=\"_blank\" rel=\"noopener\">https:\/\/bifurcaid3d.s3.us-east-2.amazonaws.com\/LM_Minicrush.mp4<\/a><\/video><\/div><\/div>        <\/div>\n        <div class=\"id3d-right\">\n            <div id=\"id3d-vid-conte\"><\/div> <div class=\"id3d-main-conte\"><\/div><div class=\"id3d-child-pages\"><\/div>        <\/div>\n    <\/div>\n\n[\/et_pb_text][et_pb_code admin_label=&#8221;Hide Bars JS Code&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<script><!-- [et_pb_line_break_holder] -->jQuery('.reveal-only-trigger-lmminicrush').click(function(argument) {<!-- [et_pb_line_break_holder] -->  setTimeout(function(){ window.dispatchEvent(new Event('resize')); }, 300);<!-- [et_pb_line_break_holder] -->});<!-- [et_pb_line_break_holder] --><\/script>[\/et_pb_code][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=&#8221;LM DK Crush&#8221; module_class=&#8221;reveal-only-content-lmdkcrush&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;0px||||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text disabled_on=&#8221;off|off|off&#8221; admin_label=&#8221;LM DK Crush&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;|||14px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]\n\t<div class=\"id3d-main-warp id3d-main-warp-single-screen\">\n\n\t\t<script id=\"screen-data-json\" type=\"text\/json\">{\"left\":\"<div id=\\\"id3d-video\\\"><div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><video class=\\\"wp-video-shortcode\\\" id=\\\"video-9690-2\\\" width=\\\"1080\\\" height=\\\"729\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_DK_Crush.mp4?_=2\\\" \\\/><a href=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_DK_Crush.mp4\\\">https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_DK_Crush.mp4<\\\/a><\\\/video><\\\/div><\\\/div>\",\"right\":\"<div id=\\\"id3d-vid-conte\\\"><\\\/div> <div class=\\\"id3d-main-conte\\\"><\\\/div><div class=\\\"id3d-child-pages\\\"><\\\/div>\",\"video_type\":\"wpmedia\",\"video_content\":[{\"time\":\"00:00:00\",\"description\":\"<a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9108\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-25\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Wire<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-25\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Guidewire selection<\\\/strong><\\\/h2><ul><li>Main Branch: Work horse wires like BMW, Runthrough, ASAHI Scion, ASAHI Prowater<\\\/li><li>Side Branch: Polymer coated (can be jailed; easy to recross) like Fielder, Hi Torque Whisper<\\\/li><li>Wire the most difficult branch first<\\\/li><li>Shaping guidewire: Shaping the wire tip either with a rounded J-shape or with a sharp angle may be sufficient to start a procedure. However, in many cases the tip curve needs to be reshaped according to the side branch takeoff angle and tortuosity. Considering the variety of anatomical settings, our best recommendation is to adapt the length and angulation of the tip curve to the given anatomy. This may require long, sharp or even multiple angulations in the tip<\\\/li><li>According to the bifurcation angle, guidewires can be shaped in 3 ways [ see figure ]<\\\/li><\\\/ul><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/Less45.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9669\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9668\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third et_column_last'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/More90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9670\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><div class='clear'><\\\/div><\\\/p>            <\\\/div>        <\\\/div> MV and SB\"},{\"time\":\"00:00:04\",\"description\":\"Pre-treat MV with 1:1 size NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-26\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-26\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:11\",\"description\":\"Consider <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8820\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-27\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Atherotomy<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-27\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Atherotomy<\\\/strong><\\\/h2><ul><li>Consider atherotomy of MV or SB if suboptimal results with NC \\\/ compliant balloon.<\\\/li><li>If SB has &gt;70% stenosis and atherotomy balloon is available, consider atherotomy as first line treatment.<\\\/li><li>Size of atherotomy balloon is usually 0.25 to 0.5 mm smaller than vessel size.<\\\/li><li>If initial attempt of atherotomy resulted in suboptimal lesion preparation, consider upgrading the atherotomy balloon to 1:1 sizing<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (0.25-0.5mm smaller than vessel diameter) if suboptimal results with NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-28\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-28\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:18\",\"description\":\"Pre-treat SB with 1:1 size NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-29\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-29\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:22\",\"description\":\"Consider <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8820\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-30\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Atherotomy<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-30\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Atherotomy<\\\/strong><\\\/h2><ul><li>Consider atherotomy of MV or SB if suboptimal results with NC \\\/ compliant balloon.<\\\/li><li>If SB has &gt;70% stenosis and atherotomy balloon is available, consider atherotomy as first line treatment.<\\\/li><li>Size of atherotomy balloon is usually 0.25 to 0.5 mm smaller than vessel size.<\\\/li><li>If initial attempt of atherotomy resulted in suboptimal lesion preparation, consider upgrading the atherotomy balloon to 1:1 sizing<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (0.25-0.5mm smaller than vessel diameter) if suboptimal results with NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-31\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-31\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:30\",\"description\":\"Advance side branch <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-32\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-32\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> (SB stent protruding into MV by about 2-4mm).\"},{\"time\":\"00:00:35\",\"description\":\"Advance 1:1 size NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-33\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-33\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> into distal MV.\"},{\"time\":\"00:00:38\",\"description\":\"Deploy side branch <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-34\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-34\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:42\",\"description\":\"Remove SB SDS and rule out distal vessel <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9690\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-35\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >dissection<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-35\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Dissection<\\\/strong><\\\/h2><p>Distal edge dissection or perforation: Caused by vessel over stretching or due to presence of large, calcified, or attenuated plaques at the edges of the stent<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:46\",\"description\":\"Inflate MV <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-36\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-36\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>, crushing SB <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-37\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-37\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:50\",\"description\":\"Remove MV <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-38\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-38\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> and rewire SB through the crushed <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-39\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-39\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> struts.\"},{\"time\":\"00:00:54\",\"description\":\"Advance NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-40\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-40\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> through SB ostium sized 1:1 to distal vessel (may use compliant balloon if NC does not pass).\"},{\"time\":\"00:01:02\",\"description\":\"Advance NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-41\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-41\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> in main vessel.\"},{\"time\":\"00:01:05\",\"description\":\"Perform simultaneous <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-42\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-42\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> inflations. (1st KISS)\"},{\"time\":\"00:01:09\",\"description\":\"Remove <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-43\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-43\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> from both vessels and remove SB guidewire.\"},{\"time\":\"00:01:13\",\"description\":\"Advance MV <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-44\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-44\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:15\",\"description\":\"Deploy MV <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-45\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-45\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:19\",\"description\":\"Remove <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-10436\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-46\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >SDS<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-46\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent Delivery System<\\\/strong><\\\/h2><p>The SDS consists of a balloon catheter on which the balloon-expandable stent is mounted<\\\/p>            <\\\/div>        <\\\/div> from MV.\"},{\"time\":\"00:01:21\",\"description\":\"<a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9688\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-47\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Rewire<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-47\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Difficult SB Rewiring after MV stenting<\\\/strong><\\\/h2><p>During SB rewiring, the wire that was used initially to cross the SB is pulled back into the guide prior to MV stenting but not all the way out of the body. The same wire is then used to recross in to SB. This is successful at most times but if facing difficulty to rewire-<\\\/p><ul><li>Try using a new hydrophilic wire like Fielder, Whisper, Sion<\\\/li><li>Use Balloon support to help redirect the wire<\\\/li><li>Reshape the wire and use pullback technique<\\\/li><li>Try swapping the wire from MV in to SB<\\\/li><li>Consider repeating POT at higher pressure or with a bigger balloon<\\\/li><li>Use angled tip microcatheters like Venture and Supercross if everything else fails<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> SB through crushed MV and SB struts and perform <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9694\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-48\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >POT<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-48\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2>Proximal Optimization Technique (POT)<\\\/h2><ul><li>POT is the technique of post dilating the proximal portion of the stent in the main vessel. The post dilatation is done with a short balloon either 1:1 in size or 0.5 mm more than that of the main vessel stent. The balloon for proximal optimization is kept in such a way that the distal marker is at the level of the bifurcation (by using a short balloon).<\\\/li><li>This leads to:<\\\/li><\\\/ul><ol><li style=\\\"list-style-type: none;\\\"><ol><li style=\\\"list-style-type: none;\\\"><ol><li>Strut expansion and stent apposition in the proximal main vessel<\\\/li><li>Reconstruction of bifurcation anatomy and reducing the risk of side branch compromise related to shifting of the carina<\\\/li><li>Facilitates side branch access after main vessel stent implantation<\\\/li><\\\/ol><\\\/li><\\\/ol><\\\/li><\\\/ol>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:31\",\"description\":\"Advance <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-49\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-49\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> through SB ostium sized 1:1 to distal vessel (may use compliant balloon if NC does not pass).\"},{\"time\":\"00:01:38\",\"description\":\"Advance NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-50\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-50\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> in main vessel.\"},{\"time\":\"00:01:41\",\"description\":\"Perform simultaneous <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-51\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-51\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> inflations. (2nd KISS).\"},{\"time\":\"00:01:45\",\"description\":\"Final angiogram to rule out distal <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-52\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-52\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> edge <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9690\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-53\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >dissection<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-53\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Dissection<\\\/strong><\\\/h2><p>Distal edge dissection or perforation: Caused by vessel over stretching or due to presence of large, calcified, or attenuated plaques at the edges of the stent<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:54\",\"description\":\"If the results are good, the procedure is finished.\"}],\"video_arec\":\"<p>[video width=\\\"1600\\\" height=\\\"1080\\\" mp4=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_DK_Crush.mp4\\\"][\\\/video]<\\\/p>\\n\",\"video_are\":\"<div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><video class=\\\"wp-video-shortcode\\\" id=\\\"video-9690-2\\\" width=\\\"1080\\\" height=\\\"729\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_DK_Crush.mp4?_=2\\\" \\\/><a href=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_DK_Crush.mp4\\\">https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_DK_Crush.mp4<\\\/a><\\\/video><\\\/div>\"}<\/script> \n\n        <nav id=\"bifurcaid3d-nav\" style=\"display: none;\">\n            <li class='nav-ajax'>\n                <a class=\"active bifurca-id3d-page-link bifurca-link\" href=\"#\" data-page-id=\"0\">Home<\/a>\n            <\/li>\n        <\/nav>\n\n        <div class=\"id3d-left\">\n        \t<div id=\"id3d-video\"><div style=\"width: 1080px;\" class=\"wp-video\"><video class=\"wp-video-shortcode\" id=\"video-9690-2\" width=\"1080\" height=\"729\" preload=\"metadata\" controls=\"controls\"><source type=\"video\/mp4\" src=\"https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_DK_Crush.mp4?_=2\" \/><a href=\"https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_DK_Crush.mp4\">https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_DK_Crush.mp4<\/a><\/video><\/div><\/div>        <\/div>\n        <div class=\"id3d-right\">\n            <div id=\"id3d-vid-conte\"><\/div> <div class=\"id3d-main-conte\"><\/div><div class=\"id3d-child-pages\"><\/div>        <\/div>\n    <\/div>\n\n[\/et_pb_text][et_pb_code admin_label=&#8221;Hide Bars JS Code&#8221; 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_module_preset=&#8221;default&#8221; custom_padding=&#8221;|||14px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]\n\t<div class=\"id3d-main-warp id3d-main-warp-single-screen\">\n\n\t\t<script id=\"screen-data-json\" type=\"text\/json\">{\"left\":\"<div id=\\\"id3d-video\\\"><div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><video class=\\\"wp-video-shortcode\\\" id=\\\"video-9690-3\\\" width=\\\"1080\\\" height=\\\"729\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_Culotte.mp4?_=3\\\" \\\/><a href=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_Culotte.mp4\\\">https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_Culotte.mp4<\\\/a><\\\/video><\\\/div><\\\/div>\",\"right\":\"<div id=\\\"id3d-vid-conte\\\"><\\\/div> <div class=\\\"id3d-main-conte\\\"><\\\/div><div class=\\\"id3d-child-pages\\\"><\\\/div>\",\"video_type\":\"wpmedia\",\"video_content\":[{\"time\":\"00:00:00\",\"description\":\"<a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9108\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-54\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Wire<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-54\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Guidewire selection<\\\/strong><\\\/h2><ul><li>Main Branch: Work horse wires like BMW, Runthrough, ASAHI Scion, ASAHI Prowater<\\\/li><li>Side Branch: Polymer coated (can be jailed; easy to recross) like Fielder, Hi Torque Whisper<\\\/li><li>Wire the most difficult branch first<\\\/li><li>Shaping guidewire: Shaping the wire tip either with a rounded J-shape or with a sharp angle may be sufficient to start a procedure. However, in many cases the tip curve needs to be reshaped according to the side branch takeoff angle and tortuosity. Considering the variety of anatomical settings, our best recommendation is to adapt the length and angulation of the tip curve to the given anatomy. This may require long, sharp or even multiple angulations in the tip<\\\/li><li>According to the bifurcation angle, guidewires can be shaped in 3 ways [ see figure ]<\\\/li><\\\/ul><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/Less45.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9669\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9668\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third et_column_last'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/More90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9670\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><div class='clear'><\\\/div><\\\/p>            <\\\/div>        <\\\/div> MV and SB.\"},{\"time\":\"00:00:04\",\"description\":\"Pre-treat MV with 1:1 size NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-55\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-55\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:11\",\"description\":\"Consider <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8820\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-56\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Atherotomy<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-56\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Atherotomy<\\\/strong><\\\/h2><ul><li>Consider atherotomy of MV or SB if suboptimal results with NC \\\/ compliant balloon.<\\\/li><li>If SB has &gt;70% stenosis and atherotomy balloon is available, consider atherotomy as first line treatment.<\\\/li><li>Size of atherotomy balloon is usually 0.25 to 0.5 mm smaller than vessel size.<\\\/li><li>If initial attempt of atherotomy resulted in suboptimal lesion preparation, consider upgrading the atherotomy balloon to 1:1 sizing<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (0.25-0.5 mm smaller than vessel diameter) if suboptimal results with NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-57\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-57\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:17\",\"description\":\"Pre-treat SB with 1:1 size NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-58\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-58\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:20\",\"description\":\"Consider <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8820\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-59\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Atherotomy<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-59\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Atherotomy<\\\/strong><\\\/h2><ul><li>Consider atherotomy of MV or SB if suboptimal results with NC \\\/ compliant balloon.<\\\/li><li>If SB has &gt;70% stenosis and atherotomy balloon is available, consider atherotomy as first line treatment.<\\\/li><li>Size of atherotomy balloon is usually 0.25 to 0.5 mm smaller than vessel size.<\\\/li><li>If initial attempt of atherotomy resulted in suboptimal lesion preparation, consider upgrading the atherotomy balloon to 1:1 sizing<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (0.25-0.5 mm smaller than vessel diameter) if suboptimal results with NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-60\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-60\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:26\",\"description\":\"First advance <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-61\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-61\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> in SB so that it extends into the LM to cover the lesion.\"},{\"time\":\"00:00:31\",\"description\":\"Deploy <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-62\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-62\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> from LM into SB.\"},{\"time\":\"00:00:35\",\"description\":\"<a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9688\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-63\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Rewire<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-63\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Difficult SB Rewiring after MV stenting<\\\/strong><\\\/h2><p>During SB rewiring, the wire that was used initially to cross the SB is pulled back into the guide prior to MV stenting but not all the way out of the body. The same wire is then used to recross in to SB. This is successful at most times but if facing difficulty to rewire-<\\\/p><ul><li>Try using a new hydrophilic wire like Fielder, Whisper, Sion<\\\/li><li>Use Balloon support to help redirect the wire<\\\/li><li>Reshape the wire and use pullback technique<\\\/li><li>Try swapping the wire from MV in to SB<\\\/li><li>Consider repeating POT at higher pressure or with a bigger balloon<\\\/li><li>Use angled tip microcatheters like Venture and Supercross if everything else fails<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> the MV through <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-64\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-64\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> struts.\"},{\"time\":\"00:00:38\",\"description\":\"<a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-65\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-65\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> MV through the SB <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-66\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-66\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> to oppose proximal part of LM stent and create path to facilitate the stent to MV.\"},{\"time\":\"00:00:46\",\"description\":\"Advance second <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-67\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-67\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> to MV leaving proximal overlap in LM stent.\"},{\"time\":\"00:00:50\",\"description\":\"Remove SB <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9108\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-68\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >wire<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-68\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Guidewire selection<\\\/strong><\\\/h2><ul><li>Main Branch: Work horse wires like BMW, Runthrough, ASAHI Scion, ASAHI Prowater<\\\/li><li>Side Branch: Polymer coated (can be jailed; easy to recross) like Fielder, Hi Torque Whisper<\\\/li><li>Wire the most difficult branch first<\\\/li><li>Shaping guidewire: Shaping the wire tip either with a rounded J-shape or with a sharp angle may be sufficient to start a procedure. However, in many cases the tip curve needs to be reshaped according to the side branch takeoff angle and tortuosity. Considering the variety of anatomical settings, our best recommendation is to adapt the length and angulation of the tip curve to the given anatomy. This may require long, sharp or even multiple angulations in the tip<\\\/li><li>According to the bifurcation angle, guidewires can be shaped in 3 ways [ see figure ]<\\\/li><\\\/ul><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/Less45.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9669\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9668\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third et_column_last'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/More90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9670\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><div class='clear'><\\\/div><\\\/p>            <\\\/div>        <\\\/div> prior to deploying MV <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-69\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-69\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:55\",\"description\":\"Remove <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-10436\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-70\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >SDS<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-70\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent Delivery System<\\\/strong><\\\/h2><p>The SDS consists of a balloon catheter on which the balloon-expandable stent is mounted<\\\/p>            <\\\/div>        <\\\/div> from the MV.\"},{\"time\":\"00:00:57\",\"description\":\"Rewire SB through the <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-71\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-71\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> struts and perform <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9694\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-72\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >POT<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-72\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2>Proximal Optimization Technique (POT)<\\\/h2><ul><li>POT is the technique of post dilating the proximal portion of the stent in the main vessel. The post dilatation is done with a short balloon either 1:1 in size or 0.5 mm more than that of the main vessel stent. The balloon for proximal optimization is kept in such a way that the distal marker is at the level of the bifurcation (by using a short balloon).<\\\/li><li>This leads to:<\\\/li><\\\/ul><ol><li style=\\\"list-style-type: none;\\\"><ol><li style=\\\"list-style-type: none;\\\"><ol><li>Strut expansion and stent apposition in the proximal main vessel<\\\/li><li>Reconstruction of bifurcation anatomy and reducing the risk of side branch compromise related to shifting of the carina<\\\/li><li>Facilitates side branch access after main vessel stent implantation<\\\/li><\\\/ol><\\\/li><\\\/ol><\\\/li><\\\/ol>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:06\",\"description\":\"Perform <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9689\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-73\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >KBI<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-73\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Kissing Balloon Inflation (KBI)<\\\/strong><\\\/h2><ul><li>Left Main Bifurcation KBI<\\\/li><\\\/ul><p style=\\\"padding-left: 40px;\\\">Balloons in the MV and SB should be 1:1 in size<\\\/p><ul><li>Non Left Main Bifurcation KBI<\\\/li><\\\/ul><p style=\\\"padding-left: 40px;\\\">Balloon of 1:1 size should be used in the MV and SB balloon is 0.5mm smaller<\\\/p><p>These steps are common to both Left Main and Non Left Main Bifurcations<\\\/p><ul><li>If SB is difficult to recross, trying using a smaller size compliant balloon.<\\\/li><li>Short balloons are recommended over longer ones to due to the ease of recrossing.<\\\/li><li>Sequential inflations are performed at 16-18atm by inflating SB balloon first followed by MV balloon at the same high atmospheres. This is then followed by aligning the proximal dots of MV and SB balloons and performing simultaneous inflations and deflations of SB and MV balloons at lower atmospheres<\\\/li><li>If during inflation the balloon slips, then consider sequential inflations with low pressures in the SB and high pressures in the MV<\\\/li><li>Advantage of kissing balloon inflation is to reduce side branch thrombosis<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:15\",\"description\":\"Final angiogram to rule out distal <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-74\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-74\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> edge <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9690\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-75\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >dissection<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-75\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Dissection<\\\/strong><\\\/h2><p>Distal edge dissection or perforation: Caused by vessel over stretching or due to presence of large, calcified, or attenuated plaques at the edges of the stent<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:22\",\"description\":\"If the results are good, the procedure is finished.\"}],\"video_arec\":\"<p>[video width=\\\"1600\\\" height=\\\"1080\\\" mp4=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_Culotte.mp4\\\"][\\\/video]<\\\/p>\\n\",\"video_are\":\"<div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><video class=\\\"wp-video-shortcode\\\" id=\\\"video-9690-3\\\" width=\\\"1080\\\" height=\\\"729\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_Culotte.mp4?_=3\\\" \\\/><a href=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_Culotte.mp4\\\">https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_Culotte.mp4<\\\/a><\\\/video><\\\/div>\"}<\/script> \n\n        <nav id=\"bifurcaid3d-nav\" style=\"display: none;\">\n            <li class='nav-ajax'>\n                <a class=\"active bifurca-id3d-page-link bifurca-link\" href=\"#\" data-page-id=\"0\">Home<\/a>\n            <\/li>\n        <\/nav>\n\n        <div class=\"id3d-left\">\n        \t<div id=\"id3d-video\"><div style=\"width: 1080px;\" class=\"wp-video\"><video class=\"wp-video-shortcode\" id=\"video-9690-3\" width=\"1080\" height=\"729\" preload=\"metadata\" controls=\"controls\"><source type=\"video\/mp4\" src=\"https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_Culotte.mp4?_=3\" \/><a href=\"https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_Culotte.mp4\">https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_Culotte.mp4<\/a><\/video><\/div><\/div>        <\/div>\n        <div class=\"id3d-right\">\n            <div id=\"id3d-vid-conte\"><\/div> <div class=\"id3d-main-conte\"><\/div><div class=\"id3d-child-pages\"><\/div>        <\/div>\n    <\/div>\n\n[\/et_pb_text][et_pb_code admin_label=&#8221;Hide Bars JS Code&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<script><!-- [et_pb_line_break_holder] -->jQuery('.reveal-only-trigger-lmculotte').click(function(argument) {<!-- [et_pb_line_break_holder] -->  setTimeout(function(){ window.dispatchEvent(new Event('resize')); }, 300);<!-- [et_pb_line_break_holder] -->});<!-- [et_pb_line_break_holder] --><\/script>[\/et_pb_code][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=&#8221;LM V-Stenting&#8221; module_class=&#8221;reveal-only-content-lmvstenting&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;0px||||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text admin_label=&#8221;LM V-Stenting&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;|||14px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]\n\t<div class=\"id3d-main-warp id3d-main-warp-single-screen\">\n\n\t\t<script id=\"screen-data-json\" type=\"text\/json\">{\"left\":\"<div id=\\\"id3d-video\\\"><div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><video class=\\\"wp-video-shortcode\\\" id=\\\"video-9690-4\\\" width=\\\"1080\\\" height=\\\"729\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_V.mp4?_=4\\\" \\\/><a href=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_V.mp4\\\">https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_V.mp4<\\\/a><\\\/video><\\\/div><\\\/div>\",\"right\":\"<div id=\\\"id3d-vid-conte\\\"><\\\/div> <div class=\\\"id3d-main-conte\\\"><\\\/div><div class=\\\"id3d-child-pages\\\"><\\\/div>\",\"video_type\":\"wpmedia\",\"video_content\":[{\"time\":\"00:00:00\",\"description\":\"<a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9108\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-76\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Wire<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-76\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Guidewire selection<\\\/strong><\\\/h2><ul><li>Main Branch: Work horse wires like BMW, Runthrough, ASAHI Scion, ASAHI Prowater<\\\/li><li>Side Branch: Polymer coated (can be jailed; easy to recross) like Fielder, Hi Torque Whisper<\\\/li><li>Wire the most difficult branch first<\\\/li><li>Shaping guidewire: Shaping the wire tip either with a rounded J-shape or with a sharp angle may be sufficient to start a procedure. However, in many cases the tip curve needs to be reshaped according to the side branch takeoff angle and tortuosity. Considering the variety of anatomical settings, our best recommendation is to adapt the length and angulation of the tip curve to the given anatomy. This may require long, sharp or even multiple angulations in the tip<\\\/li><li>According to the bifurcation angle, guidewires can be shaped in 3 ways [ see figure ]<\\\/li><\\\/ul><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/Less45.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9669\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9668\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third et_column_last'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/More90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9670\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><div class='clear'><\\\/div><\\\/p>            <\\\/div>        <\\\/div> MV and SB.\"},{\"time\":\"00:00:06\",\"description\":\"Pre-treat MV with 1:1 size NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-77\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-77\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:11\",\"description\":\"Consider <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8820\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-78\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Atherotomy<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-78\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Atherotomy<\\\/strong><\\\/h2><ul><li>Consider atherotomy of MV or SB if suboptimal results with NC \\\/ compliant balloon.<\\\/li><li>If SB has &gt;70% stenosis and atherotomy balloon is available, consider atherotomy as first line treatment.<\\\/li><li>Size of atherotomy balloon is usually 0.25 to 0.5 mm smaller than vessel size.<\\\/li><li>If initial attempt of atherotomy resulted in suboptimal lesion preparation, consider upgrading the atherotomy balloon to 1:1 sizing<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (0.25-0.5mm smaller than vessel diameter) if suboptimal results with NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-79\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-79\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:17\",\"description\":\"Pre-treat SB with 1:1 size NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-80\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-80\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:22\",\"description\":\"Consider <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8820\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-81\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Atherotomy<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-81\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Atherotomy<\\\/strong><\\\/h2><ul><li>Consider atherotomy of MV or SB if suboptimal results with NC \\\/ compliant balloon.<\\\/li><li>If SB has &gt;70% stenosis and atherotomy balloon is available, consider atherotomy as first line treatment.<\\\/li><li>Size of atherotomy balloon is usually 0.25 to 0.5 mm smaller than vessel size.<\\\/li><li>If initial attempt of atherotomy resulted in suboptimal lesion preparation, consider upgrading the atherotomy balloon to 1:1 sizing<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (0.25-0.5mm smaller than vessel diameter) if suboptimal results with NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-82\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-82\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:28\",\"description\":\"If there is plaque shift in LM then consider <strong>Mini-crush<\\\/strong> or <strong>DK-crush<\\\/strong>. If no plaque shift, proceed with V-stenting.\"},{\"time\":\"00:00:35\",\"description\":\"Advance one <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-83\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-83\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> to the SB and another to the MV.\"},{\"time\":\"00:00:42\",\"description\":\"Proximal end of stents should create carina of \\u22642mm into LM.\"},{\"time\":\"00:00:46\",\"description\":\"Deploy both stents simultaneously (10-12 atm), then deflate simultaneously.\"},{\"time\":\"00:00:51\",\"description\":\"Individual serial <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-84\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-84\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> inflation of MV at 14-16 atm.\"},{\"time\":\"00:00:57\",\"description\":\"Individual serial <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-85\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-85\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> inflation of SB at 14-16 atm.\"},{\"time\":\"00:01:02\",\"description\":\"Inflate both <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-86\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-86\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> balloons simultaneously (12 atm for 10-20 secs).\"},{\"time\":\"00:01:06\",\"description\":\"Deflate and remove both <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-87\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-87\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> balloons.\"},{\"time\":\"00:01:09\",\"description\":\"In case of <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-88\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-88\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> under-expansion advance new NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-89\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-89\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (smaller than stent length) into SB and MV (1:1 size) followed by serial inflation at 16-18 atm to obtain optimal stent expansion, followed by <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9689\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-90\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >KBI<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-90\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Kissing Balloon Inflation (KBI)<\\\/strong><\\\/h2><ul><li>Left Main Bifurcation KBI<\\\/li><\\\/ul><p style=\\\"padding-left: 40px;\\\">Balloons in the MV and SB should be 1:1 in size<\\\/p><ul><li>Non Left Main Bifurcation KBI<\\\/li><\\\/ul><p style=\\\"padding-left: 40px;\\\">Balloon of 1:1 size should be used in the MV and SB balloon is 0.5mm smaller<\\\/p><p>These steps are common to both Left Main and Non Left Main Bifurcations<\\\/p><ul><li>If SB is difficult to recross, trying using a smaller size compliant balloon.<\\\/li><li>Short balloons are recommended over longer ones to due to the ease of recrossing.<\\\/li><li>Sequential inflations are performed at 16-18atm by inflating SB balloon first followed by MV balloon at the same high atmospheres. This is then followed by aligning the proximal dots of MV and SB balloons and performing simultaneous inflations and deflations of SB and MV balloons at lower atmospheres<\\\/li><li>If during inflation the balloon slips, then consider sequential inflations with low pressures in the SB and high pressures in the MV<\\\/li><li>Advantage of kissing balloon inflation is to reduce side branch thrombosis<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:21\",\"description\":\"Final angiogram to rule out distal <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-91\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-91\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> edge <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9690\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-92\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >dissection<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-92\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Dissection<\\\/strong><\\\/h2><p>Distal edge dissection or perforation: Caused by vessel over stretching or due to presence of large, calcified, or attenuated plaques at the edges of the stent<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:25\",\"description\":\"If the results are good, the procedure is finished (Proximal <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-93\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-93\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> carina \\u2264 2mm).\"}],\"video_arec\":\"<p>[video width=\\\"1600\\\" height=\\\"1080\\\" mp4=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_V.mp4\\\"][\\\/video]<\\\/p>\\n\",\"video_are\":\"<div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><video class=\\\"wp-video-shortcode\\\" id=\\\"video-9690-4\\\" width=\\\"1080\\\" height=\\\"729\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_V.mp4?_=4\\\" \\\/><a href=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_V.mp4\\\">https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_V.mp4<\\\/a><\\\/video><\\\/div>\"}<\/script> \n\n        <nav id=\"bifurcaid3d-nav\" style=\"display: none;\">\n            <li class='nav-ajax'>\n                <a class=\"active bifurca-id3d-page-link bifurca-link\" href=\"#\" data-page-id=\"0\">Home<\/a>\n            <\/li>\n        <\/nav>\n\n        <div class=\"id3d-left\">\n        \t<div id=\"id3d-video\"><div style=\"width: 1080px;\" class=\"wp-video\"><video class=\"wp-video-shortcode\" id=\"video-9690-4\" width=\"1080\" height=\"729\" preload=\"metadata\" controls=\"controls\"><source type=\"video\/mp4\" src=\"https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_V.mp4?_=4\" \/><a href=\"https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_V.mp4\">https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_V.mp4<\/a><\/video><\/div><\/div>        <\/div>\n        <div class=\"id3d-right\">\n            <div id=\"id3d-vid-conte\"><\/div> <div class=\"id3d-main-conte\"><\/div><div class=\"id3d-child-pages\"><\/div>        <\/div>\n    <\/div>\n\n[\/et_pb_text][et_pb_code admin_label=&#8221;Hide Bars JS Code&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<script><!-- [et_pb_line_break_holder] -->jQuery('.reveal-only-trigger-lmvstenting').click(function(argument) {<!-- [et_pb_line_break_holder] -->  setTimeout(function(){ window.dispatchEvent(new Event('resize')); }, 300);<!-- [et_pb_line_break_holder] -->});<!-- [et_pb_line_break_holder] --><\/script>[\/et_pb_code][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=&#8221;LM SKS&#8221; module_class=&#8221;reveal-only-content-lmsks&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;0px||||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text admin_label=&#8221;LM SKS&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;|||14px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n\n\t<div class=\"id3d-main-warp id3d-main-warp-single-screen\">\n\n\t\t<script id=\"screen-data-json\" type=\"text\/json\">{\"left\":\"<div id=\\\"id3d-video\\\"><div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><video class=\\\"wp-video-shortcode\\\" id=\\\"video-9686-5\\\" width=\\\"1080\\\" height=\\\"729\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_SKS.mp4?_=5\\\" \\\/><a href=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_SKS.mp4\\\">https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_SKS.mp4<\\\/a><\\\/video><\\\/div><\\\/div>\",\"right\":\"<div id=\\\"id3d-vid-conte\\\"><\\\/div> <div class=\\\"id3d-main-conte\\\"><\\\/div><div class=\\\"id3d-child-pages\\\"><\\\/div>\",\"video_type\":\"wpmedia\",\"video_content\":[{\"time\":\"00:00:00\",\"description\":\"<a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9108\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-94\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Wire<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-94\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Guidewire selection<\\\/strong><\\\/h2><ul><li>Main Branch: Work horse wires like BMW, Runthrough, ASAHI Scion, ASAHI Prowater<\\\/li><li>Side Branch: Polymer coated (can be jailed; easy to recross) like Fielder, Hi Torque Whisper<\\\/li><li>Wire the most difficult branch first<\\\/li><li>Shaping guidewire: Shaping the wire tip either with a rounded J-shape or with a sharp angle may be sufficient to start a procedure. However, in many cases the tip curve needs to be reshaped according to the side branch takeoff angle and tortuosity. Considering the variety of anatomical settings, our best recommendation is to adapt the length and angulation of the tip curve to the given anatomy. This may require long, sharp or even multiple angulations in the tip<\\\/li><li>According to the bifurcation angle, guidewires can be shaped in 3 ways [ see figure ]<\\\/li><\\\/ul><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/Less45.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9669\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9668\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><\\\/p><p><div class='one_third et_column_last'>\\n\\t\\t\\t\\t\\t<img src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/05\\\/More90.svg\\\" alt=\\\"\\\" width=\\\"150\\\" height=\\\"150\\\" class=\\\"alignnone size-thumbnail wp-image-9670\\\"  role=\\\"img\\\" \\\/>\\n\\t\\t\\t\\t<\\\/div><div class='clear'><\\\/div><\\\/p>            <\\\/div>        <\\\/div> MV and SB.\"},{\"time\":\"00:00:06\",\"description\":\"Perform PTCA of the branch with more severe disease first and less severe disease next with 1:1 NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-95\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-95\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:20\",\"description\":\"Consider <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8820\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-96\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >Atherotomy<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-96\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Atherotomy<\\\/strong><\\\/h2><ul><li>Consider atherotomy of MV or SB if suboptimal results with NC \\\/ compliant balloon.<\\\/li><li>If SB has &gt;70% stenosis and atherotomy balloon is available, consider atherotomy as first line treatment.<\\\/li><li>Size of atherotomy balloon is usually 0.25 to 0.5 mm smaller than vessel size.<\\\/li><li>If initial attempt of atherotomy resulted in suboptimal lesion preparation, consider upgrading the atherotomy balloon to 1:1 sizing<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> (0.25-0.5 mm smaller than the vessel) if suboptimal results with NC <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-97\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-97\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:26\",\"description\":\"Advance SB <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-98\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-98\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> first and then in MV (1:1 sized with distal vessel).\"},{\"time\":\"00:00:30\",\"description\":\"Deploy both stents simultaneously at 10-12 atm.\"},{\"time\":\"00:00:35\",\"description\":\"Individual serial <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-99\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-99\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> inflation of MV at 14-16 atm.\"},{\"time\":\"00:00:40\",\"description\":\"Individual serial <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-100\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-100\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> inflation of SB at 14-16 atm.\"},{\"time\":\"00:00:45\",\"description\":\"Final <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9691\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-101\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >simultaneous balloon inflations<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-101\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Kissing Balloon Inflation (KBI)<\\\/strong><\\\/h2><ul><li>Left Main Bifurcation KBI<\\\/li><\\\/ul><p style=\\\"padding-left: 40px;\\\">Balloons in the MV and SB should be 1:1 in size<\\\/p><ul><li>Non Left Main Bifurcation KBI<\\\/li><\\\/ul><p style=\\\"padding-left: 40px;\\\">Balloon of 1:1 size should be used in the MV and SB balloon is 0.5mm smaller<\\\/p><p>These steps are common to both Left Main and Non Left Main Bifurcations<\\\/p><ul><li>If SB is difficult to recross, trying using a smaller size compliant balloon.<\\\/li><li>Short balloons are recommended over longer ones to due to the ease of recrossing.<\\\/li><li>Sequential inflations are performed at 16-18atm by inflating SB balloon first followed by MV balloon at the same high atmospheres. This is then followed by aligning the proximal dots of MV and SB balloons and performing simultaneous inflations and deflations of SB and MV balloons at lower atmospheres<\\\/li><li>If during inflation the balloon slips, then consider sequential inflations with low pressures in the SB and high pressures in the MV<\\\/li><li>Advantage of kissing balloon inflation is to reduce side branch thrombosis<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> at 10-12 atm in both branches.\"},{\"time\":\"00:00:49\",\"description\":\"If suboptimal results, 1:1 NC balloons for post-dilation with serial dilation (16-18 atm) followed by FKBI (12-14 atm).\"},{\"time\":\"00:00:56\",\"description\":\"Final angiogram to rule out distal <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-102\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-102\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> edge <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9690\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-103\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >dissection<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-103\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Dissection<\\\/strong><\\\/h2><p>Distal edge dissection or perforation: Caused by vessel over stretching or due to presence of large, calcified, or attenuated plaques at the edges of the stent<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:01:00\",\"description\":\"If the results are good, the procedure is finished.\"}],\"video_arec\":\"<p>[video width=\\\"1600\\\" height=\\\"1080\\\" mp4=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_SKS.mp4\\\"][\\\/video]<\\\/p>\\n\",\"video_are\":\"<div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><video class=\\\"wp-video-shortcode\\\" id=\\\"video-9686-5\\\" width=\\\"1080\\\" height=\\\"729\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_SKS.mp4?_=5\\\" \\\/><a href=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_SKS.mp4\\\">https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/04\\\/LM_SKS.mp4<\\\/a><\\\/video><\\\/div>\"}<\/script> \n\n        <nav id=\"bifurcaid3d-nav\" style=\"display: none;\">\n            <li class='nav-ajax'>\n                <a class=\"active bifurca-id3d-page-link bifurca-link\" href=\"#\" data-page-id=\"0\">Home<\/a>\n            <\/li>\n        <\/nav>\n\n        <div class=\"id3d-left\">\n        \t<div id=\"id3d-video\"><div style=\"width: 1080px;\" class=\"wp-video\"><video class=\"wp-video-shortcode\" id=\"video-9686-5\" width=\"1080\" height=\"729\" preload=\"metadata\" controls=\"controls\"><source type=\"video\/mp4\" src=\"https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_SKS.mp4?_=5\" \/><a href=\"https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_SKS.mp4\">https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/04\/LM_SKS.mp4<\/a><\/video><\/div><\/div>        <\/div>\n        <div class=\"id3d-right\">\n            <div id=\"id3d-vid-conte\"><\/div> <div class=\"id3d-main-conte\"><\/div><div class=\"id3d-child-pages\"><\/div>        <\/div>\n    <\/div>\n\n\n<p>[\/et_pb_text][et_pb_code admin_label=&#8221;Hide Bars JS Code&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><script>jQuery('.reveal-only-trigger-lmsks').click(function(argument) {<!-- [et_pb_line_break_holder] -->  setTimeout(function(){ window.dispatchEvent(new Event('resize')); }, 400);<!-- [et_pb_line_break_holder] -->});<!-- [et_pb_line_break_holder] --><\/script>[\/et_pb_code][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=&#8221;LM Tap&#8221; module_class=&#8221;reveal-only-content-lmtap&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;0px||||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text admin_label=&#8221;LM Tap&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;|||14px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n\n\t<div class=\"id3d-main-warp id3d-main-warp-single-screen\">\n\n\t\t<script id=\"screen-data-json\" type=\"text\/json\">{\"left\":\"<div id=\\\"id3d-video\\\"><div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><video class=\\\"wp-video-shortcode\\\" id=\\\"video-9690-6\\\" width=\\\"1080\\\" height=\\\"608\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/E17.mp4?_=6\\\" \\\/><a href=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/E17.mp4\\\">https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/E17.mp4<\\\/a><\\\/video><\\\/div><\\\/div>\",\"right\":\"<div id=\\\"id3d-vid-conte\\\"><\\\/div> <div class=\\\"id3d-main-conte\\\"><\\\/div><div class=\\\"id3d-child-pages\\\"><\\\/div>\",\"video_type\":\"wpmedia\",\"video_content\":[{\"time\":\"00:00:00\",\"description\":\"Advance <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-104\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-104\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> to LCx (protrude into LM by 1 mm).\"},{\"time\":\"00:00:03\",\"description\":\"Advance <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-105\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-105\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> to LM into LAD (NC balloon 0.25 mm size smaller than LAD).\"},{\"time\":\"00:00:08\",\"description\":\"Deploy <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-106\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-106\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> into LCx.\"},{\"time\":\"00:00:13\",\"description\":\"Pull SDS <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-8819\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-107\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >balloon<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-107\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Balloon size<\\\/strong><\\\/h2><ul><li>For Predilation of SB: Non-compliant (NC) balloon sized typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><li>For Predilation of MB: Non-compliant balloon size typically 1:1 to vessel size<\\\/li><li>If unable to cross with NC balloon, change to smaller diameter compliant balloon (e.g. 2.0\\\/12 mm balloon)<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> back to proximal edge of LM <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-108\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-108\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:16\",\"description\":\"Perform <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9689\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-109\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >KBI<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-109\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Kissing Balloon Inflation (KBI)<\\\/strong><\\\/h2><ul><li>Left Main Bifurcation KBI<\\\/li><\\\/ul><p style=\\\"padding-left: 40px;\\\">Balloons in the MV and SB should be 1:1 in size<\\\/p><ul><li>Non Left Main Bifurcation KBI<\\\/li><\\\/ul><p style=\\\"padding-left: 40px;\\\">Balloon of 1:1 size should be used in the MV and SB balloon is 0.5mm smaller<\\\/p><p>These steps are common to both Left Main and Non Left Main Bifurcations<\\\/p><ul><li>If SB is difficult to recross, trying using a smaller size compliant balloon.<\\\/li><li>Short balloons are recommended over longer ones to due to the ease of recrossing.<\\\/li><li>Sequential inflations are performed at 16-18atm by inflating SB balloon first followed by MV balloon at the same high atmospheres. This is then followed by aligning the proximal dots of MV and SB balloons and performing simultaneous inflations and deflations of SB and MV balloons at lower atmospheres<\\\/li><li>If during inflation the balloon slips, then consider sequential inflations with low pressures in the SB and high pressures in the MV<\\\/li><li>Advantage of kissing balloon inflation is to reduce side branch thrombosis<\\\/li><\\\/ul>            <\\\/div>        <\\\/div>.\"},{\"time\":\"00:00:21\",\"description\":\"Final angiogram to rule out distal <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9686\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-110\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >stent<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-110\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Stent size<\\\/strong><\\\/h2><ul><li>New generation DES is recommended<\\\/li><li>Size Dilemma- If Main vessel stent chosen according to proximal vessel (pMV) size there is risk of distal stent edge dissection and carinal shift which can occlude side branch. On contrary, If Main vessel stent is chosen according to distal vessel (dMV) size there is risk of stent malapposition at pMV site which can lead to stent thrombosis or can cause difficulty in guide wire exchange.<\\\/li><\\\/ul><p>We therefore recommend choosing the stent size according to dMV and its expansion proximally to pMV size by either the final kissing balloon (2 stent strategy) or by proximal optimization technique (for provisional stent strategy)<\\\/p><p>Eg 1. Proximal Vessel 3.5mm in diameter and distal vessel 2.5mm in diameter- consider 2.75mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Eg 2. Proximal Vessel 3.5mm in diameter and distal vessel 3mm in diameter \\u2013 consider a 3mm stent, deploy it at 10-12 atm and POT the proximal vessel with a 3.5mm short balloon at 16-18 atm<\\\/p><p>Side branch should be rewired prior to performing kissing balloon inflation or proximal optimization technique (POT)<\\\/p>            <\\\/div>        <\\\/div> edge <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9690\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-111\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >dissection<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-111\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Dissection<\\\/strong><\\\/h2><p>Distal edge dissection or perforation: Caused by vessel over stretching or due to presence of large, calcified, or attenuated plaques at the edges of the stent<\\\/p>            <\\\/div>        <\\\/div>. If the results are good, the procedure is finished (Consider <a class=\\\"paoc-popup popupaoc-link\\\" href=\\\"javascript:void(0);\\\" data-target=\\\"id3d-definition-modal-9692\\\" data-conf='{\\\"content\\\":{\\\"target\\\":\\\"#paoc-modal-112\\\",\\\"effect\\\":\\\"fadein\\\",\\\"positionX\\\":\\\"center\\\",\\\"positionY\\\":\\\"center\\\",\\\"fullscreen\\\":false,\\\"speedIn\\\":300,\\\"speedOut\\\":300,\\\"delay\\\":150,\\\"width\\\":\\\"60%\\\"}}' >IVUS<\\\/a><!-- no space --><!-- popup --><div id=\\\"paoc-modal-112\\\" class=\\\"paoc-popup-modal\\\">            <a href=\\\"javascript:void(0);\\\" class=\\\"paoc-popup-close paoc-close-popup\\\"><\\\/a>            <div class=\\\"paoc-popup-modal-cnt\\\">                <h2><strong>Role of IVUS in Bifurcation Stenting<\\\/strong><\\\/h2><p>IVUS plays an important role in bifurcation stenting.<\\\/p><ul><li>For pre-procedure assessment of lesion severity and characteristics especially in left main lesions.<\\\/li><li>For pre-procedure assessment of lesion severity of the ostial left circumflex in cases where the ostium appears hazy or cannot be visualized well on angiography. If there is significant disease in ostial LCx then consider doing an upfront 2 stent technique.<\\\/li><li>Post-PCI for optimization of results especially in left main stenting to make sure stent is well expanded and well opposed.<\\\/li><\\\/ul>            <\\\/div>        <\\\/div> at operator discretion prior to final angiogram).\"}],\"video_arec\":\"<p>[video width=\\\"1920\\\" height=\\\"1080\\\" mp4=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/E17.mp4\\\"][\\\/video]<\\\/p>\\n\",\"video_are\":\"<div style=\\\"width: 1080px;\\\" class=\\\"wp-video\\\"><video class=\\\"wp-video-shortcode\\\" id=\\\"video-9690-6\\\" width=\\\"1080\\\" height=\\\"608\\\" preload=\\\"metadata\\\" controls=\\\"controls\\\"><source type=\\\"video\\\/mp4\\\" src=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/E17.mp4?_=6\\\" \\\/><a href=\\\"https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/E17.mp4\\\">https:\\\/\\\/cardiologyapps.com\\\/wp-content\\\/uploads\\\/2020\\\/07\\\/E17.mp4<\\\/a><\\\/video><\\\/div>\"}<\/script> \n\n        <nav id=\"bifurcaid3d-nav\" style=\"display: none;\">\n            <li class='nav-ajax'>\n                <a class=\"active bifurca-id3d-page-link bifurca-link\" href=\"#\" data-page-id=\"0\">Home<\/a>\n            <\/li>\n        <\/nav>\n\n        <div class=\"id3d-left\">\n        \t<div id=\"id3d-video\"><div style=\"width: 1080px;\" class=\"wp-video\"><video class=\"wp-video-shortcode\" id=\"video-9690-6\" width=\"1080\" height=\"608\" preload=\"metadata\" controls=\"controls\"><source type=\"video\/mp4\" src=\"https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/07\/E17.mp4?_=6\" \/><a href=\"https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/07\/E17.mp4\">https:\/\/cardiologyapps.com\/wp-content\/uploads\/2020\/07\/E17.mp4<\/a><\/video><\/div><\/div>        <\/div>\n        <div class=\"id3d-right\">\n            <div id=\"id3d-vid-conte\"><\/div> <div class=\"id3d-main-conte\"><\/div><div class=\"id3d-child-pages\"><\/div>        <\/div>\n    <\/div>\n\n\n<p>[\/et_pb_text][et_pb_code admin_label=&#8221;Hide Bars JS Code&#8221; 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