T stenting and modified T stenting of coronary bifurcations

T stenting and modified T stenting of coronary bifurcations

In both classic T stenting and modified T stenting for coronary bifurcations, both branches are initially wired and balloon dilated. Following this, in classic T stenting, side branch stent is placed avoiding protrusion into the main branch. A balloon may be kept in the main branch to guide the position of the main branch. After dilating the side branch stent and getting the check angio to confirm satisfactory deployment, the balloon and guide wire are removed from the side branch. The main branch is then stented. The side branch is re-wired through the struts of the main branch stent and dilated, followed by final kissing inflation. In modified T stenting, two stents are simultaneously positioned in both main branch and side branch. Side branch stent is dilated first. After check angio and confirming satisfactory dilatation, the guide wire and balloon are removed from the side branch and the main branch stent is dilated. The side branch is then re-wired and dilated, followed by a final kissing balloon dilatation simultaneously in the both main branch and side branch. An advantage of the T stenting compared to V stenting is that it can address a lesion in the proximal segment of the main branch. But the coverage of side branch ostium is likely to be incomplete with T stenting in most cases.

T-stenting and small protrusion technique (TAP Stenting) is a modification used to enhance side branch ostial coverage. It is an intentional protrusion of side branch stent within the main branch during coronary bifurcation stenting which ensures side branch ostial coverage and facilitates final kissing balloon inflation.