V stenting for coronary bifurcation

V stenting for coronary bifurcation

V stenting for coronary bifurcation: V stenting for coronary bifurcation is useful when both vessels constituting the bifurcation are involved without much involvement proximal to the carina. Initially both branches are wired and balloon dilated. Then two stents are placed, one in each branch, without any significant overlap (overlap less than 5 mm) into the proximal segment. The stents are inflated alternately. Final kissing inflation is done using the same pressure in both balloons. This type of stenting is considered in left main bifurcation disease without significant involvement of the left main itself. The angle between the branches should be ideally less than ninety degrees for this approach. The important advantage of the V stenting technique is that future access to either side branch is not compromised. There is no need to re-cross any any while performing the final kissing inflation. Downside of V stenting is the difficulty in placing a proximal stent accurately if needed. This is because the proximal stent cannot be easily aligned to both the components of the double barrel. The proximal stent tends to have a bias towards any one of the distal stent. If needed at all, either a small gap can be left or it can be converted to a crush technique with the stent in the main branch crushing the other stent. In this case, a short segment of the main branch has four layers of struts. Hence while selecting cases for V stenting, only those with a very low chance of requiring a proximal stent should be chosen.