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Figure 1 Procedure for Treatment of Bifurcations Using a Provisional T-Stenting Strategy
1. Wires are advanced in both the distal main vessel and 2. the side branch; 3. The main vessel is pre-dilated if deemed necessary. Pre-dilation of the side branch is avoided where possible; 4. A stent is deployed in the main vessel, jailing the wire in the side branch; 5. Once the main vessel result is seen to be satisfactory, wires are exchanged with the main vessel wire being withdrawn and advanced through the stent struts into the side branch; 6. A kissing inflation is systematically performed in order to open the stent struts to cover the ostium of the side branch, while preserving the result in the main vessel; 7a. If at this point there is normal (Thrombolysis In Myocardial Infarction flow grade 3) flow in the side branch and <50% residual angiographic stenosis, this marks the end of the procedure; 7b. If this is not achieved, a second stent is deployed in the side branch. The side branch stent crosses the struts of the first stent and is deployed in a T configuration; followed by 7c. a final kissing inflation to optimize 7d. the final result in both branches.
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