SKS Technique Clinical Case From Sharma SK, Sweeney J, Kini AS. Coronary Bifurcation Lesions: A Current Update. Cardiol Clin 2010;28:55–70. 1

Clinical Case: SKS Technique for LAD/D1 54 yrs old, with angina pectoris, coronary ASC of native vessel, positive CTA Medical history: HTN, Hyperlipidemia, H/o prior MI, s/p BMS dLAD 10/07 Medication: Carvedilol, Plavix, ASA, Lisinopril, Lipitor, Zoloft SKS technique for mid LAD/D1 bifurcation DES in mid-LAD DES in LAD-D1 From Sharma SK, Sweeney J, Kini AS. Coronary Bifurcation Lesions: A Current Update. Cardiol Clin 2010;28:55–70. 2

Clinical Case: SKS Technique for LAD/D1 70-80% stenosis mid-LAD 70-80% stenosis in LAD-D1 bifurcation PCI Technique: 7Fr FCL 4.0 Mach1 guide into the lesion From Sharma SK, Sweeney J, Kini AS. Coronary Bifurcation Lesions: A Current Update. Cardiol Clin 2010;28:55–70 3

Clinical Case: SKS Technique for LAD/D1 mid-LAD wired by Fielder and D1 wired by RunThrough and Fielder 1.5/6mm Sprinter balloon for mid-LAD lesions at 1 atm 2.5/6mm Flextome cutting balloon at 10 atm in D1 lesion From Sharma SK, Sweeney J, Kini AS. Coronary Bifurcation Lesions: A Current Update. Cardiol Clin 2010;28:55–70 4

Clinical Case: SKS Technique for LAD/D1 mid-LAD wired by Fielder and D1 wired by RunThrough and Fielder 1.5/6mm Sprinter balloon for mid-LAD lesions at 1 atm 2.5/6mm Flextome cutting balloon at 10 atm in D1 lesion From Sharma SK, Sweeney J, Kini AS. Coronary Bifurcation Lesions: A Current Update. Cardiol Clin 2010;28:55–70 5

Clinical Case: SKS Technique for LAD/D1 SKS technique for mid-LAD/D1 bifurcation: 3.00/13 mm Cypher in mid-LAD and 2.5/18mm Cypher in D1 6

Clinical Case: SKS Technique for LAD/D1 SKS technique for mid-LAD/D1 bifurcation: 3.00/13 mm Cypher in mid-LAD and 2.5/18mm Cypher in D1 -Both inflated simultaneously at 10 atm for 10 seconds 7

Clinical Case: SKS Technique for LAD/D1 SKS technique for prox-LAD/D1 bifurcation: 3.00/13 mm Cypher in mid-LAD and 2.5/18mm Cypher in D1 Both inflated simultaneously at 10 atm for 10 seconds Both deflate and LAD stent inflated at 20 atm for 10 seconds 8

Clinical Case: SKS Technique for LAD/D1 SKS technique for mid-LAD/D1 bifurcation: 3.00/13 mm Cypher in mid-LAD and 2.5/18mm Cypher in D1 Both inflated simultaneously at 10atm for 10 seconds Both deflate and LAD stent inflated at 20 atm for 10 seconds Deflate LAD stent and inflate D1 stent at 18atm for 10 seconds 9

Clinical Case: SKS Technique for LAD/D1 SKS technique for mid-LAD/D1 bifurcation: 3.00/13 mm Cypher in mid-LAD and 2.5/18mm Cypher in D1 Both inflated simultaneously at 10atm for 10 seconds Both deflate and LAD stent inflated at 20 atm for 10 seconds Deflate LAD stent and inflate D1 stent at 18atm for 10 seconds Both again inflated simultaneously at 10 atm for 10 seconds 10

Clinical Case: SKS Technique for LAD/D1 Final Results Post SKS technique for mid-LAD/D1 bifurcation stents after plaque modifications of D1 by CB 11

Clinical Case: SKS Technique for LAD/D1 Final Results Post SKS technique for mid-LAD/D1 bifurcation stents after plaque modifications of D1 by CB 12

Bifurcation lesion involving LAD and D1 SKS Technique Bifurcation lesion involving LAD and D1

PRECISE-SKS Pilot Study Duke’s Type D Bifurcation Lesion Conventional Technique (n=49): One stent in the main vessel & provisional stent in the side-branch SKS Technique (n=51): Simultaneous kissing stent deployment in the main vessel & side-branch Primary endpoint: angiographic restenosis at 8-9 months Secondary endpoints:30-day clinical MACE 9-month TLR 1-year freedom from MACE IVUS sub study of 20 pts in each arm 1-year clinical follow-up: death, TVR, MI