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

2. 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

3. 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

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 4

5. 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

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 6

7. 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

8. 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

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 9

10. 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

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 11

12. 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

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

14. 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