{"id":8687,"date":"2025-09-20T19:35:36","date_gmt":"2025-09-20T16:35:36","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8687"},"modified":"2025-09-20T19:35:36","modified_gmt":"2025-09-20T16:35:36","slug":"general-principles-of-wiring-and-predilatation","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/general-principles-of-wiring-and-predilatation\/","title":{"rendered":"General Principles of Wiring and Predilatation"},"content":{"rendered":"<div>General Principles of Wiring and Predilatation<\/div>\n<div><\/div>\n<div>Source: Medical News \u2014 16th EBC consensus (EuroIntervention ,2022), 17th consensus (2023), and 18th consensus (2024). Latest updates highlight evolving strategies for bifurcation PCI<\/div>\n<div><\/div>\n<div><span> 1. Guidewires<\/span><\/div>\n<div><span> \u2022 Workhorse wire: balanced support and flexibility, safe for routine PCI (e.g., BMW, Runthrough, Sion).<\/span><\/div>\n<div><span> \u2022 Hydrophilic wire: slippery, for crossing tight\/calcified\/tortuous lesions or CTOs; not safe for long-term working (risk of distal perforation, poor support).<\/span><\/div>\n<div><span> \u2022 Wire exchange principle: always exchange hydrophilic for workhorse using a microcatheter (preferred) or OTW balloon \u2192 preserves access and prevents wire loss.<\/span><\/div>\n<div><span> 2. Wiring Tips<\/span><\/div>\n<div><span> \u2022 Always wire MV and SBs at the start (in trifurcation: MV + all three SBs).<\/span><\/div>\n<div><span> \u2022 Use microcatheter for tight or angulated branches, and for safe wire exchange.<\/span><\/div>\n<div><span> \u2022 Terminology:<\/span><\/div>\n<div>* Near-carina cell (distal cell, DC): the cell adjacent to the carina \u2192 correct site for rewiring.<\/div>\n<div>* Outer-wall cell (proximal cell): the cell near MV outer wall \u2192 avoid.<\/div>\n<div><span> \u2022 Guideline statement: \u201cWhen rewiring the side branch, cross through the near-carina cell (DC), not the outer-wall cell.\u201d<\/span><\/div>\n<div><span> \u2022 This prevents wire entrapment (wire trapped between stent and vessel wall), optimizes SB ostial opening, and improves kissing balloon result.<\/span><\/div>\n<div><span> 3. Predilatation<\/span><\/div>\n<div><span> \u2022 Always sequential, one branch at a time.<\/span><\/div>\n<div><span> \u2022 Never simultaneous kissing during initial preparation (to preserve carina).<\/span><\/div>\n<div><span> \u2022 Balloon size 1:1 with distal vessel.<\/span><\/div>\n<div><span> \u2022 Start with low pressure in severe stenosis or thrombus, escalate cautiously.<\/span><\/div>\n<div><span> \u2022 This rule applies to all techniques (Provisional, TAP, Culotte, Crush\/DK-Crush, TKC).<\/span><\/div>\n<div><span> 4. Re-crossing Principles by Technique<\/span><\/div>\n<div><span> 1. Provisional stenting: re-cross through near-carina cell (DC).<\/span><\/div>\n<div><span> 2. TAP \/ Culotte: proximal\/outer-wall recrossing may sometimes be used to achieve stent symmetry.<\/span><\/div>\n<div><span> 3. Crush \/ Mini-crush \/ DK-Crush: near-carina recrossing is mandatory after each crush step. In DK-Crush \u2192 required twice (after first and second crush).<\/span><\/div>\n<div><span> 4. Trifurcation (TKC): wire all branches, sequential predilatation, sequential SB stenting and crushing, near-carina rewiring each time, kissing after each, finish with final POT.<\/span><\/div>\n<div><\/div>\n<div><\/div>\n<div><\/div>\n<div><a href=\"http:\/\/pubmed.ncbi.nlm.nih.gov\/38752714\">http:\/\/pubmed.ncbi.nlm.nih.gov\/38752714<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"<p>General Principles of Wiring and Predilatation Source: Medical News \u2014 16th EBC consensus (EuroIntervention ,2022), 17th consensus (2023), and 18th consensus (2024). Latest updates highlight evolving strategies for bifurcation PCI 1. Guidewires \u2022 Workhorse wire: balanced support and flexibility, safe for routine PCI (e.g., BMW, Runthrough, Sion). \u2022 Hydrophilic wire: slippery, for crossing tight\/calcified\/tortuous lesions [&hellip;]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8687","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8687","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8687"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8687\/revisions"}],"predecessor-version":[{"id":8688,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8687\/revisions\/8688"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8687"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8687"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8687"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}