Fundamentals of percutaneous coronary bifurcation interventions

Figure 11  Step-by-step inverted culotte stenting. A: Both vessels are wired; B: The side branch (SB) stent protruding in the proximal main vessel is deployed (protrusion part is 1-3 mm in the “Mini-culotte technique”); C: Proximal optimization technique (POT) for the SB stent; D: Wire exchange. The distal main vessel (MV) wiring from the closest cell to the carina and the “U” shaped wire is advanced into the SB; E: Kissing balloon inflation (KBI) (in the “double kissing mini-culotte “technique) or classical balloon dilatation only in the distal MV ostium may be performed; F: MV stenting; G: POT for the MV stent; H: Second wire exchange. Wiring the SB through the closest cell to the carina and the “U” shaped wire crossing the MV stent; I: KBI; J: Final POT; K: Final result.