Fundamentals of percutaneous coronary bifurcation interventions

Figure 10  Step-by-step classical (provisional) culotte stenting. A: Both vessels are wired; B: After predilatation, the main vessel (MV) stent sized to the distal MV is deployed; C: First proximal optimization technique (POT); D: Wire exchange; E: Balloon dilatation of the side branch (SB) ostium; F: Deployment of the SB stent protruding into the proximal MV (1-3 mm in “mini-culotte”(shown) or more in classical culotte technique); G: POT for the SB stent; H: Second wire exchange with wiring the distal MV through the closest cell to the carina, and the other wire tip is “U” shaped to cross the SB stent; I: Kissing balloon inflation; J: Final POT; K: Final result.