<v ->Well, thank you very much for great presentations.</v> We have seven minutes to take questions. So John, shoot the question. We'll see what people have asked, and what you have chosen to ask everyone. <v ->Thank you.</v> So there are questions, that if you have a borderline lesion after a provisional strategy, do you ever use physiology assessments to guide the implantation of a side branch stent? <v ->(mumbles)</v> Because I did and you have seen from Dr. Azeem, before the second stenting, I had an acceptable result in there, sir. I'm hundred, completely sure, 100%, that the physiology will be perfect. So, what we don't control is the control. When sometimes, after implantation of a crossover stent, and a POT, you on the side branch. You have a very tight lesion that's used though. And Dr. Koo from Korea have done systematic evaluation of this kind of abrasion with FFR. And ensure that at least 50% of these tight lesions are not physiologically true. So, because this is related to the corona shift. This key move the ostium of the side branch, from the circular anatomy to novel anatomy, or sometimes even to a slit. So, this give, in the only one projection we have, the impression that we have a tight lesion. So, it's very rare that when I have the result, I showed you after the information the first time, it is clear not we can avoid to put the stent. And when the lesion is very tight, maybe I will use physiology. And in case of FFR more than .8, I probably won't keep going to second step. <v ->I would just add to what Yves said.</v> Don't forget that FFR, IFR. Why is that difficult to manipulate? And so sometimes if you've just put your stent in, you haven't done a kiss, it can be really difficult to get through stent struts. And the other part of Koo's paper, is that sometimes if you've just put the stent in, and the side branch ostium doesn't look great. And even though the physiology is important, probably the next best thing to do is a kissing inflation, and it will correct the physiology in many cases, so. <v ->I agree.</v> <v ->Alright John, any other, what other questions do you have?</v> <v ->There's another question, Dr. Louvard,</v> that you had mentioned reverse wiring. And people were interested in that technique, and if you could describe how you do it. <v ->Reverse wiring is for difficult access side branches.</v> We can use reverse wiring, which was discovered commonly with Azeem's last end, of Francesco also was one of the pioneer. I was also in Korea, assumes in Japan. So what is a reverse wire? Is to use a wire, you give an hairpin shape. No, this is a 180 angle, and with a small star shape pointing to side branch. So for example, using your micro CAT to move in the main vessel distal to the side branch. And then you will pull a bit your micro CAT, and you pull slowly the pin-shaped wire, and it will enter the side branch by pulling. Which is surprising. But this is a very effective technique. You have to be a bit patient, and to properly prepare your wire. But this is a precious techniques. <v ->And maybe I'll add to it as well,</v> is that I think now with the SuperCross, especially the SuperCross 120, it's become a little bit easier to get the- <v ->It's easier, it's easier.</v> <v ->the back one.</v> The other, thing I often see people with a SuperCross, you have to be careful though, with a SuperCross. Because if it's bent backwards, and you're not really facing the ostium, and you try and push out too hard, you can easily dissect. So it's a great tool, but be careful with a SuperCross, but it can help you in the very difficult modification. <v ->Alright, what else do you have John?</v> <v ->Thanks.</v> There are some questions. T or tap? Is one better in terms of final area and what do you prefer? <v ->I can.</v> <v ->In.</v> <v ->I can.</v> <v ->Yeah, you can answer, you can answer.</v> Because I think we all care. We all care. <v ->No, I feel the responsibility to give the answer,</v> clear answer regarding TAP and T. So TAP is, has been developed with the aim of warranting final kissing inflation. So the true adding benefit is the fact that with Tap, you have the balloon inflated in the main vessel, that is set before. And this was not the routine that we teach them, but the ideal TAP is C, so the, we should really be careful in avoiding general's mal carina. So what I like is to add TAP on top of having done all the manipulation I showed during the case, and showed, shown by also Yves Louvard during his case. So on top of this, most of the time, you have the possibility really to have no protrusion, no longer protrusion inside. For sure, since one of the pitfalls of de-stenting, can be the fact that you miss the ostium, that is the area at higher risk of osteosis. The fact that the balloon is ready for kissing, and you are prepared to have final kissing inflation. Even in the case you have some mal carina, allows you to be I mean in adaptor free to cover the ostium, which with the, I mean more confidence. But really it is important to keep time to prepare before, and then to keep time to find really the best incidents, to minimize the length of the protrusion inside the main vessel. <v ->You know John.</v> <v ->Am I correct or not?</v> <v ->You're perfect, you're perfect.</v> This is a, I think you focus on the projection. (Dr. Azeem Latib coughs) I think it's good when you dealing with the presentation. To have a walking projector. The one you don't transform the beginning to the end, and it has to be selected to show perfect separation of the vessel. Sometime it's quite difficult to find, and I cannot describe that we don't have time. And of course it be a presentation from one lesion to a zofran. <v ->Last comment, sorry, I want to fix this at the best.</v> In the case you are not a hundred percent sure about where the ostium is. It is better to perform a color, so that you have no problems inside the polygonal conference. So you protrude a little bit more, than you perform POT, and you perform a kissing. I think that is the only condition, where I like not to perform it up. Where, when I'm not 100% sure to have good visualization of side branch ostium. <v ->Agree, agree.</v> <v ->Alright, we're coming to end.</v> Thank you for great presentations and this is really very good, for the first webinar of the Sky Modification Club.

coronary interventions

physiology assessments

side branch stent

reverse wiring

TAP technique