International Circulation:I would like to ask a couple of questions regarding the bifurcation lesions. For the past two to three years especially with the appearance of DES， two stents strategy were more popular choices and from the last year， it sames that the simpler is the better . What is your idea?

Dr Yaron Almalgor ：From my point of view， I always do not think two stents are good idea. I participated in a project with side branch protection. From practical point of view， two stents are not easy to perform and the long term results did not prove that two stent are better than one stent. The next issue is not you have to realize that side branch protection or two stents implantation are aimed at big or important side branch and this is not so frequently. Usually， during our work， we should know that sometime bifurcation lesion is not real bifurcation. So in this circumstance， you should not think of two stents implantation and provisional stent strategy is reasonable.

International Circulation:Do you think two wire protection is better than two stents?

Dr Yaron Almalgor ：In my idea， two wires are wires and two stent should be avoided. I always put one stent in the main branch.

International Circulation:But if you put one stent in and you find the ostium of side branch is compromised， what should you do?

Dr Yaron Almalgor ：Well， apart from the distal LM lesion involving LAD and LCX， my secrets is to find a way to delivery one stent in the main branch and keeping good access to the side branch. You know， when you put a stent in， you could not rotate the system inside the coronary and usually the compromised side branch is caused by the squeeze of crina of the side branch by the strut of stent. So I think if you think the side branch is very important you could put two wires in and from my idea， it is often no use.

International Circulation:Sometime， if you have to put two stents in， there are many techniques you could choose， such as Crush， Culotte ，T techniques， etc. What is your favorite?

Dr Yaron Almalgor ：It depends on the situation. But for me， I never use the Crush technique. For the DES， you do not know the effect of drug release during the Crush procedure. If I have to put two stents， I would like V stents and please keep in mind that you should not change the anatomy of the vessels. During the V stents， you put two wires in and you do not re-across the wire through the stent. It reduced the deformation of the stents and vessels.

International Circulation:Do you always do Kissing balloon in your practice?

Dr Yaron Almalgor： For me no matter what technique I used， I always did the kissing ballon between main and side branches. The first kissing is crucial for side branch alignment and last kissing is so even if you put two stents in.

International Circulation:In the last month， the AHA published updated guideline for UA and NSTEMI. It is said that we must give risk classification for these patients and the PCI should be performed within 6 hours for the high risk patients， AS for the medium and low risk patients the medication therapy is the first step， so what’s your opinion?

Dr Yaron Almalgor :Yes I agree with the guideline. But some times it is hard to give a definite classification of the patients. And you know， the guideline is changeable. Medication is the same important. But you must consider the patient’s characteristics individually. For the last year， our catheter number decreased by 15% and it is because the decline of restenosis.

International Circulation:If the patient is in medium risk and stress tests show some extent ischemia， will you let him to perform the catheterization?

Dr Yaron Almalgor ：Still it depends on the situation， if this is a young patient and stress test showed marked ischemia， I won’t let myself to miss the left main lesion and if the patient is stable and medication do well， I will let him go home.