European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO Importance of Routine Use of OCT in Bifurcation Author: Yoshinobu Murasato, MD, PhD, Kyushu Medical Center, Fukuoka, Japan TIPS & TRICKS IN ROUTINE USE OF OCT Decrease contrast medium Flow reduction: 5-10ml at 2-3ml/sec Low-molecular dextran GC engage: relatively deep Avoid the patients unsuitable for the OCT examination Ostial lesion in the LMCA and RCA Diffuse diseased vessel CKD stage 3b, 4 CONCLUSION Routine use of OCT can provide useful information in vessel condition before and after treatment, which changes the strategy in 50% of the cases. It can correct stent malapposition and underexpansion, which may lead to a decrease in cardiac death/MI. A decrease in contrast medium or use of dextran can afford to more frequent OCT pull-backs for further examination in the complicated lesion. 3-D OCT imaging has a possibility to correct GW recrossing point, which leads to decrease in incomplete stent apposition, however, it still requires innovation of image qualities.
European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO 3D-OCT New implications of optimal SB re-crossing Author: Yoshinobu Onuma, MD, PhD, Horax Centre, Erasmus MC, Rotterdam, The Netherlands BACKGROUND With advent of the new-generation OCT/OFDI system (C7/8 LightLab, OFDI Terumo) with a high frame rate (100-180fps) and fast pull-back speed (20-40mm/s), 3- dimensional reconstruction of OCT became feasible due to elimination of motion artefacts. 3-dimensional OCT reconstruction gives us better understanding of complex coronary anatomy such as bifurcation, compared to the conventional 2-D OCT. CONCLUSION In 2009-2010, with advance of OCT/OFDI technology, 3D-reconstruction became feasible. In 2011-2013, the potential of the technology was demonstrated in off- line 3D-OCT with manual strut detection. In bifurcation, 3D-OCT may guide positioning of the wire through the appropriate (distal) cell. The early study suggests that such a guidance strategy reduced the incidence of malapposition in bifurcation. In 2014, the on-line 3D OCT/OFDI with automatic strut detection is available. The equipped “real-time” 3D OFDI will help utilization of 3D in clinical situation.
European Bifurcation Club 2014, EBC 2014 - Bordeaux, France BIFURCATION STENTING: LEARNING FROM BENCH AND SIMULATION Stent strut malapposition: insights from flow simulations and OCT imaging Author: Nicolas Foin, MD, PhD, National Heart Centre Singapore, Duke-NUS QUESTIONS How are blood flow patterns and shear rate affected by different degree of stent malapposition? How does baseline flow around ISA strut affect coverage at FU High shear and delayed coverage: are both contributing factors to thrombogenicity observed with ISA? METHODS Computer Model of different strut-wall malapposition distances, flow patterns and shear rates evaluated by CFD In-vivo:ISA and strut coverage (% uncovered, thickness) assessed sequentially in-vivo by OCT at both baseline and FU Comparison of shear patterns with OCT FU coverage response SUMMARY Strut-wall malapposition distances affect flow disturbances and shear rate in a dose-dependent relation. OCT sequential study revealed that baseline ISA is mostly resolved and covered at FU for strut ISA distance < 300 um More severe malapposition (ISA distance > 300 um) create higher shear disturbance with significantly higher rate of persitent malapposition and uncovered strut at FU. Strut thickness influence re-endothelialisation as well as shear rate disturbance: for minimal shear rate, thinner strut is better. Further in-vivo studies are required to evaluate the impact of flow on neointimal healing and adverse events.
European Bifurcation Club 2014, EBC 2014 - Bordeaux, France ADVANCEMENTS IN BENCH TESTING AND COMPUTER MODELING Optimal provisional coronary bifurcation stenting: Final kissing balloon dilatation or not ? Author: Gerard Finet, MD, PhD, Hospices Civils de Lyon, France OBJECTIVES Quantify the mechanical effects of the POT Quantify the differences between: FKB approach (with its modified protocols) after POT approach with no FKB but consecutive POT with SB balloon inflation (re-POT) CONCLUSION Our preliminary results with 25 fractal bifurcation models with Promus Premier® (Boston) : quantitatively validated the mechanical effects of POT showed by comparison with : FKB alone and POT + FKB with symmetric or asymmetric balloon inflaOon pressure thatwithre-POT with SB dilation provides the best mechanical results and is the simplest technique in 1-stent bifurcation strategy. SBO almost free of strut (4.9%) a very low rate of global strut malapposition (2.6%) an almost perfect morphology of the carena and the wall facing the SB ostium a maintained circular cross-sectional area of the MoV (relative elliptic ratio : 1.0) the almost perfect respect of the linear law of coronary artery bifurcation geometry (0.66) We are completing these preliminary results with 25 other fractal bifurcation bench models with Ul#master® stent (Terumo) A total of 50 experimentations in fractal bifurcation bench models.