European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING Extreme Left Main stem calcification: ROTASHOCK combination Author: Dr. Peter O'Kane, MD, Royal Bournemouth Hospital, UK CLINICAL PRESENTATION 79 year old lady Unstable angina, Troponin 250, eGFR 38 Exertional dysopnea for several months Echo: LVEF 45%with akinetic apex but good regional wall motion elsewhere
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain HOW TO TREAT (by EBC experts) - VOTING How to treat an Ostial LAD Bifurcation Lesion Author: Vladimir Dzavik, MD, PhD, University of Toronto, Canada 46 year old man Recent diagnosis of diabetes or pre-diabetes Started on metformin Several month history of exertional dyspnea and chest discomfort Attributed to being unfit Presented to a local hospital with anterior chest pain and dyspnea at rest
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA How imaging changed my strategy Author: Rahul Gupta, MD, Apollo Hospital, India CLINICAL DATA 82YRF Past PCI to LCX and DDDR PPI • Now Class III angina HT LVEF : 45%
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA Author: GUO Suxia, MD, Dongguan People's Hospital, China CASE PRESENTATION PATIENT DEMOGRAPHICS: - Age: 48 yrs. - Gender: Male RISK FACTORS: - 2-DM - Smoking history CLINICAL PRESENTATION: - Exertional chest pain for 2 years. - Echo: LVEF 47% PAST MEDICAL HISTORY: - CAG in other Hospital before one week STRATEGY LM/LAD/LCX bifurcation (1,1,1): 2 stents Middle of LCX CTO: PCI Intro-coronary imaging guidance: IVUS
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA A case of LAD CTO reperfusion guiding by IVUS Author: Xiaoping Peng, The First Affiliated Hospital of Nanchang University, China CLINICAL FACTS Liao, male, 59-year-old, admitted to hospital in 2018-09-15 Chest tightness for 2 years, aggravating for 2 months TREATMENT STRATEGY The treatment strategy of this patient is to deal with right coronary lesions first. Selective treatment is LAD CTO lesions
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA Struts across side branch an oct follow up Author: Rony Mathew, MD, DM, Lisie Heart Institute – Lisie Hospital Cochin, India CONCLUSION Struts across a major side branch may be a predictor of side branch re-stenosis. - Neo-intimal growth over the struts will compromise the side branch ostia over time. Proposed hypothesis: - Struts across SB on OCT Imaging may be an indication to kiss/PSP, even if the ostia is not compromised on angiography. Follow up OCT study required.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA Use of DES and DCB in LM Bifuration Lesion Author: Zhanying Han, MD, First Affiliated Hospital of Zhengzhou University, China BACKGROUND Although several stenting techniques are available for the treatment of de novo coronary bifurcation lesions. The treatment of coronary artery bifurcation still represents a challenge for interventional cardiologist. over the past years, different studies have proposed and analysed the use of drug-coated balloon (DCB) in the treatment of coronary artery bifurcation lesions as an alternative treatment. CLINICAL CHARACTERISTICS Zhang Q Female 76years Paroxysmal chest tightness for 10 years Agravated for 20 days Risk factor: Diabetes 1 year, Angiitis 30 years TAKE HOME MESSAGES For calcified LM bifurcation lesion, intravascular imaging is strongly recommended to help to determine the PCI strategy. Rotablation is effective to modify the calcified plaque in both MV and SB bifurcation lesion DCB may supply an alternative treatment for bifurcation lesions, thus maybe decrease the stent numbers , thrombosis and restenosis risk of side branch.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA LAD CTO and LM treated with TAP Author: Jaskaran Singh Dugal, MD, Jehangir Hospital, India HISTORY 40 year old patient Had anterior wall MI 10 years ago. He was given thrombolytic therapy with STK and subsequently continued on medical management Now presented with retrosternal pain and DOE with minimal exertion ECHO showed anterior wall RWMA hypokinesia EF 50% Risk profile - Hypertension, Hyperlipidimia Syntax Score 30 JCTO score - 2 PLAN Address CTO antegrade/retrograde • LCX/OM Bifurcation LAD/LCX/LMCA Bifurcation LAD/diagonal What Technique?
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING Unprotected LM Trifurcation lesion treated as Two sequential Bifurcations using two different stenting techniques Author: Parminder Singh, MD, DM, PGI Chandigarh, India CASE OBJECTIVE To discuss and learn: Management of LM trifurcation lesion in ACS - simplifying a multiple stent strategy CASE PRESENTATION Patient Demographics: 27 year old Male , a cab driver Clinical History: Recent onset angina class III , one episode of rest angina Dyspnoea on exertion both for last - 25 days Risk Factors: Hypertension Family History of CAD : Father, Paternal Uncle, Paternal Grandfather Diagnostic Tests: ECG revealed ST depression in V3-V6 2D Echo - Normal LV FuncDon , No RWMA ,Normal valves TROPONIN - Elevated LEARNING POINTS Distil left main trifurcation is a complex lesion - Op2mal PCI strategy - not well defined Basic rules of bifurcation lesions can be applied to trifurcation. Keep it simple: Single stent > 2 stent > 3 stent strategy preferred. Simplified by treating trifurcation as two sequential bifurcations, especially if three stent strategy is planned . By combining two stenting techniques for LM trifurcation ,good result can be achieved quickly and safely ,esp. in ACS. IVUS guidance is helpful in optimising procedure results as in other left main lesions.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING True Lumen Sandwiched in Neocarina Role of IVUS in LM CTO Author: Juan Luis Gutierrez Chico, MD, PhD, Cardiac Care - Cardiovascular Heart Centre Marbella, Spain CLINICAL PRESENTATION 54 y.o. male pt Angina CCS II TTE: LVEF 72%, no WMA SPECT: Anterior perfusion defect on exertion TAKE HOME MESSAGE Any subintimal course around carina: alert Importance of imaging to solve complications Subintimal shift? -->Plaque shift --> Carina shift --> Subintimal shift Stent the entry & exit points to subintima