Day 1 Archives - Page 3 of 6 - European Bifurcation Club

How to treat recurrent lmca instent restenosis

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING How to treat recurrent lmca instent restenosis Author: Jo Dens, MD, PhD and Daan Cottens, MD, hospital Oost-Limburg Genk, Belgium CASE PRESENTATION Male, 71 years old Presenting symptom: – Stable angina CCS 2-3 Cardiovascular risk factors: – Ex-smoker, DM +, AHT +, dyslipidemia + Medication: – Acetylsalicylic acid 80mg 1dd, clopidogrel 75mg 1dd, atorvastatin 10mg 1dd, lisinopril 20mg 1dd, bisoprolol 5mg 1dd, metformin 850mg 3dd, gliclazide 60mg 1dd, allopurinol 300mg 1dd, sublingual nitrates as needed Medical history: 1991: Myocardial infarction R/ CABG LIMA>L1cx ; RIMA>distal RCA 4/2017: Stable angina (medina 1-1-1 severe distal LMCA bifurcation stenosis) + D1 4/2017: PCI culo[e LMCA (TRYTON) + PCI D1 12/2018: Stable angina CCS 2: in-stent restenosis LMCA 12/2018: PCI LMCA – OCT guided stent optimization + drug eluting balloon SUMMARY In-stent re-restenosis remains a challenging issue Recurrence rate is high (> 5%->20%) OCT guided revascularization is preferred Different options... High pressure balloons/cutting balloons Intravascular lithotripsy Laser In-stent rota... CABG

Extreme Left Main Stem Calcification

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING Extreme Left Main Stem Calcification: Rotashock combination therapy Author: Peter O'Kane, MD FRCP, 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 PCI STRATEGY 7F EBU3.5 Guide RT wire LAD & SB wire LCx Sapphire 2.0x20 balloon not cross LAD •Rotational atherectomy 2 stent technique - culotte of DK Crush • IVUS guided throughout

A left main distal trifurcation lesion: what did I do

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING A left main distal trifurcation lesion: what did I do Author: Shih Hung Chan, MD, PhD, National Cheng Kung University Hospital, Taiwan PATIENT CHARACTERISTICS A 49-year-old male had hypertension and hyperlipidemia. He had already received percutaneous coronary intervention twice for non-ST elevation myocardial infarction and unstable angina pectoris in the past few years. This Ame, he presented with crescendo angina for 1 month. Renal function was normal. TREATMENT STRATEGIES LV assistance device: nil Debulking/plaque modification: No marked calcification: not needed in the beginning In case needed, considering cutting balloon, scoring balloon,or rotational atherectomy Intravascular image: Definitely needed IVUS Antithrombotic: aspirin, clopidogel, and heparin Stenting strategy TAKE HOME MESSAGES Percutaneous coronary intervention (PCI) for left main trifurcation lesion is challenging. No one-size-fits-all strategy is available The choice of treatment strategy is depended on the discrepancy between vessel size, extent of calcification, angle between vessels, etc. To be familial with various PCI techniques, including provisional one stent and two-stent technique as well as the way to protection side branch, is the key to successful PCI for leI main trifurcation lesion

Double Debulking for LM True Bifurcation Lesion

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING Double Debulking for LM True Bifurcation Lesion Author: Yoshihisa Kinoshita, MD, Toyohashi Heart Center, Japan CONCLUSION Although short DAPT theory becomes widespread recently, we have to keep DAPT after stenting at least 3 to 6 months at least. Especially, it is difficult to stop DAPT within 1 month for the patient who have stent in LM bifurcation lesion. However, there are some patients who cannot continue enough DAPT because of their underlying condition. Aggressive debulking without stenting occasionally brings a favorable result for such patients.

Get Clarity with OCT for LM and Bifurcation PCI Case 1 Complex Bifurcation

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain ABBOTT SYMPOSIUM Get Clarity with OCT for LM and Bifurcation PCI Case 1 Complex Bifurcation Author: Tom Johnson, MD, Bristol Heart Institute, UK CASE SUMMARY Stent failure MANDATES intra-vascular imaging Stent under-expansion common driver but multifactorial Image guidance for plaque modification is critical

Get clarity with OCT for LM and bifurcation treatment

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain ABBOTT SYPOSIUM Get clarity with OCT for LM and bifurcation treatment - Introduction Author: Thierry Lefevre, MD, ICPS, France

Megatron Synergy – The new addition to the synergy family

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BOSTON SYMPOSIUM Megatron Synergy. The new addition to the synergy family Author: Yiannis Chatzizisis, MD, PhD, University of Nebraska Medical Center, USA ONGOING/ FUTURE WORK Testing the performance of Megatron with 2-stent techniques in a larger cohort of LM bifurcations Head-to-head comparison of Megatron with other second generation DES Testing the performance of new purpose-built stents dedicated to other segments of the coronary tree e.g, distal segments A large, virtual clinical trial to show improved morphologic and biomechanical endpoints (which serve as surrogates of clinical outcomes) with purpose-built stents.

A patient with distal LM disease and large diameter discrepancy between LAD and LM

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BOSTON SYMPOSIUM A patient with distal LM disease and large diameter discrepancy between LAD and LM Author: Jens Flensted Lassen, MD, PhD, Odense University Hospital, Denmark PATIENT HISTORY Male, 60 years, Severe COL, Reduced FEV 1, EF 35 %, Diabetes, Hypertension. Family history of ischemic heart disease. Mid LAD stenosis Ostial LAD stenosis, With plaque in LM FFR: 0.67 (distally LAD) and 0.79 (between LM and proximal LAD.) Heart team decision: PCI

LM bifurcation PCI with the novel Megatron Synergy Stent: a case based discussion

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BOSTON SYMPOSIUM LM bifurcation PCI with the novel Megatron Synergy Stent: a case based discussion - Introduction Author: Thierry Lefevre, MD, PhD, ICPS, France The dream of interventional cardiologist for LM disease A stent with a good radial strength With more than 2 connectors A good visibility A low risk of longitudinal compression An optimal scaffolding and drug delivery An easy side branch access

European big data club: Updates from flow ISR study

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS European big data club: Updates from flow ISR study Author: Yiannis Chatzizisis, MD, PhD, University of Nebraska Medical Center, USA TAKE HOME MESSAGES Simulations --> Big data --> AI (๏ Machine learning ๏ Deep learning) --> Output (๏ Risk prediction ๏ Therapy)