Day 1 Archives - Page 4 of 6 - European Bifurcation Club

Read more about the article Computational hemodynamics in patient specific stented bifurcations reconstructed from intravascular imaging

Computational hemodynamics in patient specific stented bifurcations reconstructed from intravascular imaging

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS Computational hemodynamics in patient specific stented bifurcations reconstructed from intravascular imaging Author: Claudio Chiastra, MD, Politecnico di Torino, Italy CONCLUSION 3D reconstruction of stented coronary bifurcation models from OCT and angiography (or CT) --> Highly-detailed patient-specific CFD analyses Open issues 3D reconstruction CFD simulations --> Application to large clinical datasets still require a reliable, very fast methodology

DK-Culotte: Bench Evaluation

EBC 2019 - Friday 18th October 2019 DK-Culotte: bench evaluation - Benefits of DK-approach during Culotte stenting Author: Gabor G. Toth, MD, PhD, University Heart Centre Graz, Austria

DK Crush vs tap. In vitro comparison of thrombogenicity and flow

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS DK Crush vs tap. In vitro comparison of thrombogenicity and flow Author: Valeria Paradise, MD, Maasstad Hospital, Rotterdam, The Netherlands OBJECTIVE The purpose of the present study was to compare DKC vs TAP technique to evaluate their different effects in terms of strut apposition and thrombus formation in in-vitro models using OCT and computational flow reconstruction. METHODS N= 12 stents in total (Synergy n=6 and Ul(master=6) Bifurcation y-shaped model Stent with same platform were deployed using TAP or DKC technique Final POT was performed for all the experiments OCT pullback was performed from MV and SB before and after POT A peristaltic pump was used to perfuse the porcine blood through the silicone model at a flow rate of 200ml/min for 4 minutes Thrombus area was calculated from OCT pullback after perfusion CONCLUSION No difference in terms of stent struts apposition Similar acute thrombus formation POT significantly reduces EI Even when performed in silicon model, these procedures are associated with stent malapposition

Read more about the article Risk of Re-POT: Effect of proximal balloon edge dilation technique for opening side branch ostium in re proximal optimzing sequence

Risk of Re-POT: Effect of proximal balloon edge dilation technique for opening side branch ostium in re proximal optimzing sequence

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS Risk of Re-POT: Effect of proximal balloon edge dilation technique for opening side branch ostium in re proximal optimzing sequence Author: Teruyoshi Kume, MD, Kawasaki Medical School Hospital, Japan CONCLUSION Re-POT sequence is excellent PCI procedure for bifurcation lesions. In re-POT sequence, PBED technique with short balloon for SB inflation might minimize the worsening of jailing ratio at SB ostium during second POT procedure.

Risk of stent sizing according to the distal MV in LM bifurcation

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS Risk of stent sizing according to the distal MV in LM bifurcation Author: Yutaka Hikichi, MD, PhD, Saga University, Japan BACKGROUND AND PURPOSE OF THE EXPERIMENT Size selection: according to the distal MB reference? Hypothesis: Stent size influence the acute outcome Implantation methods CONCLUSION When performing a crossover stent to LMT-LAD, the stent size should be selected according to the vessel diameter on the proximal side of the bifurcation. By selecting a larger stent size, the incomplete stent apposition area can be reduced at the LCx ostium after KBT. By doing so, incomplete stent apposition volume can be reduced at the LM-shaft after KBT , and the stent expansion rate can be greatly increased. The risk of injury on the LAD distal side during stent implantation can be reduced by thorough pre- dilatation and devising the stent placement method.

Flow disturbance due to incomplete stent apposition

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS Flow disturbance due to incomplete stent apposition Author: Kiyotaka Iwasaki, PhD, Waseda University, Japan BACKGROUNDS In left main bifurcation, difference between LMT (proximal) and LAD (distal) diameters is lager compared with that in other bifurcation. Stenting without POT would induce incomplete stent apposition at proximal bifurcation side. KBT is recommended to open overlaying stent of side branch ostium especially in LM Bifurcation, because the overlaying jailed stent will potentially occupy larger at LCx and become a source for future thrombus formation, neointimal formation, and late narrowing. Although stent-size selection based on distal diameter is recommended, there is a dilemma that currently available stents have smaller expansion capability when stent-size is chosen based on distal stent-landing diameters in LAD. SUMMARY AND TAKE HOME MESSAGES POT and KBT are mandatory to reduce incomplete stent apposition. Otherwise, abnormal slow flow regions were induced at left main trunk and/or behind jailed stent crowns during the cardiac cycle, which would be a potential cause of thrombus formation and may necessitate life-long DAPT. Stent-diameter selection based on the proximal- vessel diameter is feasible to preserve stent platform design at LMT and bifurcated region, and to reduce jailed stent crowns at LCx ostium. Three-times kissing balloon inflation is feasible for reducing jailed stent crowns.

Introduction: Are bifurcation stenting simulations needed?

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS Introduction: Are bifurcation stenting simulations needed? Author: Habib Samady, MD, FACC, Emory University Hospital, USA ARE BIFURCATION STENTING SIMULATIONS NEEDED? - YES Outcomes of bifurcation PCI are not optimal Bench Micro CT studies can inform bifurcation stenting strategies Macro or vessel level hemodynamics require 3 D vessel and stent reconstruction Micro or strut level hemodynamics require complex and time consuming computational techniques for evaluating the interaction of plaque prolapse, strut morphology and perhaps stent healing Prospective studies (SHEART STENT and ISR FLOW) are underway to investigate the prognostic value of hemodynamics as they relate to vascular healing of in angulated and bifurcation PCI.

Call for the Participation in Bifurcation DEB Trials

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BIFURCATION AND DRUG ELUTING BALLOONS - VOTING Call for the Participation Bifurcation DEB Trials Author: Sudhir Rathore, MD, Frimley Health NHS Foundation Trust, UK Provisional Group: Main vessel DES + KBI+POT vs. MV DES + DEB to SB+ POT: Late Loss/ Binary restenosis at SB/MB/ MACE 2 stent strategy: (SB> 70%/ 10 mm ): 2 stent+ KBI vs. MV DES + DEB to SB + KBI Call for meeting to discuss the results of polling and further discussion.

DCB in the treatment of bifurcations: Scenarios for future studies

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BIFURCATION AND DRUG ELUTING BALLOONS - VOTING DCB in the treatment of bifurcations: Scenarios for future studies Author: Juan Luis Gutierrez Chico, MD, Cardiac Care - Cardiovascular Heart Centre Marbella, Spain 4 POSSIBLE SCENARIOS 1st scenario: NORDIC-III-like 2nd scenario: BBC-ONE-like 3rd scenario: rePOT 4th scenario: rePOT-DOT

Bifurcation treatment without a stent?

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BIFURCATION AND DRUG ELUTING BALLOONS - VOTING Bifurcation treatment without a stent? Author: Klaus Bonaventura, MD, Klinikum Ernst von Bergmann, Potsdam, Germany CONCLUSION DCB showed proven efficacy and safety in ISR and de-novo-lesions - especially in small vessels. Lesion preparation is essential in DCB treatment - but might be more challenging in bifurcation lesions. Data from small trials and individual experiences support the use of DCB in bifurcations - but we are missing THE bifurcation study.