Stop DAPT2 High Bleeding Risk sub analysis

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 STOPDAPT2 HBR Bifurcation. 1 Year outcomes from a Randomized Trial of Clopidogrel Monotherapy VS DAPT Beginning 1 Month After PCI in Patients at High Bleeding Risk Author: Hirotoshi Watanabe, MD, Kyoto University Hospital, Japan LIMITATIONS Post-hoc, and underpowered analysis. Precise ARC-HBR could not be applied.  Very few patients participated in this study with 2-stents for bifurcation. Japanese patients are known to have lower ischemic risk and higher bleeding risk compared with US/European population CONCLUSION The effects of 1-month DAPT versus 12-month DAPT on the primary and major secondary endpoints were consistent in HBR patients and any bifurcation strategy without any significant interactions. One-month DAPT was associated with significant reduction of major bleeding without any increase of cardiovascular events in HBR patients, and the absolute magnitude of bleeding events with 1-month DAPT was numerically greater in HBR patients than in non-HBR patients, although the analysis was underpowered and needed confirmation in future studies. In this study very few patients with complex PCI for bifurcation participated, but there was no sign 1-month DAPT significantly increased the coronary-related events

Bench evaluation of the Fantom scaffold (REVA) in bifurcations

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 Usability of Fantom Bioresorbable Scaffold in Non Complex Bifurcations: Technical Analysis in Bench Models Author: Gabor G. Toth, MD, PhD, University Heart Centre Graz, Austria AIM To evaluate, whether POT-SB-POT technique can be considered as a reasonable bail-out option for Fantom® bioresorbable scaffold, to tackle a simple bifurcation lesion CONCLUSION Fantom® polycarbonate copolymer coronary scaffold is considered to have improved structural characteristics Still, marked structural destruction of the scaffold has been observed in bench models when doing POT-SB-POT approach Considering that POT-SB-POT might be ‘the most gentle’ bifurcation technique from device point of view Therefore the use of Fantom® in any bifurcation anatomy should be strongly discouraged.

Learnings From the Bench and a Thrombogenicity Model

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 Learnings From the Bench and a Thrombogenicity Model Author: Nicolas Foin, MSc, PhD, National Heart Research Institute Singapore; Philips Healthcare, Belgium LEARNINGS FROM THE BENCH Bench models allow to study questions in controlled and reproducible experimental environments Make use tools such as Micro-CT, Radial & Longitudinal Strength tes;ng, 3D printing, Perfusion test, Histology, SEM Microscopy. LIMITATIONS It can only provide a partial model to investigate a question and cannot mimic the entire tissue /plaque characteristics and in-vivo biological response. Results can not always be transposed directly to in-vivo situations and should be interpreted with caution. Bench models complement, but do not replace clinical/imaging studies SUMMARY Stent underexpansion and stent malapposition distances affect flow disturbances and shear rate in a dose-dependent relation. Severe malapposition (ISA distance > 300 um) create higher shear rate with persitent malapposition + uncovered strut at follow-up. In-vitro experiments with perfused blood suggest that large malapposed stent segment create potential sites for platelet adhesion and clot development. Stent optimisation (expansion and apposition) with appropriate sizing, post-dilatation and imaging can improve local hemodynamic environment and reduce area of high shear disturbance.

Early Morning Bench News: DK Double Crush

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 Early Morning Bench News: DK Double Crush Author: Niels Ramsing Holm, MD, Aarhus University Hospital, Denmark SUMMARY Double crush in DK crush may lower risk of sub-optimal SB rewiring Use POT balloon sized to proximal reference Intravascular imaging is still required to firmly rule out suboptimal rewiring Clincal data: OCTOBER trial