European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING Algorithm when to perform OCT to optimize efficiency can we overcome OCTS limitations Author: Takayuki Okamura, MD, Yamaguchi University Hospital, Japan SUMMARY Pre-procedure OCT assessment in the main vessel provides useful information for bifurcation stenting. However, ostial assessment is fundamentally impossible, a potential disadvantage compared to IVUS, and more contrast media is used. Some ingenuities may overcome them. The biggest advantage of OCT compared to IVUS would be the guidance of the position of the guidewire into the jailed side branch when the side branch dilatation is performed. Further studies whether OCT guidance can improve clinical outcomes would be needed.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING Impact of Bifurcation Angle on Incomplete Stent Apposition Author: Masahiro Yamawaki, MD, Saiseikai Yokohama City Eastern Hospital, Japan PURPOSE To investigate the impact of the “Link free and distal re-wiring(LFD)” condition and bifurcation angle on 9-month OCT findings after 1-stenting with final kissing inflation(FKI). CONCLUSION High bifurcation (>55°) angle should be care in case of link-free on carina and distal wiring , due to uncorrected stent distortion on the opposite of side branch (SB) and distal main vessel (MV) by final kissing balloon inflation (FKI), but incomplete stent apposition (ISA) in MV decreased after 9 months Impact of bifurcation angle on 9-month OCT data was minor than those of “link and re-wire position” before FKI in this registry. FKI with optimal condition under 3D-OCT guidance reduced uneven neointima proliferation, ISA and uncovered strut after 9 months. Further study is required to demonstrate clinical impact of OCT guided bifurcation treatment.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING What are the best imaging criteria for adequate stent expansion and apposition in bifurcation lesion Author: Nicolas Amabile, MD, PhD, Institut Mutualiste Montsouris , Paris , France CONCLUSION Best imaging criteria for bifurcation PCI quality assessment are not completely established. Although consensus criteria exist for non bifurcated lesions, they might not be applicable “as they are” to bifurcations. Malapposition criteria can be applied for MV and MB. Special alention must be given in the future to redefine our objectives for adequate stent expansion.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING Imaging-guided rewiring in bifurcation : 2D and 3D OCT Author: Ryoji Nagoshi, MD, Osaka Saiseikai Nakatsu Hospital, Japan OBJECTIVE The aim of the study is to assess the impact of 3D-OCT on the procedures for bifurcation stenting including the guide wire (GW) distal rewiring rates. SUMMARY The rate of the distal GW rewiring can be higher by referring to the 3D image than only with the 2D image. The stent link loca0on over Sb orifice is important. The optimal GW rewiring position may depend on the stent link location over carina. In the LC type, it is better to consider the difference of the GW rewiring position in not only the longitudinal but also the short axis directions. CONCLUSION Three-dimensional OCT is useful for the attainment of the GW distal rewiring and provides the important information of the stent link location which cannot be revealed by the other intravascular imaging modalities.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING Plaque characters in bifurcation lesion Efficient Strategy Selection by Intracoronary Imaging Author: Nieves Gonzalo, MD, Hospital Clinico San Carlos, Spain MESSAGES Intracoronary imaging is useful to determine the plaque composition and confirm an adequate plaque preparation. Information regarding plaque distribution, calcium loca.on and vessel size can be used to select the bifurcation stenting technique
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING Balloons and stent sizing for bifurcation PCI Role of Intra-coronary Imaging Author: Yoshinobu Murasato, MD, PhD, Kyushu Medical Center, Japan TAKE HOME MESSAGES Device sizing (general): EEL-based reference diameter measurement is firstly recommended. In case of invisible EEL, lumen-based measurement is also available. For the optimal stent landing zone, it is important to avoid dissection, > 50% plaque burden, and lipid pool. Device sizing: bifurcation lesion POT and KBI balloon should be selected according to vascular branching law. In the bifurcation lesion, Finet’s law is applicable for imaging-guide reference diameter measurement, not for angio-based one. Stent should be selected considering maximal expansion capacity. Minimum expansion index considering vascular branching and tapering is more physiological to select post-dilation site and appropriate balloon.