2019 Barcelona Archives - Page 6 of 10 - European Bifurcation Club

Impella and LM Stenting with PS and POT: Keep it Simple

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CASES SESSIONS - TIPS & TRICKS Impella and LM Stenting with PS and POT: Keep it Simple Author: Johan Bennett, MD, PhD, University Hospitals Leuven, The Netherlands CLINICAL CASE 64 year old male Diabetes Mellitus, ex-smoker Prostrate cancer with bone mets (stable on hormone therapy) Presented with ACS and pulmonary oedema SUMMARY Protected High risk PCI of LM bifurcation Impella CP supported Ventriculo-arterial uncoupling Provisional LM stenting Intracoronary imaging to ensure optimal result

A case of huge coronary perforation during insertion of a long stent in severe calcified bifurcation lesion

A case of huge coronary perforation during insertion of a long stent in severe calcified bifurcation lesion Author: Yoshinobu Murasato, MD, PhD, Kyushu Medical Center, Japan Take home messages: • A long stent insertion in the calcified bifurcation lesion led to stack of the stent and S-figure flection which resulted in huge coronary perforation. • The situation that 1/3 of the stent remained in the guiding catheter might induce strong push-ability to make S-figure flection in the coronary artery. • When we feel hard resistance during insertion of a long stent, we should consider another option as the following earlier. Biplane fluoroscopy for detailed observation of the stent stack Buddy wire to change the wire bias Guide extension catheter to enhance back-up force and prevent the stent flection inside the coronary artery.

Protective Strategy for Side Branch in Complex Bifurcation Lesions During PCI

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain COMPLICATION CASES Protective Strategy for Side Branch in Complex Bifurcation Lesions During PCI Author: Man Wang, MD, Fuwai Hospital, China SUMMARY Provisional stenting strategy is preferred in non-left main BIF Jailed balloon technique is effective for keeping side branch open with high success rate of rewiring Easy withdrawal of jailed wire and balloon in SB Rewiring and final KBI is not necessary when SB TIMI flow is 3

Unexpected Global Dissection

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain COMPLICATION CASES Unexpected Global Dissection Author: Jorge Palazuelos Molinero, MD, PhD, Prof A. CASE REPORT. INDEX ANGIOGRAPHY Female, 70 yo. HTN. Referred to cath lab for chest pain with posi1ve exercise test CONCLUSION Keep calm Patient care Step by step approach: 1. expert operator supervision 2. Adequate material Be aware of deep intuba1on, extensor catheters and mechanical contrast injections

Short LM – Problem of ostial coverage

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain COMPLICATION CASES Devil wears Prada: LM stenting, problem of ostium coverage Author: Himanshu Gupta, MD, DM, PGI Chandigarh, India CLINICAL PROFILE 50 Years Male HTN, No DM, Former Smoker 1 episode of Syncope 10 days back ECG – Normal with no baseline ST changes Evaluated at OSH and found to have CAD LVEF- Normal LV function with no baseline RWMA or valve disease PROBLEM After FKB the LAD wire position was lost as the balloon got stuck on the wire LAD rewired with another wire Position of the fresh LAD wire in doubt?? LCX wire is good–Maybe, we have done a FKB already LEARNING POINTS Short LM and abnormal take off can cause problems FKB not mandatory in provisional SB strategy If u KISS – It should be good and safe Rewiring always after POT – But be careful Use dual lumen catheter to wire SB if in doubt Never do POT on SB wire Use Guide extension to prevent LSD Angiographic follow up if possible

Extreme Left Main stem calcification: ROTASHOCK combination

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

How to treat an Ostial LAD Bifurcation Lesion

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

How imaging changed my strategy

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%

A case of IVUS to LM Bifurcation lesion with IABP support

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

A case of LAD CTO reperfusion guiding by 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