2019 Barcelona Archives - Page 9 of 10 - European Bifurcation Club

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.

DEB for In-Stent Restenosis: What about Coronary Bifurcations?

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BIFURCATION AND DRUG ELUTING BALLOONS - VOTING DEB for in Stent Restenosis: What about Coronary Bifurcations? Author: Fernando Alfonso, MD, PhD, Hospital Universitario de La Princesa, Madrid, Spain DEB for ISR: When DEB are preferred over DES? Multiple previous stent layers? High-bleeding risk? FirstISR (DES for recurrences)? ISR at bifurcation (relevant branch) Data? CONCLUSION DES & DEB for Pts with ISR (IA) DEB for bifurcations DEB preferred for ISR including a relevant bifurcation More evidence is required to identify the best strategy for patients with ISR at bifurcation

Existing data on drug coated balloons and coronary bifurcation treatment

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BIFURCATION AND DRUG ELUTING BALLOONS - VOTING Existing data on drug coated balloons and coronary bifurcation treatment Author: Mario Araya, MD, Clinica Alemana De Santiago/ Thorax National Institute, Chile 4 STRATEGIES TESTED DCB with BMS DCB with DES DCB-only strategy DCB in bifurcaAon restenosis WHERE DO WE STAND Trials of DCB in bifurcaAon treatment use different protocols and devices, in small trials. No POT, low kissing. We need more data. Only paclitaxel-coated balloon have been reported. In general, the use of pDCB appears to be effective and safe in SB. The use of pDCB + BMS is inferior to conventional DES treatment The use of pDCB + DES (Everolimus) show excellent results in small registries . Only-DCB strategy is feasible and safe. In Restenosis of bifurcation, including LM, DCB tx show promising results compare to DES

Existing Drug Coated Balloon Technology

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BIFURCATION AND DRUG ELUTING BALLOONS - VOTING Existing Drug Coated Balloon Technology Author: Deiti Prvulovic, MD, PhD, KBC Rijeka, Croatia CONCLUSION DCB technology evolve toward the development of new delivery methods and new drugs for the broader adoption of these technologies DCB must be tested in RCT with sufficient statistical power to detect at least noninferiority against new generation DES with hard clinical endpoints

Introduction: Bifurcation and drug eluting balloons

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BIFURCATION AND DRUG ELUTING BALLOONS - VOTING Introduction: Bifurcation and drug eluting balloons Author: Sudhir Rathore, MD, Frimley Health NHS Foundation Trust, UK

Read more about the article A randomized trial evaluating on line three dimensional of guided PCI vs angiography guided PCI in bifurcation lesions OPTIMUM STUDY

A randomized trial evaluating on line three dimensional of guided PCI vs angiography guided PCI in bifurcation lesions OPTIMUM STUDY

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING A randomized trial evaluating on line three dimensional of guided pci vs angiography guided pci in bifurcation lesions: optium study Author: Yoshinobu Onuma, MD, PhD, Erasmus Medical Center, The Netherlands BACKGROUND In bifurcation PCI, re-crossing the distal cell with a wire after main vessel stenting is important to avoid creating a de novo metal carina1. Those protruded/malapposed struts result in lower tissue strut coverage of the side branch ostium and more overhanging metal into the main branch after implantation of the stent. Angiography guided PCI is limited in recognizing the recrossing position, while intracoronary imaging during PCI has a potential to visualize the recrossing point and to optimize the acute results. The feasibility of off-line 3-dimensional optical frequency domain imaging (OFDI) in bifurcation and its potential benefits were demonstrated in retrospective studies. However, the feasibility and efficacy of on-line 3D OFDI guided PCI in bifurcation lesion has not yet been fully investigated. OBJECTIVE To determine whether bifurcation PCI guided by on-line 3D- OFDI is superior to bifurcation PCI with angiographic guidance in terms of incomplete stent apposition (ISA) in bifurcation segment. CONCLUSION In the randomized trial of bifurcation PCI, 3D-OFDI guidance was superior to angio-guidance in acute incomplete strut apposition (creation of metal carina) of bifurcation segment (3D-OFDI 19.5±15.8% vs. angio: 27.5%±14.2%, p=0.008). Excellent feasibility of online 3D-OFDI was demonstrated (98%). After mandatory POT, the first wiring position was not optimal in 45% of cases, requiring 2nd attempt to redirect the wire into the optimal cell when 3D-OFDI guidance was used. On-line 3D OFDI images help operator to undergo rewiring to the optimal cell, resulting in a lower rate of malapposition compared with angiography guided PCI.