How to treat recurrent lmca instent restenosis

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING How to treat recurrent lmca instent restenosis Author: Jo Dens, MD, PhD and Daan Cottens, MD, hospital Oost-Limburg Genk, Belgium CASE PRESENTATION Male, 71 years old Presenting symptom: – Stable angina CCS 2-3 Cardiovascular risk factors: – Ex-smoker, DM +, AHT +, dyslipidemia + Medication: – Acetylsalicylic acid 80mg 1dd, clopidogrel 75mg 1dd, atorvastatin 10mg 1dd, lisinopril 20mg 1dd, bisoprolol 5mg 1dd, metformin 850mg 3dd, gliclazide 60mg 1dd, allopurinol 300mg 1dd, sublingual nitrates as needed Medical history: 1991: Myocardial infarction R/ CABG LIMA>L1cx ; RIMA>distal RCA                                                         4/2017: Stable angina (medina 1-1-1 severe distal LMCA bifurcation stenosis) + D1 4/2017: PCI culo[e LMCA (TRYTON) + PCI D1 12/2018: Stable angina CCS 2: in-stent restenosis LMCA 12/2018: PCI LMCA – OCT guided stent optimization + drug eluting balloon SUMMARY In-stent re-restenosis remains a challenging issue Recurrence rate is high (> 5%->20%) OCT guided revascularization is preferred Different options... High pressure balloons/cutting balloons Intravascular lithotripsy Laser In-stent rota... CABG

Extreme Left Main Stem Calcification

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING Extreme Left Main Stem Calcification: Rotashock combination therapy Author: Peter O'Kane, MD FRCP, 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 PCI STRATEGY 7F EBU3.5 Guide RT wire LAD & SB wire LCx Sapphire 2.0x20 balloon not cross LAD •Rotational atherectomy 2 stent technique - culotte of DK Crush • IVUS guided throughout

New dedicated bifurcation balloon

European Bifurcation Club 2016 - EBC 2016 - Rotterdam, The Netherlands News New dedicated bifurcation balloon Author: Dr K. Al-Saadon, MD CEO, MEDIX INNOVATORS, Ontario , Canada DOWNLOAD HERE