One Stent Bifurcation Techniques and Possible Bail Out Solutions Using Multimodality Imaging

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain MEDTRONIC SYMPOSIUM One Stent Bifurcation Techniques and Possible Bail Out Solutions Using Multimodality Imaging Author: Goran Stankovic, MD, Clinical Center of Serbia, Serbia BIFURCATION EDUCATION IS NEEDED Collaboration between EBC, Visible Heart Lab (VHL) and Medtronic initiated by EBC at 2012 meeting; There is a need to create: Educational program for fellows and young IC’s, aimed to help understanding bifurcation treatment techniques, complications and outcomes; The idea: A series of case scenarios, where trainee can learn step-by-step performance of different bifurcation stenting techniques and based on a combination of imaging technologies and computer simulation. OBJECTIVES Optimization of provisional one-stent bifurcation PCI technique and possible bail out solutions using multimodality imaging, including Visible Heart lab and OCT.

One Stent Bifurcation Techniques and Possible Bail Out Solutions Using Multimodality Imaging – Introduction

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain MEDTRONIC SYMPOSIUM  - One stent bifurcation techniques and possible bail out solutions using multimodality imaging Introduction Author: Goran Stankovic, MD, Clinical Center of Serbia, Serbia BIFURCATION EDUCATION IS NEEDED Collaboration between EBC, Visible Heart Lab (VHL) and Medtronic initiated by EBC at 2012 meeting; There is a need to create: – Educational program for fellows and young IC’s, aimed to help understanding bifurcation treatment techniques, complications and outcomes; The idea: – A series of case scenarios, where trainee can learn step-by-step performance of different bifurcation stenting techniques and based on a combination of imaging technologies and computer simulation.

The Twilight Trial

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 3 The Twilight Trial: Ticagrelor with or without aspirin in high-risk patients after PCI Author: Vladimir Dzavik, MD, PhD, Toronto General Hospital, Canada TRIAL HYPOTHESIS In patients undergoing PCI who are at high risk for ischemic or hemorrhagic complications and who have completed a 3-month course of dual antiplatelet therapy with ticagrelor plus aspirin, continued treatment with ticagrelor monotherapy would be superior to ticagrelor plus aspirin with respect to clinically relevant bleeding and would not lead to ischemic harm. TRIAL OBJECTIVES Primary Objective: To determine the impact of SAPT (ticagrelor monotherapy) versus DAPT (ticagrelor plus aspirin) for 12 months in reducing clinically relevant bleeding (BARC 2, 3 or 5) among high-risk patients who have undergone successful PCI. Secondary Objective: To determine the impact of SAPT (ticagrelor monotherapy) versus DAPT (ticagrelor plus aspirin) for 12 months on major ischemic adverse events (all-cause death, non-fatal MI or stroke) among high-risk patients who have undergone successful PCI. CONCLUSION In high-risk patients who underwent PCI and were treated with ticagrelor and aspirin for 3 months without any major adverse (bleeding or ischemic) events, an antiplatelet strategy of continuing ticagrelor monotherapy resulted in: substantially less bleeding than ticagrelor plus aspirin without increasing ischemic events over a period of 1 year

Outcome After One Stent Technique in Bifurcation

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 2 Outcome After One Stent Technique in Bifurcation: SB Strut Opening VS. Leave Alone Author: Chang-Wook Nam, MD, PhD, Keimyung University Dongsan Hospital, Korea PURPOSE OF THE CURRENT STUDY The aim of the current study is to evaluate the long-term clinical outcome according to SB opening procedure of bifurcation lesion after 1-stent crossover technique from COBIS 3 registry. LIMITATIONS Not free from selection bias as an observational study. Additional imaging study may have provided more information on the plaque progression The number of patients and events was too small to properly adjust for an adequate statistical power. The duration of a dual antiplatelet therapy for these higher- risk patients is still controversial SUMMARY There is the improvement of acute angiographic result in SB opening after simple crossover stenting. However, SB opening after simple crossover stenting did not show improvement in long-term clinical outcome compared to leave alone after simple crossover stenting. In addition, in both left main and true bifurcation, the simple crossover wit h additional SB opening did not showed a better long-term clinical outcome. Therefore, routine KBT after simple crossover may not be recommended. Provisional approach with FFR guidance will help to select the patients who need additional complex bifurcation procedure.

Feasibility and Efficacy of the Jailed Pressure Wire Technique for Coronary Bifurcation Lesions

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 2 Feasibility and Efficacy of the Jailed Pressure Wire Technique for Coronary Bifurcation Lesions Author: Manuel Pan, MD, Reina Sofia Hospital, Spain BACKGROUND Evaluation of side branch result during PS: A current challenge When to dilate or stenting the side branch? When to do anything else? Until now, good result: TIMI III flow and no significant compromise of SB ostium FFR is a good method to evaluate SB compromise. OBJECTIVES Safety and feasibility of jailed pressure wire. Utility of physiological SB evaluation using iFR as a new index CONCLUSION The use of jailed pressure wire to monitor SB results for bifurcations treated by provisional stenting seems to be safe. The iFR index seems to provide new physiological information about the significance of the SB stenosis.

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.

Ivus guided LAD CTO/LM – bifurcation stenting

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CASE SESSION - TIPS & TRICKS Ivus guided lad cto lm bifurcation stenting Author: Dr Joby K Thomas, MD, DM, Caritas Hospital Kerala, India SUMMARY Patient underwent CABG and mitral valve repair in 2014 at a different hospital Had effort angina which revealed occluded LIMA and both SVGs(2017) They attempted PTCA , did RCA and ‘ramus ‘ stenting LAD was ostial CTO , which they could not succeed in doing Patient still has angina Check angio showed patent stents in RCA and ‘ramus’ That converted a 0,1,1 LM distal bifurcation to 0,1,0 But LAD ostial CTO with no stump