LM Bifurcation Complication or ‘should we have touched it?’
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CASE SESSION - TIPS & TRICKS LM Bifurcation Complication or 'should we have touched it?' LM DEB PCI on high risk bleeding…
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
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 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
Struts across side branch an oct follow up
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA Struts across side branch an oct follow up Author: Rony Mathew, MD, DM, Lisie Heart Institute – Lisie Hospital Cochin, India CONCLUSION Struts across a major side branch may be a predictor of side branch re-stenosis. - Neo-intimal growth over the struts will compromise the side branch ostia over time. Proposed hypothesis: - Struts across SB on OCT Imaging may be an indication to kiss/PSP, even if the ostia is not compromised on angiography. Follow up OCT study required.
Use of DES and DCB in LM Bifuration Lesion
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA Use of DES and DCB in LM Bifuration Lesion Author: Zhanying Han, MD, First Affiliated Hospital of Zhengzhou University, China BACKGROUND Although several stenting techniques are available for the treatment of de novo coronary bifurcation lesions. The treatment of coronary artery bifurcation still represents a challenge for interventional cardiologist. over the past years, different studies have proposed and analysed the use of drug-coated balloon (DCB) in the treatment of coronary artery bifurcation lesions as an alternative treatment. CLINICAL CHARACTERISTICS Zhang Q Female 76years Paroxysmal chest tightness for 10 years Agravated for 20 days Risk factor: Diabetes 1 year, Angiitis 30 years TAKE HOME MESSAGES For calcified LM bifurcation lesion, intravascular imaging is strongly recommended to help to determine the PCI strategy. Rotablation is effective to modify the calcified plaque in both MV and SB bifurcation lesion DCB may supply an alternative treatment for bifurcation lesions, thus maybe decrease the stent numbers , thrombosis and restenosis risk of side branch.
LAD CTO and LM treated with TAP
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA LAD CTO and LM treated with TAP Author: Jaskaran Singh Dugal, MD, Jehangir Hospital, India HISTORY 40 year old patient Had anterior wall MI 10 years ago. He was given thrombolytic therapy with STK and subsequently continued on medical management Now presented with retrosternal pain and DOE with minimal exertion ECHO showed anterior wall RWMA hypokinesia EF 50% Risk profile - Hypertension, Hyperlipidimia Syntax Score 30 JCTO score - 2 PLAN Address CTO antegrade/retrograde • LCX/OM Bifurcation LAD/LCX/LMCA Bifurcation LAD/diagonal What Technique?