Bifurcation Archives - Page 4 of 12 - European Bifurcation Club

A left main distal trifurcation lesion: what did I do

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING A left main distal trifurcation lesion: what did I do Author: Shih Hung Chan, MD, PhD, National Cheng Kung University Hospital, Taiwan PATIENT CHARACTERISTICS A 49-year-old male had hypertension and hyperlipidemia. He had already received percutaneous coronary intervention twice for non-ST elevation myocardial infarction and unstable angina pectoris in the past few years. This Ame, he presented with crescendo angina for 1 month. Renal function was normal. TREATMENT STRATEGIES LV assistance device: nil Debulking/plaque modification: No marked calcification: not needed in the beginning In case needed, considering cutting balloon, scoring balloon,or rotational atherectomy Intravascular image: Definitely needed IVUS Antithrombotic: aspirin, clopidogel, and heparin Stenting strategy TAKE HOME MESSAGES Percutaneous coronary intervention (PCI) for left main trifurcation lesion is challenging. No one-size-fits-all strategy is available The choice of treatment strategy is depended on the discrepancy between vessel size, extent of calcification, angle between vessels, etc. To be familial with various PCI techniques, including provisional one stent and two-stent technique as well as the way to protection side branch, is the key to successful PCI for leI main trifurcation lesion

Double Debulking for LM True Bifurcation Lesion

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING Double Debulking for LM True Bifurcation Lesion Author: Yoshihisa Kinoshita, MD, Toyohashi Heart Center, Japan CONCLUSION Although short DAPT theory becomes widespread recently, we have to keep DAPT after stenting at least 3 to 6 months at least. Especially, it is difficult to stop DAPT within 1 month for the patient who have stent in LM bifurcation lesion. However, there are some patients who cannot continue enough DAPT because of their underlying condition. Aggressive debulking without stenting occasionally brings a favorable result for such patients.

Get Clarity with OCT for LM and Bifurcation PCI Case 1 Complex Bifurcation

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain ABBOTT SYMPOSIUM Get Clarity with OCT for LM and Bifurcation PCI Case 1 Complex Bifurcation Author: Tom Johnson, MD, Bristol Heart Institute, UK CASE SUMMARY Stent failure MANDATES intra-vascular imaging Stent under-expansion common driver but multifactorial Image guidance for plaque modification is critical

Get clarity with OCT for LM and bifurcation treatment

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain ABBOTT SYPOSIUM Get clarity with OCT for LM and bifurcation treatment - Introduction Author: Thierry Lefevre, MD, ICPS, France

Megatron Synergy – The new addition to the synergy family

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BOSTON SYMPOSIUM Megatron Synergy. The new addition to the synergy family Author: Yiannis Chatzizisis, MD, PhD, University of Nebraska Medical Center, USA ONGOING/ FUTURE WORK Testing the performance of Megatron with 2-stent techniques in a larger cohort of LM bifurcations Head-to-head comparison of Megatron with other second generation DES Testing the performance of new purpose-built stents dedicated to other segments of the coronary tree e.g, distal segments A large, virtual clinical trial to show improved morphologic and biomechanical endpoints (which serve as surrogates of clinical outcomes) with purpose-built stents.

A patient with distal LM disease and large diameter discrepancy between LAD and LM

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BOSTON SYMPOSIUM A patient with distal LM disease and large diameter discrepancy between LAD and LM Author: Jens Flensted Lassen, MD, PhD, Odense University Hospital, Denmark PATIENT HISTORY Male, 60 years, Severe COL, Reduced FEV 1, EF 35 %, Diabetes, Hypertension. Family history of ischemic heart disease. Mid LAD stenosis Ostial LAD stenosis, With plaque in LM FFR: 0.67 (distally LAD) and 0.79 (between LM and proximal LAD.) Heart team decision: PCI

Read more about the article Computational hemodynamics in patient specific stented bifurcations reconstructed from intravascular imaging

Computational hemodynamics in patient specific stented bifurcations reconstructed from intravascular imaging

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS Computational hemodynamics in patient specific stented bifurcations reconstructed from intravascular imaging Author: Claudio Chiastra, MD, Politecnico di Torino, Italy CONCLUSION 3D reconstruction of stented coronary bifurcation models from OCT and angiography (or CT) --> Highly-detailed patient-specific CFD analyses Open issues 3D reconstruction CFD simulations --> Application to large clinical datasets still require a reliable, very fast methodology

DK Crush vs tap. In vitro comparison of thrombogenicity and flow

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS DK Crush vs tap. In vitro comparison of thrombogenicity and flow Author: Valeria Paradise, MD, Maasstad Hospital, Rotterdam, The Netherlands OBJECTIVE The purpose of the present study was to compare DKC vs TAP technique to evaluate their different effects in terms of strut apposition and thrombus formation in in-vitro models using OCT and computational flow reconstruction. METHODS N= 12 stents in total (Synergy n=6 and Ul(master=6) Bifurcation y-shaped model Stent with same platform were deployed using TAP or DKC technique Final POT was performed for all the experiments OCT pullback was performed from MV and SB before and after POT A peristaltic pump was used to perfuse the porcine blood through the silicone model at a flow rate of 200ml/min for 4 minutes Thrombus area was calculated from OCT pullback after perfusion CONCLUSION No difference in terms of stent struts apposition Similar acute thrombus formation POT significantly reduces EI Even when performed in silicon model, these procedures are associated with stent malapposition

Read more about the article Risk of Re-POT: Effect of proximal balloon edge dilation technique for opening side branch ostium in re proximal optimzing sequence

Risk of Re-POT: Effect of proximal balloon edge dilation technique for opening side branch ostium in re proximal optimzing sequence

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS Risk of Re-POT: Effect of proximal balloon edge dilation technique for opening side branch ostium in re proximal optimzing sequence Author: Teruyoshi Kume, MD, Kawasaki Medical School Hospital, Japan CONCLUSION Re-POT sequence is excellent PCI procedure for bifurcation lesions. In re-POT sequence, PBED technique with short balloon for SB inflation might minimize the worsening of jailing ratio at SB ostium during second POT procedure.

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.