European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION Ideal LM Author: Rober Jan Van Geuns, MD, PhD, Radboudumc, The Netherlands CONCLUSIONS After 2 years, in patients undergoing LM-PCI, a Bioabsorbable Polymer Everolimus-Eluting Platinum Chromium stent (Synergy) followed by 4 months DAPT was non-inferior to a Permanent Polymer Everolimus- Eluting Cobalt Chromium stent (Xience) followed by 12 months DAPT with respect to the composite end point of death from any cause or MI or ischemia-driven target vessel revascularization. No difference in ischemic events up to 24 months • No difference in definite/probable stent thrombosis • No stent thrombosis in either group from 4 to 12 months (Synergy off DAPT) Excess BARC 3 or 5 bleeding in short DAPT group but... •4/11 were on OAC/NOAC (2 on triple Rx) and 7/11 were off DAPT • Trial not powered for bleeding events
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.
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
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
European Bifurcation Club 2005, EBC 2005 - Bordeaux, France DEBATE - Which approach for LM stenting with DES? Which approach for LM stenting with DES? Insights from the Thoraxcenter DES Author: Angela Hoye, MD, Castle Hill Hospital, UK METHODOLOGY As a policy, all elective patients presenting with significant (>50% by visual estimation) LM disease are evaluated by both interventional cardiologists and cardiac surgeons and the decision to opt for PCI or surgery is reached by consensus The interventional strategy was left to the operator’s discretion All patients were maintained on lifelong aspirin, with clopidogrel for 1 month in those treated with BMS, and 6 months for those treated with DES MACE: death CONCLUSION Compared with historical data of bare metal stents, the adverse event rate is lower following DES implantation for LMS disease The majority of adverse events occur within 1 year The long-term angiographic outcome of the main vessel was not significantly affected whether or not the side branch was stented The long-term angiographic outcome of non-stented side branches was similar to that of stented side branches Both single stent and 2-stent strategies appear to be reasonable options for the therapy of distal LMS disease There is unlikely to be a single strategy that is broadly applicable to all anatomies and lesion subtypes. Further research with randomised studies is needed to evaluate outcomes with respect to the strategy used for differing bifurcation lesions