LM Bifurcation Distal PCI – If You Use Crush Technique It Should Be DK Crush

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CONSENSUS SESSION - VOTING LM Bifurcation Distal PCI - If You Use Crush Technique It Should Be DK Crush Author: Imad Sheiban, MD, PhD, Pederzoli Hospital -Pechiera D/G (Verona), Italy Left main Bifurcation : It is different , not MV- SB but 2 MVs .. Optimal treatment should be provided for both branches TAKE HOME MESSAGES: For complex LM BLs, 2-stent technique especially DK crush is associated with Excellent clinical outcome Serial Randomized Clinical Trials were able to demonstrate that in complex bifurcations , DK Crush is associated with better clinical outcome as compared to other techniques and should be be considered a the gold standard when crush technique is used

Long Term Outcome of DK Crush Studies on LMB

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION Long Term Outcome of DK Crush Studies on LMB Author: Zhaoqing Sun, MD, Shengjing Hospital Affiliated to China Medical University, China SUMMARY A simple LMB lesion can be treated with a single-stent provisional approach ; while a 2-stent strategy is preferred for complex lesions DK-Crush is an optimal choice in 2-stent strategy The ongoing EBC MAIN study will provide additional information on the optimal treatment of LMCA bifurcation lesions

Nano Crush in Left Main

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 3 Nano Crush in Left Main Author: Gianluca Rigatelli, MD, PhD, Rovigo General Hospital, Italy NANO CRUSH FACTS 2014 : conceiving the technique and first application of the technique in LM and non-LM patients 2015 : application in shock patients 2017 : publication first preliminary series in Cardiovasc Revasc Med 2018 : publication of bench and computational fluid dynamic study in Cathet Cardiovasc Interv 2019 : Nano-Crush in Left main and cardiogenic shock in Cardiovasc Revasc Med 2019 : comparison between Nano-Crush and Culotte in Left main in Int J Cardiovasc Imag CONCLUSION Nano-crush stenting in Left Main showed improved long- term outcomes with low TVF, low mortality and 0% thrombosis compared to other double stent techniques Nano-crush stenting in Left Main provided easy and fast revascularization, low X-ray exposure and low contrast dose Nano-crush stenting can be an alternative to DK-crush in complex Left Main bifurcation disease

Early Morning Bench News: DK Double Crush

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 Early Morning Bench News: DK Double Crush Author: Niels Ramsing Holm, MD, Aarhus University Hospital, Denmark SUMMARY Double crush in DK crush may lower risk of sub-optimal SB rewiring Use POT balloon sized to proximal reference Intravascular imaging is still required to firmly rule out suboptimal rewiring Clincal data: OCTOBER trial

Difficult SB Access with Size Discrepancy to MB

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CASES SESSION - TIPS & TRICKS Difficult SB Access with size discrepancy to MB Author: Khaled Al Shaibi, MD, King Fahd Armed Forces Hospital, Saudi Arabia CASE HISTORY 80 year old female Hypertension Unstable angina ECHO:-EF = 50% no significant valve pathology Coronary angiography:- Distal leI main plus three vessel disease (SYNTAX score = 36 ) Turned down by surgeons due to fraility

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

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

DK-Crush II study

European Bifurcation Club 2010, EBC 2010 - Budapest, Hungary Hot topics DK-Crush II study: A Prospective Randomized Trial of Double Kissing Crush vs. Provisional Stenting Technique for Coronary Bifurcation Lesions Author: Shao-Liang Chen, MD, Nanjing First Hospital, Nanjing, China