European Bifurcation Club 2014 - EBC 2014 - Bordeaux, France Bifurcation stenting: learning from bench and simulation Further Optimization of Kissing Balloon Inflation: Insight from computer simulations Author: Peter Mortier, MD, FEops / Ghent University, Belgium CONCLUSION Side branch access: A good kissing inflation does not guarantee optimal side branch access - A large variability was observed with each stent design Inflating the side branch balloon first optimizes side branch access Stent strut apposition: Malapposed struts are always present near the side branch ostium Reducing the pressure in the SB balloon does not increase the amount of malapposed stent struts The elliptical deformation in the proximal segment can be reduced by reducing the pressure in the side branch balloon prior to inflating the main branch balloon.
European Bifurcation Club 2014 - EBC 2014 - Bordeaux, France Bifurcation stenting: learning from bench and simulation Flow Modeling based on 3d oct reconstructions Author: Gabriele Dubini, MD, Politecnico di Milano, Italy AIM Development of an automated reconstruction method of a stented coronary bifurcation model starting from OCT images Construction of a 3D model of the bifurcation to perform a Computational Fluid Dynamic (CFD) simulation and calculate hemodynamic quantities related to restenosis CONCLUSION An automated reconstruction method of an in-vitro stented coronary bifurcation model starting from OCT images was developed The 3D geometry obtained from this reconstruction method can be used to perform CFD simulations to quantify hemodynamic variables related to restenosis on the basis of OCT exams, to predict the regions with the highest risk of restenosis
European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO Why I prefer IVUS in bifurca3on guidance Author: Masahiro Yamawaki, MD, PhD, Saiseikai Yokohama City Eastern Hospital, Japan SUMMARY The mechanism of luminal widening by FKI was stretching vessel wall. FKI corrected carina/plaque-shift in about 30%. Plaque shift dominantly occurred(50%) The vessel anatomy assessed by IVUS before intervention /FKI was predictable for plaque/ carina shift, and associated with residual SB ostium stenosis despite FKI. CONCLUSION Why I prefer IVUS in bifurcation guidance” Because we can check optimal result after stenting by IVUS. In addition, IVUS before- and during PCI helps us to .... know precise anatomy, and predict SB compromise as well as luminal widening after FKI. make decision of final strategy of bifurcation-PCI make our procedure logical and predictable !
European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO Side Branch Evaluation by OCT Author: Niels Ramsing Holm, MD, Aarhus University Hospital, Denmark CONCLUSION Do not advance an imaging wire into a jailed SB Observe imaging depth evaluating SBs by MV 3D-OCT SB pullback for full evaluation of two-stent techniques Adjustable 2D measurement planes may be new standard in ostial assessment Do not advance an imaging wire into a jailed SB Observe imaging depth evaluating SBs by MV 3D-OCT SB pullback for full evaluation of two-stent techniques Adjustable 2D measurement planes may be new standard in ostial assessment
European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO OCT in assessment of stent failure at the bifurcation level Author: Tom Adriaenssens, MD, PhD, University Hospitals Leuven, Belgium CONCLUSION Bifurcation PCI treated segments do not constitute a majority of cases with ST in the Prestige OCT registry (16/230) Inclusion bias possible (more severe cases did not make it to the cath lab/did not undergo OCT during PCI) Problems of thrombus around floating struts and UC/MA/overlap in remote areas but related to bifurcation PCI technique predominant
European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO Importance of Routine Use of OCT in Bifurcation Author: Yoshinobu Murasato, MD, PhD, Kyushu Medical Center, Fukuoka, Japan TIPS & TRICKS IN ROUTINE USE OF OCT Decrease contrast medium Flow reduction: 5-10ml at 2-3ml/sec Low-molecular dextran GC engage: relatively deep Avoid the patients unsuitable for the OCT examination Ostial lesion in the LMCA and RCA Diffuse diseased vessel CKD stage 3b, 4 CONCLUSION Routine use of OCT can provide useful information in vessel condition before and after treatment, which changes the strategy in 50% of the cases. It can correct stent malapposition and underexpansion, which may lead to a decrease in cardiac death/MI. A decrease in contrast medium or use of dextran can afford to more frequent OCT pull-backs for further examination in the complicated lesion. 3-D OCT imaging has a possibility to correct GW recrossing point, which leads to decrease in incomplete stent apposition, however, it still requires innovation of image qualities.