European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 3 Impact of Final KB and of Imaging on Patients Treated on ULMCA With Thin Strut Stents Author: Fabrizio D Ascenzo, MD, Città della Salute e della Scienza, Italy THIN STENTS IN ULM 792 patients with ULM stenosis Treated with thin struts stents After 16 months (12-22) 44 (5.5%) experienced TLR CONCLUSION Imaging reduced restenosis in ULM and should be exploited more. FKI for sure reduce restenosis in 2 stents If you perform provisional, perform FKI with a short overlap
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING What are the Best Imaging Criteria for Adequate Stent Expansion and Apposition in Bifurcation Lesion Author: Nicolas Amabile, MD, PhD, Institut Mutualiste Montsouris, Paris, France CONCLUSION Best imaging criteria for bifurcation PCI quality assessment are not completely established. Although consensus criteria exist for non bifurcated lesions, they might not be applicable “as they are” to bifurcations. Malapposition criteria can be applied for MV and MB. Special alention must be given in the future to redefine our objectives for adequate stent expansion.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 2 Trend of Bifurcation PCI from COBIS I to COBIS III Author: Joon Hyung Doh, MD, PhD, Inje University Ilsan Paik Hospital, Goyang, Korea & Ki Hong Choi, MD, Samsung Medical Center, Seoul, Korea CONTEXT Trend of Bifurcation PCI in Korea using COBIS I, COBIS II, and COBIS III Registries Comparison of Inclusion Criteria and Baseline Characteristics Changes of Treatment Strategies Comparison of Follow-up Clinical Outcomes SUMMARY From COBIS I to COBIS III, left main bifurcation PCI is increasing. 1-stent strategy is still the most preferred technique (81.5% in COBIS III), even in LM bifurcation PCI. Among various 2-stenting techniques, the ‘crush technique’ is the most commonly used in Korea. The use of IVUS and trans-radial intervention are also on the rise in patients under went PCI with bifurcation lesion. Although proportion of FKB was reduced in COBIS III (compared with COBIS II), th e concept of POT have been newly developed and widely used. From COBIS I to COBIS III, the incidence of MACE (cardiac death, MI, and TLR) tren d toward to decrease in real world bifurcation PCI.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 2 Outcome After One Stent Technique in Bifurcation: SB Strut Opening VS. Leave Alone Author: Chang-Wook Nam, MD, PhD, Keimyung University Dongsan Hospital, Korea PURPOSE OF THE CURRENT STUDY The aim of the current study is to evaluate the long-term clinical outcome according to SB opening procedure of bifurcation lesion after 1-stent crossover technique from COBIS 3 registry. LIMITATIONS Not free from selection bias as an observational study. Additional imaging study may have provided more information on the plaque progression The number of patients and events was too small to properly adjust for an adequate statistical power. The duration of a dual antiplatelet therapy for these higher- risk patients is still controversial SUMMARY There is the improvement of acute angiographic result in SB opening after simple crossover stenting. However, SB opening after simple crossover stenting did not show improvement in long-term clinical outcome compared to leave alone after simple crossover stenting. In addition, in both left main and true bifurcation, the simple crossover wit h additional SB opening did not showed a better long-term clinical outcome. Therefore, routine KBT after simple crossover may not be recommended. Provisional approach with FFR guidance will help to select the patients who need additional complex bifurcation procedure.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 2 From QFR to OFR: Intracoronary OCT-derived FFR for assessment of stenosis severity Author: Shengxian Tu, MD, PhD, Shanghai Jiao Tong University, China Limitations of angiography-based FFR Angiographic image overlap and significant foreshortening Post-PCI optimization: stent mal-apposition/under-expansion OFR Analysis Steps Automatic OCT lumen contour delineation and 3D reconstruction Automatic reconstruction of cut- planes at the side branches ostia Compute OFR using the QFR algorithm SUMMARY OFR (OCT-based FFR) provides lesion morphology and physiological assessment in a single OCT pullback. Compared with FFR, OFR showed good diagnostic accuracy, excellent reproducibility and short analysis time. OFR had substantially better diagnostic accuracy than OCT-MLA. OFR is promising for use in the cath lab for PCI optimization.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 2 Feasibility and Efficacy of the Jailed Pressure Wire Technique for Coronary Bifurcation Lesions Author: Manuel Pan, MD, Reina Sofia Hospital, Spain BACKGROUND Evaluation of side branch result during PS: A current challenge When to dilate or stenting the side branch? When to do anything else? Until now, good result: TIMI III flow and no significant compromise of SB ostium FFR is a good method to evaluate SB compromise. OBJECTIVES Safety and feasibility of jailed pressure wire. Utility of physiological SB evaluation using iFR as a new index CONCLUSION The use of jailed pressure wire to monitor SB results for bifurcations treated by provisional stenting seems to be safe. The iFR index seems to provide new physiological information about the significance of the SB stenosis.
EBC 2019 - Barcelona, Spain NEWS 1 BiOSS Lim C bench test Author: Francois Derimay, MD, PhD, Hospices Civils de Lyon, France QUESTIONS & ANSWERS Which scope for the BiOSS Lim C? - Spontaneously, 40% of the expected geometries are possible Which behavior of the diameters during inflation? - Very compliant balloon with homothetic inflation Which use out of scope? - Strict homothetic inflation without over segmentary expansion Which proximal maximum expansion capacity? - Post dilatation capacity ≥ to classical DES What about SB management? - Control of the connector position possibly difficult Non systematic SBI
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 2 After Single Crossover stenting; “KBT or not KBT”, that is the question. Routine KBT is always necessary? Author: Satoru Mitomo, MD, New Tokyo Hospital, Japan WHAT THE DATA TELLS If we can take single-stent strategy, the outcomes would be much better than those in 2-stent strategy. LCx ostium itself might be independently associated with high restenosis rates. The fact may be partially explained by unique anatomical feature; “hinge motion”, twitching and bending. LMT PCI results could be hampered with high restenosis rates in LCx ostium; however the incidence may not be directly associated with fatal prognosis.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 The Visible Heart Project and the Atlas of Human Cardiac Anatomy Author: Paul A Iaizzo, PhD, University of Minnesota, USA VHL COLLABORATIONS AND SUMMARY The Visible Heart Laboratories has abilities to study perfusion fixed human hearts as well as reanimated large mammalian hearts including. We can uniquely study the device-tissue interfaces while using numerous imaging modalities simultaneously. One can perform optimal and/or sub-optimal (on purpose) without worrying about procedure times, contrast injections, and/or outcomes. We have perform many bifurcation stenting procedures and subsequent performed computational modeling which can be used for 3D printing or generating VR scenes. The free-access website: “The Atlas of Human Cardiac Anatomy” is a unique educational tool.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 STOPDAPT2 HBR Bifurcation. 1 Year outcomes from a Randomized Trial of Clopidogrel Monotherapy VS DAPT Beginning 1 Month After PCI in Patients at High Bleeding Risk Author: Hirotoshi Watanabe, MD, Kyoto University Hospital, Japan LIMITATIONS Post-hoc, and underpowered analysis. Precise ARC-HBR could not be applied. Very few patients participated in this study with 2-stents for bifurcation. Japanese patients are known to have lower ischemic risk and higher bleeding risk compared with US/European population CONCLUSION The effects of 1-month DAPT versus 12-month DAPT on the primary and major secondary endpoints were consistent in HBR patients and any bifurcation strategy without any significant interactions. One-month DAPT was associated with significant reduction of major bleeding without any increase of cardiovascular events in HBR patients, and the absolute magnitude of bleeding events with 1-month DAPT was numerically greater in HBR patients than in non-HBR patients, although the analysis was underpowered and needed confirmation in future studies. In this study very few patients with complex PCI for bifurcation participated, but there was no sign 1-month DAPT significantly increased the coronary-related events