European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 Usability of Fantom Bioresorbable Scaffold in Non Complex Bifurcations: Technical Analysis in Bench Models Author: Gabor G. Toth, MD, PhD, University Heart Centre Graz, Austria AIM To evaluate, whether POT-SB-POT technique can be considered as a reasonable bail-out option for Fantom® bioresorbable scaffold, to tackle a simple bifurcation lesion CONCLUSION Fantom® polycarbonate copolymer coronary scaffold is considered to have improved structural characteristics Still, marked structural destruction of the scaffold has been observed in bench models when doing POT-SB-POT approach Considering that POT-SB-POT might be ‘the most gentle’ bifurcation technique from device point of view Therefore the use of Fantom® in any bifurcation anatomy should be strongly discouraged.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 Learnings From the Bench and a Thrombogenicity Model Author: Nicolas Foin, MSc, PhD, National Heart Research Institute Singapore; Philips Healthcare, Belgium LEARNINGS FROM THE BENCH Bench models allow to study questions in controlled and reproducible experimental environments Make use tools such as Micro-CT, Radial & Longitudinal Strength tes;ng, 3D printing, Perfusion test, Histology, SEM Microscopy. LIMITATIONS It can only provide a partial model to investigate a question and cannot mimic the entire tissue /plaque characteristics and in-vivo biological response. Results can not always be transposed directly to in-vivo situations and should be interpreted with caution. Bench models complement, but do not replace clinical/imaging studies SUMMARY Stent underexpansion and stent malapposition distances affect flow disturbances and shear rate in a dose-dependent relation. Severe malapposition (ISA distance > 300 um) create higher shear rate with persitent malapposition + uncovered strut at follow-up. In-vitro experiments with perfused blood suggest that large malapposed stent segment create potential sites for platelet adhesion and clot development. Stent optimisation (expansion and apposition) with appropriate sizing, post-dilatation and imaging can improve local hemodynamic environment and reduce area of high shear disturbance.
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
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CASE SESSION - TIPS & TRICKS Clinical Case Author: Julien Adjedj, MD, Institut Arnault Tzanck, France 68 YEAR OLD MALE PATIENT HIV Previous inferior MI in 2006 Left main equivalent PCI in 2006 Cypher 3.5 x 18 mm Dyspnea NYHA II LVEF 40% inferior akinesia
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CASE SESSION - TIPS & TRICKS Ivus guided lad cto lm bifurcation stenting Author: Dr Joby K Thomas, MD, DM, Caritas Hospital Kerala, India SUMMARY Patient underwent CABG and mitral valve repair in 2014 at a different hospital Had effort angina which revealed occluded LIMA and both SVGs(2017) They attempted PTCA , did RCA and ‘ramus ‘ stenting LAD was ostial CTO , which they could not succeed in doing Patient still has angina Check angio showed patent stents in RCA and ‘ramus’ That converted a 0,1,1 LM distal bifurcation to 0,1,0 But LAD ostial CTO with no stump
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CASE SESSION - TIPS & TRICKS Complete Revascularization with ROTA Author: Tanveer Rab, MD, Emory University School of Medicine Atlanta, Georgia, USA OUTCOMES PROCEDURAL Contrast: 300 cc Exposure: 4.5 Gy LVEDP: 22 LFA preclosed; post closure completed after removal of 14 Fr Cook sheath RFA access sheath perclosed IN HOSPITAL Hemodialysis same night post procedure and on 3rd day post procedure Transfusion of 1 unit of blood Felt much improved and ambulant Home, post procedure day 4 AT ONE YEAR Came off hemodialysis Creatinine stabilized at 3.0 LVEF improved to 45 % MR improved (mild) Alive and well at 1 year
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
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CASES SESSIONS - TIPS & TRICKS Impella and LM Stenting with PS and POT: Keep it Simple Author: Johan Bennett, MD, PhD, University Hospitals Leuven, The Netherlands CLINICAL CASE 64 year old male Diabetes Mellitus, ex-smoker Prostrate cancer with bone mets (stable on hormone therapy) Presented with ACS and pulmonary oedema SUMMARY Protected High risk PCI of LM bifurcation Impella CP supported Ventriculo-arterial uncoupling Provisional LM stenting Intracoronary imaging to ensure optimal result
A case of huge coronary perforation during insertion of a long stent in severe calcified bifurcation lesion Author: Yoshinobu Murasato, MD, PhD, Kyushu Medical Center, Japan Take home messages: • A long stent insertion in the calcified bifurcation lesion led to stack of the stent and S-figure flection which resulted in huge coronary perforation. • The situation that 1/3 of the stent remained in the guiding catheter might induce strong push-ability to make S-figure flection in the coronary artery. • When we feel hard resistance during insertion of a long stent, we should consider another option as the following earlier. Biplane fluoroscopy for detailed observation of the stent stack Buddy wire to change the wire bias Guide extension catheter to enhance back-up force and prevent the stent flection inside the coronary artery.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain COMPLICATION CASES Protective Strategy for Side Branch in Complex Bifurcation Lesions During PCI Author: Man Wang, MD, Fuwai Hospital, China SUMMARY Provisional stenting strategy is preferred in non-left main BIF Jailed balloon technique is effective for keeping side branch open with high success rate of rewiring Easy withdrawal of jailed wire and balloon in SB Rewiring and final KBI is not necessary when SB TIMI flow is 3