European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain COMPLICATION CASES Unexpected Global Dissection Author: Jorge Palazuelos Molinero, MD, PhD, Prof A. CASE REPORT. INDEX ANGIOGRAPHY Female, 70 yo. HTN. Referred to cath lab for chest pain with posi1ve exercise test CONCLUSION Keep calm Patient care Step by step approach: 1. expert operator supervision 2. Adequate material Be aware of deep intuba1on, extensor catheters and mechanical contrast injections
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain COMPLICATION CASES Devil wears Prada: LM stenting, problem of ostium coverage Author: Himanshu Gupta, MD, DM, PGI Chandigarh, India CLINICAL PROFILE 50 Years Male HTN, No DM, Former Smoker 1 episode of Syncope 10 days back ECG – Normal with no baseline ST changes Evaluated at OSH and found to have CAD LVEF- Normal LV function with no baseline RWMA or valve disease PROBLEM After FKB the LAD wire position was lost as the balloon got stuck on the wire LAD rewired with another wire Position of the fresh LAD wire in doubt?? LCX wire is good–Maybe, we have done a FKB already LEARNING POINTS Short LM and abnormal take off can cause problems FKB not mandatory in provisional SB strategy If u KISS – It should be good and safe Rewiring always after POT – But be careful Use dual lumen catheter to wire SB if in doubt Never do POT on SB wire Use Guide extension to prevent LSD Angiographic follow up if possible
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING Extreme Left Main stem calcification: ROTASHOCK combination Author: Dr. Peter O'Kane, MD, 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
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain HOW TO TREAT (by EBC experts) - VOTING How to treat an Ostial LAD Bifurcation Lesion Author: Vladimir Dzavik, MD, PhD, University of Toronto, Canada 46 year old man Recent diagnosis of diabetes or pre-diabetes Started on metformin Several month history of exertional dyspnea and chest discomfort Attributed to being unfit Presented to a local hospital with anterior chest pain and dyspnea at rest
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA Author: GUO Suxia, MD, Dongguan People's Hospital, China CASE PRESENTATION PATIENT DEMOGRAPHICS: - Age: 48 yrs. - Gender: Male RISK FACTORS: - 2-DM - Smoking history CLINICAL PRESENTATION: - Exertional chest pain for 2 years. - Echo: LVEF 47% PAST MEDICAL HISTORY: - CAG in other Hospital before one week STRATEGY LM/LAD/LCX bifurcation (1,1,1): 2 stents Middle of LCX CTO: PCI Intro-coronary imaging guidance: IVUS
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA A case of LAD CTO reperfusion guiding by IVUS Author: Xiaoping Peng, The First Affiliated Hospital of Nanchang University, China CLINICAL FACTS Liao, male, 59-year-old, admitted to hospital in 2018-09-15 Chest tightness for 2 years, aggravating for 2 months TREATMENT STRATEGY The treatment strategy of this patient is to deal with right coronary lesions first. Selective treatment is LAD CTO lesions
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA Struts across side branch an oct follow up Author: Rony Mathew, MD, DM, Lisie Heart Institute – Lisie Hospital Cochin, India CONCLUSION Struts across a major side branch may be a predictor of side branch re-stenosis. - Neo-intimal growth over the struts will compromise the side branch ostia over time. Proposed hypothesis: - Struts across SB on OCT Imaging may be an indication to kiss/PSP, even if the ostia is not compromised on angiography. Follow up OCT study required.
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 TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA LAD CTO and LM treated with TAP Author: Jaskaran Singh Dugal, MD, Jehangir Hospital, India HISTORY 40 year old patient Had anterior wall MI 10 years ago. He was given thrombolytic therapy with STK and subsequently continued on medical management Now presented with retrosternal pain and DOE with minimal exertion ECHO showed anterior wall RWMA hypokinesia EF 50% Risk profile - Hypertension, Hyperlipidimia Syntax Score 30 JCTO score - 2 PLAN Address CTO antegrade/retrograde • LCX/OM Bifurcation LAD/LCX/LMCA Bifurcation LAD/diagonal What Technique?