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
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 3 Keynote lecture: Lessons learned from COBIS studies: 2004 to 2019 Author: Bon Kwon Koo, MD, PhD & Young Bin Song, MD, PhD, Seoul National University Hospital, Samsung Medical Center, Seoul, Korea WHAT MAKES THE DIFFERENCE? Safer access: More trans-radial approach Better stents and better stenting technique Better PCI technique: Better kissing, NC balloon.... Better concept: Imaging guidance, SB relevance Better risk stratification: SB occlusion, risk stratification CONCLUSION COBIS registry started with bifurcation PCI patients since 2004 are s till ongoing with dedicated QCA core laboratory/CRO, independent st atistical analysis team and event adjudication committee. Results of COBIS studies expanded our knowledge on bifurcation tr eatment and improved the patients’ clinical outcomes. Ongoing COBIS III study will provide more insights on coronary bifu rcation lesions and their treatment.
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 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.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 Pre-kissing for Medina 1,1,1 bifurcation lesions Author: Francesco Burzotta, MD, A. Gemelli Hospital, Italy PROCEDURAL RESULTS SB flow <3 after MV stent Need of guidewires different from workhorse for SB re-wiring Failure of SB re-wiring Failure of SB dilation ANY SB “TROUBLE” (composite of blue items) SB “TROUBLE” predictors (multivariate analysis): - No PRE-KISSING - SB TIMI flow <3 - SB lesion >5 mm - Medina lesion class 1,1,1
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.