European Bifurcation Club Archives - Page 4 of 68

The Visible Heart Project and the Atlas of Human Cardiac Anatomy

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.

Stop DAPT2 High Bleeding Risk sub analysis

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

Bench evaluation of the Fantom scaffold (REVA) in bifurcations

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.

Learnings From the Bench and a Thrombogenicity Model

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.

Early Morning Bench News: DK Double Crush

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

Clinical Case

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

Ivus guided LAD CTO/LM – bifurcation stenting

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

Complete Revascularization with Rota

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

Difficult SB Access with Size Discrepancy to MB

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

Impella and LM Stenting with PS and POT: Keep it Simple

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