One Stent Bifurcation Techniques and Possible Bail Out Solutions Using Multimodality Imaging

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain MEDTRONIC SYMPOSIUM One Stent Bifurcation Techniques and Possible Bail Out Solutions Using Multimodality Imaging Author: Goran Stankovic, MD, Clinical Center of Serbia, Serbia BIFURCATION EDUCATION IS NEEDED Collaboration between EBC, Visible Heart Lab (VHL) and Medtronic initiated by EBC at 2012 meeting; There is a need to create: Educational program for fellows and young IC’s, aimed to help understanding bifurcation treatment techniques, complications and outcomes; The idea: A series of case scenarios, where trainee can learn step-by-step performance of different bifurcation stenting techniques and based on a combination of imaging technologies and computer simulation. OBJECTIVES Optimization of provisional one-stent bifurcation PCI technique and possible bail out solutions using multimodality imaging, including Visible Heart lab and OCT.

Culotte Technique with Endoscopic Visible Heart Imaging and OCT

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain MEDTRONIC SYMPOSIUM  - One stent bifurcation techniques and possible bail out solutions using multimodality imaging. Culotte Technique with Endoscopic Visible Heart Imaging and OCT Author: Jens Flensted Lassen, MD, PhD, Odense University Hospital, Denmark SUMMARY OF THE PROCEDURE 1. Implant the first stent. Provisional stenting is a philosophy starting with one stent The procedure develops stepwise. You can stop at any step keeping the procedure as simple as possible (But not too simple) Kiss is for positioning of the carina Pot is for correcting the proximal Part of the stent To ”deep” POT may crush the carina area, but is needed to correct the stent distortion KISS with short balloons makes room for a more proximal POT-Balloon placement. 2. Consider the need for a second stent T, TAP, and Culotte are all just techniques with a second stent and defined only by how deep the stent is placed, according to the side branch ostium. CONCLUSION The stepwise progression of the the provisional strategy makes it possible to stop at any stage when the result is satisfying.

Impact of Final KB and of Imaging on Patients Treated on ULMCA With Thin Strut Stents

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

How imaging changed my strategy

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA How imaging changed my strategy Author: Rahul Gupta, MD, Apollo Hospital, India CLINICAL DATA 82YRF Past PCI to LCX and DDDR PPI • Now Class III angina HT LVEF : 45%

Get Clarity with OCT for LM and Bifurcation PCI Case 1 Complex Bifurcation

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain ABBOTT SYMPOSIUM Get Clarity with OCT for LM and Bifurcation PCI Case 1 Complex Bifurcation Author: Tom Johnson, MD, Bristol Heart Institute, UK CASE SUMMARY Stent failure MANDATES intra-vascular imaging Stent under-expansion common driver but multifactorial Image guidance for plaque modification is critical

Impact of Bifurcation Angle on Incomplete Stent Apposition

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING Impact of Bifurcation Angle on Incomplete Stent Apposition Author: Masahiro Yamawaki, MD, Saiseikai Yokohama City Eastern Hospital, Japan PURPOSE To investigate the impact of the “Link free and distal re-wiring(LFD)” condition and bifurcation angle on 9-month OCT findings after 1-stenting with final kissing inflation(FKI). CONCLUSION High bifurcation (>55°) angle should be care in case of link-free on carina and distal wiring , due to uncorrected stent distortion on the opposite of side branch (SB) and distal main vessel (MV) by final kissing balloon inflation (FKI), but incomplete stent apposition (ISA) in MV decreased after 9 months Impact of bifurcation angle on 9-month OCT data was minor than those of “link and re-wire position” before FKI in this registry. FKI with optimal condition under 3D-OCT guidance reduced uneven neointima proliferation, ISA and uncovered strut after 9 months. Further study is required to demonstrate clinical impact of OCT guided bifurcation treatment.

Plaque characters in bifurcation lesion Efficient Strategy Selection by Intracoronary Imaging

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING Plaque characters in bifurcation lesion Efficient Strategy Selection by Intracoronary Imaging Author: Nieves Gonzalo, MD, Hospital Clinico San Carlos, Spain MESSAGES Intracoronary imaging is useful to determine the plaque composition and confirm an adequate plaque preparation. Information regarding plaque distribution, calcium loca.on and vessel size can be used to select the bifurcation stenting technique

FFR in side branch: a substudy of Nordic

European Bifurcation Club 2010, EBC 2010 - Budapest, Hungary IMAGING SESSION FFR in side branch: a substudy of Nordic Author: I. Kumsars, MD, P. Stradins Hospital, Riga, Latvia