EBC 2020 - LIVE! IMAGING SESSION: NOBLE IVUS and a glimpse into OCTOBER - Dr Niels Ramsing Holm
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 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 AWARD CASE SESSION - VOTING Extreme Left Main Stem Calcification: Rotashock combination therapy Author: Peter O'Kane, MD FRCP, 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 PCI STRATEGY 7F EBU3.5 Guide RT wire LAD & SB wire LCx Sapphire 2.0x20 balloon not cross LAD •Rotational atherectomy 2 stent technique - culotte of DK Crush • IVUS guided throughout
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING Algorithm when to perform OCT to optimize efficiency can we overcome OCTS limitations Author: Takayuki Okamura, MD, Yamaguchi University Hospital, Japan SUMMARY Pre-procedure OCT assessment in the main vessel provides useful information for bifurcation stenting. However, ostial assessment is fundamentally impossible, a potential disadvantage compared to IVUS, and more contrast media is used. Some ingenuities may overcome them. The biggest advantage of OCT compared to IVUS would be the guidance of the position of the guidewire into the jailed side branch when the side branch dilatation is performed. Further studies whether OCT guidance can improve clinical outcomes would be needed.
European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO Why I prefer IVUS in bifurca3on guidance Author: Masahiro Yamawaki, MD, PhD, Saiseikai Yokohama City Eastern Hospital, Japan SUMMARY The mechanism of luminal widening by FKI was stretching vessel wall. FKI corrected carina/plaque-shift in about 30%. Plaque shift dominantly occurred(50%) The vessel anatomy assessed by IVUS before intervention /FKI was predictable for plaque/ carina shift, and associated with residual SB ostium stenosis despite FKI. CONCLUSION Why I prefer IVUS in bifurcation guidance” Because we can check optimal result after stenting by IVUS. In addition, IVUS before- and during PCI helps us to .... know precise anatomy, and predict SB compromise as well as luminal widening after FKI. make decision of final strategy of bifurcation-PCI make our procedure logical and predictable !