“KBT or not KBT”, that is the Question

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.

Risk of stent sizing according to the distal MV in LM bifurcation

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS Risk of stent sizing according to the distal MV in LM bifurcation Author: Yutaka Hikichi, MD, PhD, Saga University, Japan BACKGROUND AND PURPOSE OF THE EXPERIMENT Size selection: according to the distal MB reference? Hypothesis: Stent size influence the acute outcome Implantation methods CONCLUSION When performing a crossover stent to LMT-LAD, the stent size should be selected according to the vessel diameter on the proximal side of the bifurcation. By selecting a larger stent size, the incomplete stent apposition area can be reduced at the LCx ostium after KBT. By doing so, incomplete stent apposition volume can be reduced at the LM-shaft after KBT , and the stent expansion rate can be greatly increased. The risk of injury on the LAD distal side during stent implantation can be reduced by thorough pre- dilatation and devising the stent placement method.

Flow disturbance due to incomplete stent apposition

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS Flow disturbance due to incomplete stent apposition Author: Kiyotaka Iwasaki, PhD, Waseda University, Japan BACKGROUNDS In left main bifurcation, difference between LMT (proximal) and LAD (distal) diameters is lager compared with that in other bifurcation. Stenting without POT would induce incomplete stent apposition at proximal bifurcation side. KBT is recommended to open overlaying stent of side branch ostium especially in LM Bifurcation, because the overlaying jailed stent will potentially occupy larger at LCx and become a source for future thrombus formation, neointimal formation, and late narrowing. Although stent-size selection based on distal diameter is recommended, there is a dilemma that currently available stents have smaller expansion capability when stent-size is chosen based on distal stent-landing diameters in LAD. SUMMARY AND TAKE HOME MESSAGES POT and KBT are mandatory to reduce incomplete stent apposition. Otherwise, abnormal slow flow regions were induced at left main trunk and/or behind jailed stent crowns during the cardiac cycle, which would be a potential cause of thrombus formation and may necessitate life-long DAPT.  Stent-diameter selection based on the proximal- vessel diameter is feasible to preserve stent platform design at LMT and bifurcated region, and to reduce jailed stent crowns at LCx ostium. Three-times kissing balloon inflation is feasible for reducing jailed stent crowns.

Recent data from the J-Reverse study

European Bifurcation Club 2013, EBC 2013 - London, UK NEWS SESSION Recent data from the J-Reverse study Author: Yoshinobu Murasato, MD, New Yukuhashi Hospital, Japan