LM Archives - Page 2 of 7 - European Bifurcation Club

Nano Crush in Left Main

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

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

LM Bifurcation Complication or ‘should we have touched it?’

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CASE SESSION - TIPS & TRICKS LM Bifurcation Complication or 'should we have touched it?' LM DEB PCI on high risk bleeding…

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

Extreme Left Main stem calcification: ROTASHOCK combination

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING Extreme Left Main stem calcification: ROTASHOCK combination Author: Dr. Peter O'Kane, MD, 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

A case of IVUS to LM Bifurcation lesion with IABP support

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

Use of DES and DCB in LM Bifuration Lesion

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA Use of DES and DCB in LM Bifuration Lesion Author: Zhanying Han, MD, First Affiliated Hospital of Zhengzhou University, China BACKGROUND Although several stenting techniques are available for the treatment of de novo coronary bifurcation lesions. The treatment of coronary artery bifurcation still represents a challenge for interventional cardiologist. over the past years, different studies have proposed and analysed the use of drug-coated balloon (DCB) in the treatment of coronary artery bifurcation lesions as an alternative treatment. CLINICAL CHARACTERISTICS Zhang Q Female 76years Paroxysmal chest tightness for 10 years Agravated for 20 days Risk factor: Diabetes 1 year, Angiitis 30 years TAKE HOME MESSAGES For calcified LM bifurcation lesion, intravascular imaging is strongly recommended to help to determine the PCI strategy. Rotablation is effective to modify the calcified plaque in both MV and SB bifurcation lesion DCB may supply an alternative treatment for bifurcation lesions, thus maybe decrease the stent numbers , thrombosis and restenosis risk of side branch.

LAD CTO and LM treated with TAP

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA LAD CTO and LM treated with TAP Author: Jaskaran Singh Dugal, MD, Jehangir Hospital, India HISTORY 40 year old patient Had anterior wall MI 10 years ago. He was given thrombolytic therapy with STK and subsequently continued on medical management Now presented with retrosternal pain and DOE with minimal exertion ECHO showed anterior wall RWMA hypokinesia EF 50% Risk profile - Hypertension, Hyperlipidimia Syntax Score 30 JCTO score - 2 PLAN Address CTO antegrade/retrograde • LCX/OM Bifurcation LAD/LCX/LMCA Bifurcation LAD/diagonal What Technique?

Unprotected LM Trifurcation Lesion treated as two sequential bifurcations

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING Unprotected LM Trifurcation lesion treated as Two sequential Bifurcations using two different stenting techniques Author: Parminder Singh, MD, DM, PGI Chandigarh, India CASE OBJECTIVE To discuss and learn: Management of LM trifurcation lesion in ACS - simplifying a multiple stent strategy CASE PRESENTATION Patient Demographics: 27 year old Male , a cab driver Clinical History: Recent onset angina class III , one episode of rest angina Dyspnoea on exertion both for last - 25 days Risk Factors: Hypertension Family History of CAD : Father, Paternal Uncle, Paternal Grandfather Diagnostic Tests: ECG revealed ST depression in V3-V6 2D Echo - Normal LV FuncDon , No RWMA ,Normal valves TROPONIN - Elevated LEARNING POINTS Distil left main trifurcation is a complex lesion - Op2mal PCI strategy - not well defined Basic rules of bifurcation lesions can be applied to trifurcation. Keep it simple: Single stent > 2 stent > 3 stent strategy preferred. Simplified by treating trifurcation as two sequential bifurcations, especially if three stent strategy is planned . By combining two stenting techniques for LM trifurcation ,good result can be achieved quickly and safely ,esp. in ACS. IVUS guidance is helpful in optimising procedure results as in other left main lesions.

True Lumen Sandwiched in Neocarina

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING True Lumen Sandwiched in Neocarina Role of IVUS in LM CTO Author: Juan Luis Gutierrez Chico, MD, PhD, Cardiac Care - Cardiovascular Heart Centre Marbella, Spain CLINICAL PRESENTATION 54 y.o. male pt Angina CCS II TTE: LVEF 72%, no WMA SPECT: Anterior perfusion defect on exertion TAKE HOME MESSAGE Any subintimal course around carina: alert Importance of imaging to solve complications Subintimal shift? -->Plaque shift --> Carina shift --> Subintimal shift Stent the entry & exit points to subintima