LM Archives - Page 3 of 7 - European Bifurcation Club

Extreme Left Main Stem Calcification

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

A left main distal trifurcation lesion: what did I do

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING A left main distal trifurcation lesion: what did I do Author: Shih Hung Chan, MD, PhD, National Cheng Kung University Hospital, Taiwan PATIENT CHARACTERISTICS A 49-year-old male had hypertension and hyperlipidemia. He had already received percutaneous coronary intervention twice for non-ST elevation myocardial infarction and unstable angina pectoris in the past few years. This Ame, he presented with crescendo angina for 1 month. Renal function was normal. TREATMENT STRATEGIES LV assistance device: nil Debulking/plaque modification: No marked calcification: not needed in the beginning In case needed, considering cutting balloon, scoring balloon,or rotational atherectomy Intravascular image: Definitely needed IVUS Antithrombotic: aspirin, clopidogel, and heparin Stenting strategy TAKE HOME MESSAGES Percutaneous coronary intervention (PCI) for left main trifurcation lesion is challenging. No one-size-fits-all strategy is available The choice of treatment strategy is depended on the discrepancy between vessel size, extent of calcification, angle between vessels, etc. To be familial with various PCI techniques, including provisional one stent and two-stent technique as well as the way to protection side branch, is the key to successful PCI for leI main trifurcation lesion

Double Debulking for LM True Bifurcation Lesion

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain AWARD CASE SESSION - VOTING Double Debulking for LM True Bifurcation Lesion Author: Yoshihisa Kinoshita, MD, Toyohashi Heart Center, Japan CONCLUSION Although short DAPT theory becomes widespread recently, we have to keep DAPT after stenting at least 3 to 6 months at least. Especially, it is difficult to stop DAPT within 1 month for the patient who have stent in LM bifurcation lesion. However, there are some patients who cannot continue enough DAPT because of their underlying condition. Aggressive debulking without stenting occasionally brings a favorable result for such patients.

Get clarity with OCT for LM and bifurcation treatment

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain ABBOTT SYPOSIUM Get clarity with OCT for LM and bifurcation treatment - Introduction Author: Thierry Lefevre, MD, ICPS, France

Megatron Synergy – The new addition to the synergy family

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BOSTON SYMPOSIUM Megatron Synergy. The new addition to the synergy family Author: Yiannis Chatzizisis, MD, PhD, University of Nebraska Medical Center, USA ONGOING/ FUTURE WORK Testing the performance of Megatron with 2-stent techniques in a larger cohort of LM bifurcations Head-to-head comparison of Megatron with other second generation DES Testing the performance of new purpose-built stents dedicated to other segments of the coronary tree e.g, distal segments A large, virtual clinical trial to show improved morphologic and biomechanical endpoints (which serve as surrogates of clinical outcomes) with purpose-built stents.

LM bifurcation PCI with the novel Megatron Synergy Stent: a case based discussion

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BOSTON SYMPOSIUM LM bifurcation PCI with the novel Megatron Synergy Stent: a case based discussion - Introduction Author: Thierry Lefevre, MD, PhD, ICPS, France The dream of interventional cardiologist for LM disease A stent with a good radial strength With more than 2 connectors A good visibility A low risk of longitudinal compression An optimal scaffolding and drug delivery An easy side branch access

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.

Existing data on drug coated balloons and coronary bifurcation treatment

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BIFURCATION AND DRUG ELUTING BALLOONS - VOTING Existing data on drug coated balloons and coronary bifurcation treatment Author: Mario Araya, MD, Clinica Alemana De Santiago/ Thorax National Institute, Chile 4 STRATEGIES TESTED DCB with BMS DCB with DES DCB-only strategy DCB in bifurcaAon restenosis WHERE DO WE STAND Trials of DCB in bifurcaAon treatment use different protocols and devices, in small trials. No POT, low kissing. We need more data. Only paclitaxel-coated balloon have been reported. In general, the use of pDCB appears to be effective and safe in SB. The use of pDCB + BMS is inferior to conventional DES treatment The use of pDCB + DES (Everolimus) show excellent results in small registries . Only-DCB strategy is feasible and safe. In Restenosis of bifurcation, including LM, DCB tx show promising results compare to DES

Provisional stenting strategy in Left main

European Bifurcation Club 2014, EBC 2014 - Bordeaux, France CASES: TIPS & TRICKS AND COMPLICATIONS Provisional stenting strategy in Left main Author: Carlos Garcia Alonso, Institut Cardiovasculaire Paris Sud, France