Read more about the article Importance of Routine Use of OCT in Bifurcation

Importance of Routine Use of OCT in Bifurcation

European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO Importance of Routine Use of OCT in Bifurcation Author: Yoshinobu Murasato, MD, PhD, Kyushu Medical Center, Fukuoka, Japan TIPS & TRICKS IN ROUTINE USE OF OCT Decrease contrast medium Flow reduction: 5-10ml at 2-3ml/sec Low-molecular dextran GC engage: relatively deep Avoid the patients unsuitable for the OCT examination Ostial lesion in the LMCA and RCA Diffuse diseased vessel CKD stage 3b, 4 CONCLUSION Routine use of OCT can provide useful information in vessel condition before and after treatment, which changes the strategy in 50% of the cases. It can correct stent malapposition and underexpansion, which may lead to a decrease in cardiac death/MI. A decrease in contrast medium or use of dextran can afford to more frequent OCT pull-backs for further examination in the complicated lesion. 3-D OCT imaging has a possibility to correct GW recrossing point, which leads to decrease in incomplete stent apposition, however, it still requires innovation of image qualities.

Read more about the article 3D-OCT New implications of optimal SB re-crossing

3D-OCT New implications of optimal SB re-crossing

European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO 3D-OCT New implications of optimal SB re-crossing Author: Yoshinobu Onuma, MD, PhD, Horax Centre, Erasmus MC, Rotterdam, The Netherlands BACKGROUND With advent of the new-generation OCT/OFDI system (C7/8 LightLab, OFDI Terumo) with a high frame rate (100-180fps) and fast pull-back speed (20-40mm/s), 3- dimensional reconstruction of OCT became feasible due to elimination of motion artefacts. 3-dimensional OCT reconstruction gives us better understanding of complex coronary anatomy such as bifurcation, compared to the conventional 2-D OCT. CONCLUSION In 2009-2010, with advance of OCT/OFDI technology, 3D-reconstruction became feasible. In 2011-2013, the potential of the technology was demonstrated in off- line 3D-OCT with manual strut detection. In bifurcation, 3D-OCT may guide positioning of the wire through the appropriate (distal) cell. The early study suggests that such a guidance strategy reduced the incidence of malapposition in bifurcation. In 2014, the on-line 3D OCT/OFDI with automatic strut detection is available. The equipped “real-time” 3D OFDI will help utilization of 3D in clinical situation.

Read more about the article Stent strut malapposition: Insights from simulations and oct imaging

Stent strut malapposition: Insights from simulations and oct imaging

European Bifurcation Club 2014, EBC 2014 - Bordeaux, France BIFURCATION STENTING: LEARNING FROM BENCH AND SIMULATION Stent strut malapposition: insights from flow simulations and OCT imaging Author: Nicolas Foin, MD, PhD, National Heart Centre Singapore, Duke-NUS QUESTIONS How are blood flow patterns and shear rate affected by different degree of stent malapposition? How does baseline flow around ISA strut affect coverage at FU High shear and delayed coverage: are both contributing factors to thrombogenicity observed with ISA? METHODS Computer Model of different strut-wall malapposition distances, flow patterns and shear rates evaluated by CFD In-vivo:ISA and strut coverage (% uncovered, thickness) assessed sequentially in-vivo by OCT at both baseline and FU Comparison of shear patterns with OCT FU coverage response SUMMARY Strut-wall malapposition distances affect flow disturbances and shear rate in a dose-dependent relation. OCT sequential study revealed that baseline ISA is mostly resolved and covered at FU for strut ISA distance < 300 um More severe malapposition (ISA distance > 300 um) create higher shear disturbance with significantly higher rate of persitent malapposition and uncovered strut at FU. Strut thickness influence re-endothelialisation as well as shear rate disturbance: for minimal shear rate, thinner strut is better. Further in-vivo studies are required to evaluate the impact of flow on neointimal healing and adverse events.

Read more about the article Summary and take home messages from Parallel 2

Summary and take home messages from Parallel 2

European Bifurcation Club 2014, EBC 2014 - Bordeaux, France PARALLEL SESSIONS SYNOPSIS The Top 3 take home messages from the bifurcation quantitative analysis parallel session Author: Patrick Serruys, MD, PhD, Imperial College London, UK

Read more about the article Potential Benefits of FKB

Potential Benefits of FKB

European Bifurcation Club 2014, EBC 2014 - Bordeaux, France NEWS 2 SESSION Potential Benefit of FKB After Single stent approach – Insights from OCT Author: Yoshinobu Murasato, MD, Kyushu Medical Center, Japan OBJECTIVE The aim of this study is to assess the impact of FKI on the stent strut apposition, neointimal coverage and thrombus attachment in the coronary bifurcation lesion 9 months after either EES or SES implantation using OCT. CONCLUSION FKI brought the following beneficial effects on the single stent approach in the bifurcation lesion. Enlarged lumen maintained in the proximal segment Homogeneous neointimal distribution Fewer jailed struts Fewer thrombus attachments Beneficial effect of FKI to achieve larger lumen in the proximal segment was weakened in DM patients probably due to more accelerated form of atherosclerosis.

Read more about the article Consensus statement on use and analysis

Consensus statement on use and analysis

European Bifurcation Club 2013, EBC 2013 - London, UK The EBC debate on stepwise OCT guiding for bifurcation treatment Consensus statement on use and analysis Author: Niels Ramsing Holm, MD, Aarhus University Hospital, Denmark

Read more about the article The final result – How perfect should it be?

The final result – How perfect should it be?

European Bifurcation Club 2013, EBC 2013 - London, UK The EBC debate on stepwise OCT guiding for bifurcation treatment The final result - How perfect should it be? Author: Juan Luis Gutiérrez Chico, MD, PhD, Klinikum der Ludwig-Maximilian Universität, München, Germany

Read more about the article OCT for BVS implantation in bifurcation lesions

OCT for BVS implantation in bifurcation lesions

European Bifurcation Club 2013, EBC 2013 - London, UK The EBC debate on stepwise OCT guiding for bifurcation treatment OCT for BVS implantation in bifurcation lesions Author: Holger Nef, MD, PhD, University of Giessen, Germany