European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 3 Keynote lecture: Lessons learned from COBIS studies: 2004 to 2019 Author: Bon Kwon Koo, MD, PhD & Young Bin Song, MD, PhD, Seoul National University Hospital, Samsung Medical Center, Seoul, Korea WHAT MAKES THE DIFFERENCE? Safer access: More trans-radial approach Better stents and better stenting technique Better PCI technique: Better kissing, NC balloon.... Better concept: Imaging guidance, SB relevance Better risk stratification: SB occlusion, risk stratification CONCLUSION COBIS registry started with bifurcation PCI patients since 2004 are s till ongoing with dedicated QCA core laboratory/CRO, independent st atistical analysis team and event adjudication committee. Results of COBIS studies expanded our knowledge on bifurcation tr eatment and improved the patients’ clinical outcomes. Ongoing COBIS III study will provide more insights on coronary bifu rcation lesions and their treatment.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 Pre-kissing for Medina 1,1,1 bifurcation lesions Author: Francesco Burzotta, MD, A. Gemelli Hospital, Italy PROCEDURAL RESULTS SB flow <3 after MV stent Need of guidewires different from workhorse for SB re-wiring Failure of SB re-wiring Failure of SB dilation ANY SB “TROUBLE” (composite of blue items) SB “TROUBLE” predictors (multivariate analysis): - No PRE-KISSING - SB TIMI flow <3 - SB lesion >5 mm - Medina lesion class 1,1,1
EBC 2019 - Barcelona, Spain NEWS 1 BiOSS Lim C bench test Author: Francois Derimay, MD, PhD, Hospices Civils de Lyon, France QUESTIONS & ANSWERS Which scope for the BiOSS Lim C? - Spontaneously, 40% of the expected geometries are possible Which behavior of the diameters during inflation? - Very compliant balloon with homothetic inflation Which use out of scope? - Strict homothetic inflation without over segmentary expansion Which proximal maximum expansion capacity? - Post dilatation capacity ≥ to classical DES What about SB management? - Control of the connector position possibly difficult Non systematic SBI
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain COMPLICATION CASES Protective Strategy for Side Branch in Complex Bifurcation Lesions During PCI Author: Man Wang, MD, Fuwai Hospital, China SUMMARY Provisional stenting strategy is preferred in non-left main BIF Jailed balloon technique is effective for keeping side branch open with high success rate of rewiring Easy withdrawal of jailed wire and balloon in SB Rewiring and final KBI is not necessary when SB TIMI flow is 3
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain COMPLICATION CASES Devil wears Prada: LM stenting, problem of ostium coverage Author: Himanshu Gupta, MD, DM, PGI Chandigarh, India CLINICAL PROFILE 50 Years Male HTN, No DM, Former Smoker 1 episode of Syncope 10 days back ECG – Normal with no baseline ST changes Evaluated at OSH and found to have CAD LVEF- Normal LV function with no baseline RWMA or valve disease PROBLEM After FKB the LAD wire position was lost as the balloon got stuck on the wire LAD rewired with another wire Position of the fresh LAD wire in doubt?? LCX wire is good–Maybe, we have done a FKB already LEARNING POINTS Short LM and abnormal take off can cause problems FKB not mandatory in provisional SB strategy If u KISS – It should be good and safe Rewiring always after POT – But be careful Use dual lumen catheter to wire SB if in doubt Never do POT on SB wire Use Guide extension to prevent LSD Angiographic follow up if possible
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain TIPS AND TRICKS IN BIFURCATION PCI - THE SYNERGY BETWEEN EBC AND ASIA Struts across side branch an oct follow up Author: Rony Mathew, MD, DM, Lisie Heart Institute – Lisie Hospital Cochin, India CONCLUSION Struts across a major side branch may be a predictor of side branch re-stenosis. - Neo-intimal growth over the struts will compromise the side branch ostia over time. Proposed hypothesis: - Struts across SB on OCT Imaging may be an indication to kiss/PSP, even if the ostia is not compromised on angiography. Follow up OCT study required.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS DK Crush vs tap. In vitro comparison of thrombogenicity and flow Author: Valeria Paradise, MD, Maasstad Hospital, Rotterdam, The Netherlands OBJECTIVE The purpose of the present study was to compare DKC vs TAP technique to evaluate their different effects in terms of strut apposition and thrombus formation in in-vitro models using OCT and computational flow reconstruction. METHODS N= 12 stents in total (Synergy n=6 and Ul(master=6) Bifurcation y-shaped model Stent with same platform were deployed using TAP or DKC technique Final POT was performed for all the experiments OCT pullback was performed from MV and SB before and after POT A peristaltic pump was used to perfuse the porcine blood through the silicone model at a flow rate of 200ml/min for 4 minutes Thrombus area was calculated from OCT pullback after perfusion CONCLUSION No difference in terms of stent struts apposition Similar acute thrombus formation POT significantly reduces EI Even when performed in silicon model, these procedures are associated with stent malapposition
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BIFURCATION AND DRUG ELUTING BALLOONS - VOTING Call for the Participation Bifurcation DEB Trials Author: Sudhir Rathore, MD, Frimley Health NHS Foundation Trust, UK Provisional Group: Main vessel DES + KBI+POT vs. MV DES + DEB to SB+ POT: Late Loss/ Binary restenosis at SB/MB/ MACE 2 stent strategy: (SB> 70%/ 10 mm ): 2 stent+ KBI vs. MV DES + DEB to SB + KBI Call for meeting to discuss the results of polling and further discussion.
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