EBC 2020 - LIVE! PITFALLS & TROUBLESHOOTING SESSION: Provisional Culotte stenting: Choices, pitfalls and troubleshooting - Dr Vlad Dzavik
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION Assessing Optimal Percutaneous Coronary Intervention for Left Main Coronary Artery Stenting Registry Author: Kazushige Kadota, MD, PhD, Kurashiki Central Hospital, Japan SUMMARY 1 The Long-term outcomes ager stent implantation for unprotected LMCA lesions were not determined by the bifurcation lesion types, but were related to the 2- stent strategy. Also, the difference in the rates of TLR and ST between 1-stent and 2-stent strategies were observed within 1 year. SUMMARY 2 Drug-eluting stent implantation ager rotational atherectomy was a safe and feasible strategy for complex bifurcation lesions. In this strategy, the 2-stent approach was associated with markedly worse 5-year clinical outcomes than the 1-stent approach. The events rate within 1 year were significantly higher for all outcomes in the 2-stent strategy group than in the 1-stent strategy group. CONCLUSION The AOI-LMCA registry confirmed that a simple stenting strategy could be recommended for treating leg main bifurcation lesions in real world practice. Meticulous care should be paid within 1 year after using a complex stenting strategy.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION Coronary CT Guided Left Main Bifurcation PCI Author: Masaaki Okutsu, MD, New Tokyo Hospital, Chiba, Japan Introduction Current consensus of LMT bifurcation PCI recommends single stent strategy. However, LCX ostium has sometimes severe stenosis or occlusion after crossover stenting unexpectedly. There are some factors that affect to jailed LCX ostium. – MB plaque, SB plaque, low angle, and ...Calcification is one of them. Objective To investigate the relationship between calcium thickness at LMT bifurcation and LCX ostium deterioration after LMT-LAD crossover single stenting. Conclusion Coronary CT might be able to measure calcium thickness. Calcium thickness of ostial LAD might affect LCX ostium stenosis deterioration after crossover stenting from LMT to LAD.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION Long Term Outcome of DK Crush Studies on LMB Author: Zhaoqing Sun, MD, Shengjing Hospital Affiliated to China Medical University, China SUMMARY A simple LMB lesion can be treated with a single-stent provisional approach ; while a 2-stent strategy is preferred for complex lesions DK-Crush is an optimal choice in 2-stent strategy The ongoing EBC MAIN study will provide additional information on the optimal treatment of LMCA bifurcation lesions
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION Long Term Results after PCI of Unprotected Distal Left Main Stenosis Author: Miroslaw Ferenc, MD, University Heart Center Freiburg, Germany CONCLUSIONS Compared with single stenting, double stenting was associated with a significantly higher long-term risk of MACE. Higher incidence of TLR, whereas the risk of death, MI, or stent thrombosis was similar After critical first year the MACE during long term follow-up similar between single and double stenting Randomized study EBC-Main ongoing (single vs double)
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain NEWS 1 The Visible Heart Project and the Atlas of Human Cardiac Anatomy Author: Paul A Iaizzo, PhD, University of Minnesota, USA VHL COLLABORATIONS AND SUMMARY The Visible Heart Laboratories has abilities to study perfusion fixed human hearts as well as reanimated large mammalian hearts including. We can uniquely study the device-tissue interfaces while using numerous imaging modalities simultaneously. One can perform optimal and/or sub-optimal (on purpose) without worrying about procedure times, contrast injections, and/or outcomes. We have perform many bifurcation stenting procedures and subsequent performed computational modeling which can be used for 3D printing or generating VR scenes. The free-access website: “The Atlas of Human Cardiac Anatomy” is a unique educational tool.
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
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain BENCH & COMPUTATIONAL BIFURCATION STENT SIMULATIONS Introduction: Are bifurcation stenting simulations needed? Author: Habib Samady, MD, FACC, Emory University Hospital, USA ARE BIFURCATION STENTING SIMULATIONS NEEDED? - YES Outcomes of bifurcation PCI are not optimal Bench Micro CT studies can inform bifurcation stenting strategies Macro or vessel level hemodynamics require 3 D vessel and stent reconstruction Micro or strut level hemodynamics require complex and time consuming computational techniques for evaluating the interaction of plaque prolapse, strut morphology and perhaps stent healing Prospective studies (SHEART STENT and ISR FLOW) are underway to investigate the prognostic value of hemodynamics as they relate to vascular healing of in angulated and bifurcation PCI.