EBC 2020 - LIVE! IMAGING SESSION: 3D OCT-guided LM bifurcation PCI: Impact of 3-D imaging on optimal wiring and subsequent procedure - Dr Yoshi Murasato DOWNLOAD PDF
A case of huge coronary perforation during insertion of a long stent in severe calcified bifurcation lesion Author: Yoshinobu Murasato, MD, PhD, Kyushu Medical Center, Japan Take home messages: • A long stent insertion in the calcified bifurcation lesion led to stack of the stent and S-figure flection which resulted in huge coronary perforation. • The situation that 1/3 of the stent remained in the guiding catheter might induce strong push-ability to make S-figure flection in the coronary artery. • When we feel hard resistance during insertion of a long stent, we should consider another option as the following earlier. Biplane fluoroscopy for detailed observation of the stent stack Buddy wire to change the wire bias Guide extension catheter to enhance back-up force and prevent the stent flection inside the coronary artery.
European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CORONARY BIFURCATION IMAGING Balloons and stent sizing for bifurcation PCI Role of Intra-coronary Imaging Author: Yoshinobu Murasato, MD, PhD, Kyushu Medical Center, Japan TAKE HOME MESSAGES Device sizing (general): EEL-based reference diameter measurement is firstly recommended. In case of invisible EEL, lumen-based measurement is also available. For the optimal stent landing zone, it is important to avoid dissection, > 50% plaque burden, and lipid pool. Device sizing: bifurcation lesion POT and KBI balloon should be selected according to vascular branching law. In the bifurcation lesion, Finet’s law is applicable for imaging-guide reference diameter measurement, not for angio-based one. Stent should be selected considering maximal expansion capacity. Minimum expansion index considering vascular branching and tapering is more physiological to select post-dilation site and appropriate balloon.
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.
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.
European Bifurcation Club 2013, EBC 2013 - London, UK NEWS SESSION Recent data from the J-Reverse study Author: Yoshinobu Murasato, MD, New Yukuhashi Hospital, Japan
European Bifurcation Club 2008 - EBC 2008 - Prague, Czech Republic D family techniques T-stenting and small protrusion (TAP) technique for restenotic lesion after single stenting in the left main coronary bifurcation Author: Yoshinobu Murasato MD, PhD, Dept. of Cardiovascular Medicine, New Yukuhashi Hospital, Japan