Further Optimization of Kissing Balloon Inflation: Insight from computer simulations

European Bifurcation Club 2014 - EBC 2014 - Bordeaux, France Bifurcation stenting: learning from bench and simulation Further Optimization of Kissing Balloon Inflation: Insight from computer simulations Author: Peter Mortier, MD, FEops / Ghent University, Belgium CONCLUSION Side branch access: A good kissing inflation does not guarantee optimal side branch access - A large variability was observed with each stent design Inflating the side branch balloon first optimizes side branch access Stent strut apposition: Malapposed struts are always present near the side branch ostium Reducing the pressure in the SB balloon does not increase the amount of malapposed stent struts The elliptical deformation in the proximal segment can be reduced by reducing the pressure in the side branch balloon prior to inflating the main branch balloon.

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Flow Modeling based on 3D OCT reconstructions

European Bifurcation Club 2014 - EBC 2014 - Bordeaux, France Bifurcation stenting: learning from bench and simulation Flow Modeling based on 3d oct reconstructions Author: Gabriele Dubini, MD, Politecnico di Milano, Italy AIM Development of an automated reconstruction method of a stented coronary bifurcation model starting from OCT images Construction of a 3D model of the bifurcation to perform a Computational Fluid Dynamic (CFD) simulation and calculate hemodynamic quantities related to restenosis CONCLUSION An automated reconstruction method of an in-vitro stented coronary bifurcation model starting from OCT images was developed The 3D geometry obtained from this reconstruction method can be used to perform CFD simulations to quantify hemodynamic variables related to restenosis on the basis of OCT exams, to predict the regions with the highest risk of restenosis

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In-silico bifurcation stenting

European Bifurcation Club 2014 - EBC 2014 - Bordeaux, France Bifurcation stenting: learning from bench and simulation In-silico bifurcation stenting Author: Jolanda Wentzel, MD, Erasmus MC, Rotterdam, The Netherlands

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OCT guided BVS Implantation

European Bifurcation Club 2014 - EBC 2014 - Bordeaux, France Live bifurcation stenting guidance: OCT, IVUS, FFR & ANGIO OCT guided BVS Implantation Author: Pascal Motreff, MD, University Hospital, Clermont-Ferrand, France

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Why I prefer IVUS in bifurcation guidance

European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO Why I prefer IVUS in bifurca3on guidance Author: Masahiro Yamawaki, MD, PhD, Saiseikai Yokohama City Eastern Hospital, Japan SUMMARY The mechanism of luminal widening by FKI was stretching vessel wall. FKI corrected carina/plaque-shift in about 30%. Plaque shift dominantly occurred(50%) The vessel anatomy assessed by IVUS before intervention /FKI was predictable for plaque/ carina shift, and associated with residual SB ostium stenosis despite FKI. CONCLUSION Why I prefer IVUS in bifurcation guidance” Because we can check optimal result after stenting by IVUS. In addition, IVUS before- and during PCI helps us to .... know precise anatomy, and predict SB compromise as well as luminal widening after FKI. make decision of final strategy of bifurcation-PCI make our procedure logical and predictable !

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Side Branch Evaluation by OCT

European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO Side Branch Evaluation by OCT Author: Niels Ramsing Holm, MD, Aarhus University Hospital, Denmark CONCLUSION Do not advance an imaging wire into a jailed SB Observe imaging depth evaluating SBs by MV 3D-OCT SB pullback for full evaluation of two-stent techniques Adjustable 2D measurement planes may be new standard in ostial assessment Do not advance an imaging wire into a jailed SB Observe imaging depth evaluating SBs by MV 3D-OCT SB pullback for full evaluation of two-stent techniques Adjustable 2D measurement planes may be new standard in ostial assessment

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OCT in Stent Failure

European Bifurcation Club 2014, EBC 2014 - Bordeaux, France LIVE BIFURCATION STENTING GUIDANCE: OCT, IVUS, FFR & ANGIO OCT in assessment of stent failure at the bifurcation level Author: Tom Adriaenssens, MD, PhD, University Hospitals Leuven, Belgium CONCLUSION Bifurcation PCI treated segments do not constitute a majority of cases with ST in the Prestige OCT registry (16/230) Inclusion bias possible (more severe cases did not make it to the cath lab/did not undergo OCT during PCI) Problems of thrombus around floating struts and UC/MA/overlap in remote areas but related to bifurcation PCI technique predominant

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