The 3 top Messages from technique Specific problems Solving

Transcription

1 The 3 top Messages from technique Specific problems Solving Alaide Chieffo Interventional Cardiology Unit San Raffaele Hospital Milan - Italy

2 PROBLEMS DURING PROVISIONAL: SB PROTECTION AND RESCUE Francesco Burzotta Institute of Cardiology, Catholic University of the Sacred Heart, Rome - Italy

3 CAN WE PREDICT SB COMPROMISE? SB compromise is a reality during provisional technique (with jailed wire) and is not fully predictable!! Rooms for technical improvement More prevention of SBs occlusion: SB PROTECTION TECHNIQUES Salvage of compromised SBs: SB RESCUE TECHNIQUES

4 SB PROTECTION TECHNIQUES Not new (but understimated?): Two Wire Protection Oda et al. Cardiovasc Interv and Ther 2010

5 EBC Meeting Parallel Sessione 2 12:30-14:00 Technique specific problem solving Problems During Complex Stenting Strategies Dr. Remo Albiero Director Cath Lab Istituto Clinico San Rocco - Ome (Brescia) - Italy 8 min

6 What is a Complex Bifurcation? SB stenosis severity >75% SB Size >2 mm SB stenosis length >510 mm SB takeoff angle, Ca++

7 Two Stent Strategies Complex Techniques Yes No DK Mini-Crush Culotte/ Mini-Culotte V touching Simultaneous Kissing Stent (SKS) Classic Crush

8 PROBLEMS WITH OSTIAL LAD STENTING Manuel Pan. Reina Sofia Hospital. University of Cordoba.

9 STRATEGIES IN THE TREATMENT OF OSTIAL LAD LESIONS PES stent Taxus 3 x 32 mm & KB stent across stent Xience 3.5 x 15 mm stent Cortesía de Dra. Vaquerizo (2009) Szabo Technique

10 CONCLUSIONS Ostial disease of the LAD can be treated with one stent across or precise/floating DES. In cases with large bifurcation angle and IVUS documentation of absence of disease in distal left main, a strategy with isolated ostial LAD stenting may be a good strategy. A spiky carina by IVUS is a risk factor for CX ostial compromise. The treatment of these lesions with BVS needs further evaluation.

11 LCX President / Director of Cardiology / New Tokyo Hospital essor of Department of Advanced Cardiovascular Medicin Kumamoto University Consultant / National Cardiovascular Center / Osaka Sunao Nakamura FACC, FAHA, FESC, FSCAI

12 Lesson 3 LCX ostium itself independently shows high restenosis rate in patients with LMT-PCI. Now we donʼt have consensus for treating LCX ost. Prox. How about BRS???

13 Do not chase to much!! LCX is a different animal This is very unique part of coronary artery!!! So called, HINGE POINT... But point is moving and Twitching And not so much important as compared with LAD and RCA for keeping Ejection fraction of the patientʼs HEART

14 Lesson 5 How many jailed struts, or how much area that jailed struts occupies in the area of ostium of LCX seems to be a determinant factor of Future Endotherialization for the coverage of these jailed struts. Finishing the case with optimum KBT is very indispensable for LMT bifurcation PCI

15 1 Problems with Calcified Bifurcation lesions Dr J S Dugal HOD cardiology JH Pune

16 1 hardware Guiding catheter XB F Wire BMW,ROTAFLOPPY Support catheter Finecross (Termo) Rotator 1.5mm (Boston scientific) Balloon 2.5,3.0x10,3.0x15,3.5x10,4x08 Stents 3x24,3.5x16 Synergy (Boston scientific) IVUS Opticross

17 A restenosis/stent thrombosis after BRS: How to treat? Antonios Karanasos Department of Cardiology, Hippokration Hospital, Athens Research associate, Thoraxcenter, Erasmus MC

18 Differences from metallic stents Need for predilation à incomplete lesion coverage? Need for adequate preparation à underexpansion? Neoatherosclerosis reduced in BRS? Bioresorption radial strength reduced after some time Controversial role of strut fracture - dismantling

19 Pathomechanism-tailored treatment Incomplete lesion coverage à consider additional BVS/metallic DES Underexpansion à Optimize expansion with balloon dilation/metallic DES Malapposition à Optimize apposition with balloon dilation/if large mismatch metallic DES implantation Restenosis/neoatherosclerosis à metallic DES implantation, if sufficient lumen consider new BRS DEB in restenosis <6 months?

20 Pathomechanism-tailored treatment Felix C et al, Eurointervention 2015

21 Take-home messages Always use invasive imaging to identify mechanism of failure In suboptimal implantation goal is to optimize expansion and lesion coverage In neointimal tissue growth, a metallic stent should be considered Treatment of very late scaffold thrombosis should account for scaffold dismantling

22 Mini-crush or DK-crush technique: 1 year follow-up OCT result Nanjing No.1 Hospital, China Nanjing Heart Center Lin Song

23 Mini-Crush bifucation aeea: fully cover

24 DK-CRUSH bifurcation area

25 Conclusion Mini-crush technique is not the same conception to DK. More or less stent struts at area of bifurcation in Mini-crush Technique. Location side branch stent is very important at mini-crush Need more time to follow up mini-crush technique.