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Meetingsummary- consensusachieved?
JensFlenstedLassenMD,PH.D.,FESC.OnBehalfoftheEBCBoard
12thEBCmeeting,Rotterdam2016
• Science– clinicaltrials• Classificationanddescriptionofstenttechniques– commonlanguage• Descriptionoflesionsandflowdynamics– AnatomyandPhysiology• Descriptionofdevices– mechanicalandbiologicalproperties• - Andalargevarietyofotherinputs
• BenchTesting– PCItechnicaland3Dunderstanding• Intravascularimaging(OCT/OFDI)– onlineeasyandreallife
12th EBCMeetingsummaryTheessentials oftheEBCconsensus
• 11:15-12:30Towards aworldwide consensus onbifurcation stenting• Chair:A.Banning,T.Lefèvre,A.Latib Panel:R.Bhagwat,HC.Tan,M.Behan• Topic 1.POT-Side-POTshould be theroutine inprovisional stenting• 3'Current EBCpositionT.Lefèvre• 5'ProG.Finet• 5'Con(finalkissing remains)HC.Gwon• 10’Discussion andvoting• 2'Conclusion:EBCpositionchangedorvalidA.Banning• Topic 2.When using Culottetechnique always stenttheMVfirst• 3'Current EBCpositionT.Lefèvre• 5'ProB.Chevalier• 5'ConS.Rathore• 10'Discussion andvoting• 2'Conclusion:EBCpositionchangedorvalidA.Banning• Topic 3.In1,1,1bifurcation DK-Crush should be theelective technique ofchoice• 3'Current EBCpositionT.Lefèvre• 5'ProSL.Chen• 5'ConO.Darremont• 10'Discussion andvoting• 2'Conclusion:EBCpositionchangedorvalidA.Banning
12th EBCMeetingsummaryThevoting sessions
• BenchTesting
• Intravascularimaging(OCT/OFDI/IVUS)
12th EBCMeetingsummaryThemain tools forunderstanding
Tecnical issues ofbifurcation stenting
BenchTestingandCoronaryArteryBifurcations:AConsensusDocumentfromtheEuropeanBifurcationClub
V11.10.16
OrmistonJ,Kassab G,Finet G,Mickley T,Chatzizisis Y,BrownB,,FoinN,Eckermann F,Wentzel J,Murasato Y,DarremontO,IwasakiY,Demangeon L,Hikichi ,Lefevre T,Louvard Y,Murasato Y,StankovichG,Tittlebach M,Beier S,Yazaki Y,Hojeibane H,Wooton J.
Isthereanyoneelsewhowouldliketocontribute?Isthereanyoneonthelistwhoshouldnotbe?Netravali A.Position,institutionlocationofauthors
ü LargestDESsize(4.0mm)over-expandedwith6.0mmSCballoonat14ATM
Foin, Ng. et al. 2015
MLD:5.7mm
LumenMLDafterover-expansion
MLD:5.6mm
MLD:5.3mm
MLD:5.8mm
MLD:6.0mm*on4.5-5.0XLsize(5.6mm on4.0size)
MLD:5.9mm
NewDESPlatforms
POT– Needed!
Proximalincompletestentapposition
CourtesyofNicolasFoin
Proximalincompletestentapposition
§ AutomatedMeasurements§ StentRoadmap§ AppositionIndicator§ 3DBifurcationMode
§ Side-branchdetection§ Carinaview
§ Expanded3DNavigation§ 3Dflythroughview§ Objectsegmentation
What’sNewinOCT–andwillitmakeadifference?
8
YES!
• ItwillbehighlyimportantfortheEBCmemberstobepreparedforthediscussionofthetechnicalsolutionsinLMstentinginthenearfuture.
• FocusonstentingtechniquesusedindiscussedstudiesandInsightsfromBenchtestingandintravascularimagingwillbehighlyimportantinthatdiscussion.
• Importantpointsinthatrespecthavealreadybeenraisedduringthelasttwodays:
- AwarenessofmaximaldilatationcapacityofavailablestentsforLMPCIseemsmandatory.- Potentialriskofgettingbehindtheproximalpartofthestentstrutsduringrewiring– evenafterPOTintaperedvessels.- potentialriskofcrushingtheproximalLMstentwiththeguidingcatheterduringtheprocedure
12th EBCMeetingsummaryPCIoftheLeft Main
EXCEL&NOBLE.latebrakingtrialsTCT2016,
MondayOctober31.Simultaneouspublicationin
NEJM&TheLancet
12th EBCMeetingsummaryPCIoftheLeft Main
Noble & Excell
• Itis(strongly)recommendedtouseintravascularimagingifacomplexLMPCI(orotherbifurcation)don'tgosmooth.
• Itis(strongly)recommendedtohaveaccesstointravascularimagingwhendoingelectiveLMstenting.
12th EBCMeetingsummaryPCIoftheLeft Main
• Science– clinicaltrials• Classificationanddescriptionofstenttechniques– commonlanguage• Descriptionofanatomyandflowdynamics– clinicalsignificance• Descriptionofdevices– mechanicalandbiologicalproperties• - Andalargevarietyofotherinputs
• BenchTesting– PCItechnicaland3Dunderstanding- consensus• Intravascularimaging(OCT/OFDI)– onlineeasyandmature
12th EBCMeetingsummaryTheessentials oftheEBCconsensus
Meetingsummary- consensusachieved??
Yes– butinfewareassomeconfusionona
higherlevel!!
12thEBCmeeting,Rotterdam2016
12th EBCconsensusFocusinthe2016th edition
• Overalleditingandshorteningofthegeneraltext• Returnofshortdescriptiverecommendationsattheendofeachsection• Moretables,figuresandillustrations
Specialfocusinthisyearsconsensus:
• Updateonsidebranchsignificanceandlesionscharacteristics• UpdateontechnicalstepsinProvisionalbifurcationstentingstrategy• SpecialfocusonLMstenting– (differentfromotherbifurcations)• Upgradeonintravascularimaging• UpgradeonBWS
Thank you for your attention
”Which way you ought to go depends on where you wantto get to”
TheCheshire cat,Alice´sAdventuresinWonderland,LewisCarroll(1865)