Goran Stankovic, MD, PhD
@GoranEBC
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Interventional cardiologist; researcher; professor; trialist #Bifurcation #LeftMain #EuropeanBifurcationClub #EuroPCR #EAPCI @PCRonline All opinions my own.
Belgrade, Republic of Serbia
Joined August 2018
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How to do TAP stenting, by
@GoranEBC
&
@zlatkombegovic
#bifurcation
@PCRonline
@sbrugaletta
@mirvatalasnag
@NanjingFirst
@BURZOTTA_F
@DFCapodanno
@flensted_jens
@VisibleHeartLab
@GreggWStone
@twj1974
@rutherfordmed
@ncurzen
@NicFoin
@JEscaned
@ESHLOF
@MonteHeart
@RonnieLass
47
610
1K
How to rescue occluded SB following MV stenting: "🎈on jailed wire" 🙏 to
@ZMehmedbegovic
@BURZOTTA_F
@flensted_jens
@twj1974
@Ryvetsprog
@DrthierryL
@PCRonline
@sbrugaletta
@mirvatalasnag
@mmamas1973
@nicolasamabile
@JEscaned
@WomenAs1
@DFCapodanno
@BifurcationClub
@GreggWStone
16
150
371
How to do mini Culotte stenting,
@GoranEBC
and
@zlatkombegovic
#EAPCI
#bifurcation
#PCReCourse
@BifurcationClub
@PCRonline
@sbrugaletta
@DFCapodanno
@gabor_gt
@mirvatalasnag
@NanjingFirst
@BURZOTTA_F
@twj1974
@mmamas1973
@Ryvetsprog
@MPAOSS
@EAPCPresident
@GreggWStone
@TCTMD
7
135
342
@uziyahya46
@zlatkombegovic
@PCRonline
@sbrugaletta
@mirvatalasnag
@NanjingFirst
@BURZOTTA_F
@DFCapodanno
@flensted_jens
@VisibleHeartLab
@GreggWStone
@twj1974
@rutherfordmed
@ncurzen
@NicFoin
@JEscaned
@ESHLOF
@MonteHeart
@RonnieLass
Learning TAP part 2: fly-through animation depicts metallic neocarina! Thank you for positive feedbacks & even more for constructive criticism; Lern more at
#PCReCourse
@WijnsWilliam
@sbrugaletta
@nickaram
@Ortega_Paz
@PCRonline
@gabor_gt
@DFCapodanno
@azeemlatib
@mirvatalasnag
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62
158
15 EBC
@BifurcationClub
@twj1974
@NanjingFirst
@sbrugaletta
@PCRonline
@mirvatalasnag
@mmamas1973
@GreggWStone
@Ryvetsprog
@MPAOSS
Learn from Yosihisa Kinoshita how to treat the LM 0,0,1
#bifurcation
with DCA + DCB, without stent😃
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I would like to invite you all to propose the most interesting topics for XVI
@BifurcationClub
meeting, which will take place in PALMA DE MALLORCA, SPAIN on 23th & 24th October 2020. We also invite you to submit successful and/or complication cases for the best EBC case award!
"You never know what is enough unless you know what is more than enough"
➡️"PCI for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club" by Jens Flensted Lassen
@GoranEBC
et al.
#EIJBestOf
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Sincere gratitude for attending
#EBC2023
, and please share your knowledge and experience with colleagues in your countries
@BifurcationClub
@alaide_chief
@WomenAs1
@BURZOTTA_F
@Ryvetsprog
@twj1974
@MPAOSS
@DrSaritaRao2
@NielsRHolm
@stefan_harb
@DFCapodanno
@DrPeterOKane
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The benefits of proximal optimization
#bifurcation
@GoranEBC
&
@ZMehmedbegovic
@BifurcationClub
@dzavik_vlad
@mirvatalasnag
@sbrugaletta
@PCapranzano
@NielsRHolm
@NicFoin
@MilasinD18
@nickaram
@rutherfordmed
@Ryvetsprog
@DrJMHill
@Billal72073638
@billgogas
@DrPeterOKane
@drptca
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My pleasure and privilege to discuss the Culotte technique with Bernard Chevalier, who described it in 1998, and David Hildick Smith, PI of the BBC-ONE, first randomized Culotte study with DES! Join us and learn all you need to know!
Miss out on the Learning Culotte session with
@GoranEBC
during
#EuroPCR
? Here's another opportunity! Join him, B. Chevalier &
@Ryvetsprog
for this free webinar: Case-based step-by-step culotte technique in a
#bifurcation
on
6 June 4 pm Paris time (UTC+2)
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@surreyHEART
@PCRonline
@VisibleHeartLab
Thank you very much. Most two-stent techniques have a metallic neocarina. It is created by the SB stent in TAP, and by the MV stent in the DK-Crush!
@BURZOTTA_F
@twj1974
@mirvatalasnag
@sbrugaletta
@NielsRHolm
@flensted_jens
@ODarremont
@MPAOSS
@YChatzizisis
@Ortega_Paz
@NicFoin
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No evidence for routine KISS in provisional but, when performed, a short NC balloons recommended, especially for the SB, sized according to reference diameters, but with minimal protrusion into the SB. Main advantage of KISS is to re-position carina in the center.
@giuseppe_ando
@RadialFirstBot
@PCRonline
@MinervaCardioa1
@FrancescoSapori
@GoranEBC
@mirvatalasnag
Great result 👏 do you always perform FKB in your provisional LM-LAD PCI?
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To be precise, join us in a critical appraisal of the DK-Crush technique and current ESC guideline recommendations and learn from the experts a DK-Crush troubleshooting!
@NanjingFirst
@GreggWStone
@billgogas
@mirvatalasnag
@sbrugaletta
@BifurcationClub
@PCRonline
@mmamas1973
On 05/092019 at 4:00pm Paris time why not join
@GoranEBC
A Banning & M Lesiak for this FREE webinar 📱💻 on "Case-based step-by-step DK-crush technique in a
#bifurcation
", module 4 of this year's series!
@EuroInterventio
@PCRonline
@BifurcationClub
#EAPCI
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@mirvatalasnag
@PCRonline
@BifurcationClub
@ACCinTouch
@biljana_parapid
@SimoneBiscaglia
@Tabaza
@Ortega_Paz
@sbrugaletta
@mmamas1973
@DocSavageTJU
@fischman_david
@Pooh_Velagapudi
@adityadoc1
Join us today at 16:00 CET to discuss with
@mirvatalasnag
& J. de la Torre Hernandez the use of DK-Crush vs. TAP stenting for
#LeftMain
PCI. Join us to understand when a two-stent strategy should be selected and learn how to adapt LM treatment strategy to the underlying anatomy!
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Longer SB stent protrusion into the MV (should not be more than 2-3 mm) is done intentionally to better illustrate and simplify appreciation of certain technical steps, like a “proximal” re-crossing into the SB or "SB ostial optimization" after stent deployment.
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Vaccine selfie, so happy to get the 1st dose of the Pfizer-Biontech Covid vaccine😁
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@PCRonline
@ANazmiCalik
@BURZOTTA_F
@sbrugaletta
@mirvatalasnag
@MilasinD18
@gabor_gt
@KardiologieHH
@aayshacader
@NicolaRyanI1
@guilbon
@belcid7
@QuinaCatarina
@DrArifK
@EGallinoro
@ICigalini
@Marta33717088
@draylinsafak
@KanarBatur
@cpgale3
@twj1974
@italian_cot
@delPortilloJH
@EzmanShariff
@AsherElad
@BiascoDr
@mmamas1973
Join us to explore the most contemporary LM PCI data from the EBC-MAIN and the ROLEX studies, as well as to discuss common pitfalls and troubleshooting (abluminal wiring, longitudinal stent deformation, stent protrusion in the aorta) with
@BURZOTTA_F
and Prof. Jacek Legutko!
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Studies evaluating clinical effects of kissing balloon inflation in coronary bifurcation stenting. EuroIntervention 2020;16:192-194
@EuroInterventio
@sbrugaletta
@DFCapodanno
@mirvatalasnag
@Ortega_Paz
@nickaram
@flensted_jens
@BURZOTTA_F
@twj1974
@gabor_gt
@MPAOSS
@mmamas1973
2
19
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@jedicath
@mirvatalasnag
@drptca
@BifurcationClub
@latambif
@AmBifClub
@ajaykirtane
@mmamas1973
@GreggWStone
@agtruesdell
@KambisMashayek1
@kaschenke
@FelixValencia10
@sbrugaletta
@aspergian1
@AntoniousAttall
@ShariqShamimMD
@mobitz
@perc_surgeon
In my view, distal Cx has a relatively short lesion, while OM has diffuse disease, unfavorable angle, probably difficult to wire. My strategy, inverted provisional stenting LCx to OM, then POT, KISS and evaluate! If distal circumflex is compromised select a T, TAP or Culotte!
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Thank you
The best step-by-step training approach of bifurcation PCI with visible heart by
@GoranEBC
How do you calculate a bifurcation vessel size?
@crfheart
@BifurcationClub
@Dr_JorgePadilla
@PCRonline
#TCT2019
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Join
@MPAOSS
@SFournierMD
and
@GoranEBC
for PCR Webinar on Bifurcations, we start in 30 minutes and are looking forward to hearing your questions and comments
0
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@sbrugaletta
@MilasinD18
@gabor_gt
@JEscaned
@PCRonline
@escardio
SINERGY – BIFURCATION DAY, on Thursday, September 10th, from 4pm to 5pm CET: Left main PCI in focus: My approach to LM PCI by Antonio Colombo, Tips&Tricks of DK Crush by Shao-Liang Chen, with a LIVE case by Javier Escaned with expert commentary, Thierry Lefevre & Goran Stankovic.
5
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LM Bifurcation PCI consensus statements: European, by Yves Lovard, Chinese, by
@NanjingFirst
and Japanese, by Sunao Nakamura. We definitely need to work together and collaborate with Canadian, Indian and LATAM bifurcation clubs to produce a "Global" Bifurcation Club Consensus👍
2
7
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Attend “Optimal LM bifurcation stenting technique: a patient-centered approach” session at
#PCReCourse
with Jean Fajadet,
@DrthierryL
and
@GoranEBC
to learn how to adapt LM treatment strategy to the underlying anatomy and to learn when and how to perform step-by-step TAP stenting
1
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Top cited article in Eurointervention in 2022 is the 15th EBC consensus document, Congratulations to
@BURZOTTA_F
and the whole EBC board👏
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SINERGY Belgrade 2019 Bifurcation Clinic: Provisional stenting by Yves Louvard & DK-Crush Masterclass, with step-by-step technique description in bench by Prof. Shao-Liang Chen
@NanjingFirst
and
@dzavik_vlad
and PCR NextGen facilitation by
@gabor_gt
@MilasinD18
@ZMehmedbegovic
0
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@mmamas1973
@gabor_gt
@DrJosefLudwig1
@dr_mosama
@ajaykirtane
@SVRaoMD
@RodrigoBagur
@DocSavageTJU
@fischman_david
@GreggWStone
@rwyeh
@Hragy
@adityadoc1
@Pooh_Velagapudi
@aayshacader
@NanjingFirst
@BifurcationClub
@DrthierryL
@flensted_jens
@BURZOTTA_F
@MPAOSS
@twj1974
@Ryvetsprog
@ODarremont
@RemoAlbiero
@sbrugaletta
@mirvatalasnag
@DFCapodanno
@Ortega_Paz
@CCook_MD
Dear Twitter Friends, thank you very much for feedback and support🙏 and welcome to virtual
@BifurcationClub
meeting on October 22-23! Please submit your selection of the best published LM/bifurcation PCI articles/studies in 2020 for possible presentation at the EBC News session!
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PCR Main arena live cases
Words of wisdom - Jean Fayadet
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Directional Coronary Atherectomy (DCA) plus Drug Coated Balloon (DCB); Even more interesting, DCA+DCB for distal LM will be presented
@DFCapodanno
@mirvatalasnag
@BifurcationClub
@twj1974
@mmamas1973
@sbrugaletta
@PCRonline
@NanjingFirst
@billgogas
@nickaram
@GoranEBC
@billgogas
@BifurcationClub
@twj1974
@NanjingFirst
@sbrugaletta
@PCRonline
@mirvatalasnag
@mmamas1973
@GreggWStone
@Ryvetsprog
@MPAOSS
What does the DCA + DCB mean?
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Left main PCI: are we giving the kiss the attention it deserves?
@GoranEBC
@MilasinD18
@zlatkombegovic
@PCRonline
@EuroInterventio
@sbrugaletta
@DFCapodanno
@mirvatalasnag
@Ortega_Paz
@nickaram
@flensted_jens
@BURZOTTA_F
@twj1974
@gabor_gt
@MPAOSS
1
5
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#EBC2019
EBC call for a Bifurcation "Big Data"
Can we plan with simulation which technique will provide optimal result in each individual coronary bifurcation?
@twj1974
@mirvatalasnag
@YChatzizisis
@Udio_NT
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Corsair or Tornus catheters may be used as an alternative if OTW balloon fails.
2) We removed all the “stucked” wires with a simple technique. First thing is to never apply force when the wire don’t come out easily- avoid tip fracture. The hint is to insert a OTW or rapid exchange device over the stucked wire it will release it smoothly your wire. See above
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Passing the EAPCI Certification Exam certifies your knowledge and skill in the field of percutaneous interventional cardiology. Ready to put yourself to the test? The next exams will take place online on Tuesday 18 May. Register by 2 May for the physicians' exam and NAP exam
1
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EAPCI education and training grants allow EAPCI Members under 40 years of age to train for a year at another institution – in your own country (exceptionally this year) or elsewhere. Both candidates and host centres are open. Apply by 30 April!
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@mirvatalasnag
@billgogas
@drptca
@Ortega_Paz
@sbrugaletta
@MilasinD18
@SimoneBiscaglia
@GreggWStone
@saraceciliamtz
@SJcardio
@dcscant
@SCAI
@PCRonline
Need AP caudal to better see both vessels but seems to me that steptwise approach could be: predilatation and provisional stent from Cx to OM, than POT and KISS and, if needed, a 2nd stent T/TAP to distal Cx.
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@aayshacader
@SCAI
@SCAI_Prez
@PCRonline
@BifurcationClub
@azeemlatib
@ArasiMaran
@perc_surgeon
@rwyeh
@agtruesdell
@rachkataria
@mirvatalasnag
@UjjwalRastogiMD
@yaqoub_lina
@Tesslagra
@sabeedak1
@ShaziaTHussain1
@CaraCarahendry
@Ortega_Paz
@novitskiynic
@bhavanadhar
@cardio_gotya
Overlapping, proximal MV balloon diameter, can be calculated as follows: MV balloon diameter plus 1/3 of the SB balloon diameter😇
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Proximal, overlaping diameter of two kissing balloons equals: full diameter of a bigger balloon plus 1/3 of a diameter of smaller balloon; example: LAD balloon 3.5, LCx balloon 3.0, overlap 3.5mm + 1mm = 4.5 mm
@GoranEBC
Bit concerned whether effevtive diameters of 2 KBs will be > 5 mm..3.5mm onyx can be flared upto 5mm
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@gabor_gt
@mmamas1973
@DrJosefLudwig1
@dr_mosama
@ajaykirtane
@SVRaoMD
@RodrigoBagur
@DocSavageTJU
@fischman_david
@GreggWStone
@rwyeh
@Hragy
@adityadoc1
@Pooh_Velagapudi
@aayshacader
@MilasinD18
In my view, the simplicity of Medina is unbeatable and should stay! What I learned from DK-Crush V & Definition II
@NanjingFirst
, in true LM bifurcations, when Cx lesion is tight and longer than 10mm (16mm in DK-Crush V and 19mm in Definition II) two stents are better!
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Seems like planned 2 stent strategy; one option is inverted provisional: stent LAD-diagonal, POT, KISS, and T/TAP stent for LAD; second option - DK-Crush.
54 yr old gentleman.AWSTEMI in 2011.CAG showed totally occluded D1.pLAD 20-30%lesion.On OMT .Class IIIEA.EST +ve
@7METS
.Echo -hypokinetic mid & apical anterior scar.Upfront 1 stent or 2 stent strategy?
@PCRonline
@sbrugaletta
@GoranEBC
@Ortega_Paz
11
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Great demonstration! Final POT balloon position probably too distal and, as a result, some carina (and stent strut) shift and worse angio result at the LCx ostium. If second POT is performed, balloon should be positioned at the proximal stent edge!
72yrold GM.CP -7hrs.STE V1-V6.7F slender RRA. 2 bifurcations. Distal lesion stented with 3.0X18mmOnyx.Stented from LM into LAD across LCX &D1 3.5X26mmOnyx.pLAD approx with 4mmballoon. LM POT with 5mm balloon. KB with 2 3.5mm C balloons.rePOT 5mm. PSS strategy
@GoranEBC
@PCRonline
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Today we will focus on stent optimization techniques in provisional, POT and KISS, when to perform and how to do it!😁
@mirvatalasnag
@mmamas1973
@sbrugaletta
@DFCapodanno
@sicigise
@EuroInterventio
@BifurcatioClub
Good also for DK-crush believers😉
@NanjingFirst
@bgmdphd
Would you like to extend & refine your
#bifurcation
toolbox? Join
@GoranEBC
, J. F. Lassen and
@MilasinD18
today at 16h Paris time for this free PCR webinar on a step-by-step algorithm for provisional side branch stenting in non-LM bifurcations! 🖥️📱
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@PCRonline
@mc_morice
This webinar is excellent opportunity to ask
@Ryvetsprog
@mc_morice
and
@GoranEBC
anything you would like to know about the stepwise provisional stenting, learn why provisional does not mean a single stent & can we use provisional if/when we plan upfront to stent both branches!
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Please share dilemmas and topics you would like to learn more!
1
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POT-SBI-rePOT is currently investigated as an alternative to KISS or POT-KISS-POT; main advantage of techniques with kiss is repositioning carina in the center, which is important for shear stress pattern.
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The first kiss instead of SB ballooning (figure E) is important because SB balloon inflation may push some metal inside the MB and complicate MB stent cross. Recent modification of DK-crush is a double POT, first after MB stent and final POT after second kiss.
@SCAI
@CCIJournal
Interesting this paper from Fuwai Hospital in China. It is kind like a DK crush but without the 1st kissing. Just SB ballooning and FKB then POT.
@GoranEBC
@MPAOSS
@OjedaOjeda18
@BifurcationClub
@lorenzo2509
@CarlosAlfonsoMD
@lamelaspablo
@vgaldana
@CharryPablo
@jsenior64
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3
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PCR Webinar "Ostial CX during crossover LM stenting: when and how to treat", December 13, 5:00 PM CET, with
@Ryvetsprog
@flensted_jens
. Join us to discuss the indications after EBC-MAIN & ROLEX and treatment strategies: POT-KISS-POT, 2nd stent, and the evolving concepts with DCB.
0
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@sbrugaletta
1.5 or smaller 🎈, but very important to place first 🎈inside the stent (sized for POT after SB 🎈passage into the SB, with or without inflation: the key to reestablish the flow and visualise the ostium).
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SINERGY Bifurcation Clinic two-day program designed in cooperation with European Bifurcation Club (
@BifurcationClub
), The Left Main&Coronary Bifurcation Summit - CBS
@NanjingFirst
@billgogas
, and PCR NextGen
@gabor_gt
@MilasinD18
@sbrugaletta
@PCRonline
1
4
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@mirvatalasnag
@AntoniousAttall
@drsonyaburgess
@mmamas1973
@Hragy
@IndiaCvt
@mathur_a
@NishithChandra
@drptca
@Dr_AshokSeth
@twj1974
@LAzzaliniMD
@SVRaoMD
@perc_surgeon
@WAboshokka
@fischman_david
@DocSavageTJU
@hect2701
@ncurzen
@DrAnkushG
@ajaykirtane
@rwyeh
@dr_mosama
@mandeep_mayo
@DrRajeshG1
@akbarul
@ShaziaTHussain1
@adityadoc1
Inverted provisional (MV to SB stent) and 2 stents only if necessary. It is important to understand a clinical relevance of these SBs because only 20% of them outside LM supply >10% of myocardium.
@mmamas1973
it will be intersting to see how many large SBs were in your analysis.
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Well deserved, Bravo Salvatore!👏
Hot 🔥 off the press! We're delighted to announce the appointment of
@sbrugaletta
from
@hospitalclinic
🇪🇸 as the new Editor-in Chief of PCRonline! Read more here
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@sbrugaletta
@PCRonline
@BURZOTTA_F
@EuroInterventio
@twj1974
All the credit for great animations and innovative way to present the essential steps and pitfalls of the POT procedure goes to my colleagues
@zlatkombegovic
and Dario Jelic👍👏
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Key step is a MV balloon sizing for SB stent crush, 1:1 distal sizing is too small, 1:1 proximal sizing is too big. Probably something in between or selection of proximal sizing but with low inflation pressure.
@lamelaspablo
@SCAI
@CCIJournal
@GoranEBC
@MPAOSS
@OjedaOjeda18
@BifurcationClub
@lorenzo2509
@CarlosAlfonsoMD
@vgaldana
@CharryPablo
@jsenior64
I believe it’s preferable to cover the whole ostium with the stent regardless of the SB angulation. Although as pointed by Professor
@GoranEBC
there is a concern with this technique of just SB post stent ballooning regarding metal protrusion in the MV which difficult MV stenting.
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Bifurcation Clinic at SINERGY 2019 in Belgrade: IVUS guided LM PCI by
@dzavik_vlad
, session moderation and comments by Yves Louvard,
@NanjingFirst
@GoranEBC
0
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@mirvatalasnag
@mmamas1973
@twj1974
@RodrigoBagur
@ncurzen
@chadialraies
@timir_paul
@DocSavageTJU
@djc795
@fischman_david
@rajivxgulati
@DFCapodanno
@agtruesdell
@tristonsmithmd
@SripalBangalore
@ShaziaTHussain1
@Pooh_Velagapudi
@SukhNijjer
@aayshacader
Thank you very much
@mirvatalasnag
we are disappointed with unexpectedly low rate of POT in the current practice and this definitely needs to be improved 😀
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Because of very unfevorable Cx angle side branch stenting first; depends on expertise and personal preference, either inverted provisional, from LM to Cx, then KISS and LAD stenting (T/TAP) or DK-Crush upfront.
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@mirvatalasnag
@SCAI
@APSIC6
@perc_surgeon
@twj1974
@saraceciliamtz
@Allison_Dupont
@FrederickWelt
@_WayneBatchelor
@sbrugaletta
@BURZOTTA_F
@nicolasamabile
@alaide_chief
@mmamas1973
@aayshacader
@KardiologieHH
@drptca
@DrPeterOKane
@LAzzaliniMD
@azeemlatib
@ShariqShamimMD
@AntoniousAttall
@NishithChandra
@IndahSP_MD
IVUS guided crossover LM-LCx, with POT and KISS, then evaluate.
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@shaoliang_chen
Thank you very much dear Shao-Liang, we missed your wisdom in excellent bifurcation sessions during the
#EuroPCR2022
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@sbrugaletta
@MilasinD18
@gabor_gt
@JEscaned
@PCRonline
@escardio
SINERGY – BIFURCATION DAY, on Thursday, September 10th, the On-demand channel from 1pm CET: Meet the experts: Yves Louvard, Shao-Liang Chen & Alaide Chieffo will provide their expert comments to 3 contestants presenting LM & bifurcation PCI cases from everyday practice.
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@Costa_F_8
@marceabud
@luciotpadilla
@ICBAonline
@BURZOTTA_F
We should distinguish between: 1) the final POT, which should be optional, only if the proximal stent length permits safe POT balloon inflation far from new carina, and 2) final proximal inflation, which is balloon expansion of the proximal stent edge, which I strongly encourage!
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@BifurcationClub
@twj1974
@RemoAlbiero
@sbrugaletta
@mirvatalasnag
@BURZOTTA_F
@alaide_chief
@DrthierryL
@nicolasamabile
Big Thank You to our faculty and all attendees, to our industry partners and Medi8 Events, and special thank you to EBC board members who made this meeting possible!
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It looks like planned two-stent strategy, provisional stenting LM-LAD, POT, 3rd wire to circ, then KISS and, if distal recross was done, T-stenting for LCx, otherwise TAP. It could also be done as inverted provisional, with the first stent LM-LCx and then T stenting for LAD.
56 year old patient from OSH with acute NSTEMI small elevation of Troponin. EF reported 35-40%. What would you do or want to know?
@mirvatalasnag
@drptca
@GoranEBC
@billgogas
@BaoGTran
@GreggWStone
@mmamas1973
@DocSavageTJU
@ShariqShamimMD
@cardiojaydoc02
#ACCFIT
#EAPCI
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SB ballooning pushes metal inside the MV and narrows the space for MV stent passage. Sequential MV ballooning pushes metal back towards the SB. That is why the first kiss was recommended.
@uribemd72
@SCAI
@CCIJournal
@GoranEBC
@MPAOSS
@OjedaOjeda18
@BifurcationClub
@lorenzo2509
@CarlosAlfonsoMD
@vgaldana
@CharryPablo
@jsenior64
MV is MB? And can u expand about stenting problem? Thanks!
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EBC-MAIN randomized study compares provisional and planned two stent strategy for LM PCI, and we hope to finish the enrollment soon.
Dear Bill, I agree with DK-Crush V results that DK crush may achieve better results than provisional in "complex" LM lesions according to Definition trial criteria. Results should not be generalized since study population was really complex, with mean Cx lesion length of 16mm.
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Thanks to European Cardiovascular Research Institute the first randomized trial to appraise the optimal DAPT duration in HBR patients treated with contemporary DES.
Design & rationale of the Management of High Bleeding Risk Patients Post Bioresorbable Polymer Stent Implantation w Abbreviated vs Standard DAPT
#MASTERDAPT
Valgimigli et al
@mc_morice
@GoranEBC
Landmark trial in the making
Glad we’re part of it
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Dear Bill, I agree with DK-Crush V results that DK crush may achieve better results than provisional in "complex" LM lesions according to Definition trial criteria. Results should not be generalized since study population was really complex, with mean Cx lesion length of 16mm.
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Thank you Mirvat. If I may add, SC balloons could be used for POT if proximal vessel stent legth permits. With SC balloons diameter can increase at higher pressure when needed.
@TopKinisisCon
@drptca
@stefan_harb
@mmamas1973
@AspriAlexia
@drrashid05
@nolanjimradial
@GoranEBC
Bifurcation tips:
POT
Imaging
Bail out strategy for provisional
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Collaboration with the PCR NextGen brings a next level of education in bifurcation PCI techniqes, a combination of coronary angiograms, bench testing and simulation, angioscopy inside the pig heart coronaries (Visible heart lab) and Micro focus CT with Fly-through reconstruction!
PCR NextGen @ SINERGY congress in Serbia: Join a simulator-based session on learning complex
#bifurcation
PCI techniques by
@GoranEBC
& facilitated by PCR
#NextGen
representatives Gabor Toth &
@MilasinD18
See you in Belgrade on Thu 12 Sep 09:30-12:00!
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@AlesqQuadros
@lamelaspablo
@ajaykirtane
@rwyeh
@GreggWStone
@cghanratty
@evandrofilhobr
@djc795
@felixdamasds
@ColinBerryMD
My interpretation: LAD proximal/ostial difuse disease and short lesion in Diag - 7Fr, 3 wires, crossover stent LM-LAD, with POT and Kiss, than T/TAP in Diag if necessary. Image-guidance recommended. DK-Crush not my first choice because of short diagonal lesion.
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Save the date and register for the SINERGY meeting (Serbian conference on interventional cardiology, cardiovascular imaging, and drug therapy), Belgrade, 12-14 September 2019;
@escardio
@BifurcationClub
@mirvatalasnag
@NanjingFirst
@billgogas
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At Belgrade-Sinergy city pod interventional cardiologists from the South East Europe connected with zoom to discuss the first day of the
#EuroPCR2021
Thank you for sharing your experience and "know how", the reward is better treatment of our patients😷
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Thank you Mirvat, almost all evidence in favor of provisional. DK-Crush V had very complex lesions, with difuse disease (mean Cx length 16mm) and better outcome of upfront 2 stents is realistic!
@mmamas1973
@LCC_DrMalik
@CaraCarahendry
@ShrillaB
@adityadoc1
@MusaSharkawi
@andrewwiper
@drandrewsharp
@sbrugaletta
@sanjaysastry
@danmckenzie73
@fwitherow
@Hragy
@DrPaulRees
@saraceciliamtz
@GoranEBC
provisional, kissing, POT ✅
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Many thanks to Prof. Shao-Liang Chen
@NanjingFirst
for sharing with colleagues from SE Europe knowledge and experience, for his commitment and support! The Belt and Road Initiative opens the door for training, education and future common scientific projects!
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When you kiss inside the LM stent you restart the healing process and endothelization which has probably been already completed by the time of fup LCx treatment and you have to take into account LM re-PCI when you decide about DAPT duration following second procedure.
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PCR webinar on planning and performing bifurcation PCI requiring 2 stents upfront, 4 October at 4PM CET!
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In my view, you do it during the index PCI because 2 wires are in place and NC balloon for LAD and POT balloon for LM ready to use and the LM stent healing process starts at that time. Of course it is easy to rewire Cx at fup, but If you Kiss LM then that will have impact on DAPT
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@MarcoJe80135689
@jedicath
@sbrugaletta
@mirvatalasnag
@ALEX_MISCHIE
@JACCJournals
@BifurcationClub
@TCTMD
@EuroInterventio
@NanjingFirst
@VisibleHeartLab
, in-vitro angioscopy evaluation of bifurcation PCI in swine heart, showed that balloon in the main vessel, sized according to distal MV, cannot completely crush SB stent and obstructs MV lumen. 2nd ballon, sized to prox MV (like POT) necessary for adequate crush.
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@sbrugaletta
@aayshacader
@PCRonline
@mirvatalasnag
@twj1974
@mmamas1973
@DrPeterOKane
@Hragy
@DrAsifQasim
@ShrillaB
@azeemlatib
@Ortega_Paz
@gabor_gt
@PCapranzano
@ICigalini
Probably when the Definition II study criteria for complex lesion are met! Even if you plan 2 stents upfront, you can follow the provisional stepwise strategy, and start by stenting of the either MV or SB, do POT and KISS, than stent other branch with T, TAP or Culotte stenting!
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Now we need to put that info in the context of INDICATION for revascularization, as well as STRATEGY selection in specific lesion subsets, like non-LM
#bifurcations
: small ischemia: keep SB open; large ischemia: optimal SB result, with either one or two stents!
@BifurcationClub
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Crossover LM-LAD, POT and KISS.
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Thank you so much to all of you, you are so kind and I'm still recovering from new ESC guidelines and DK-Crush 2b recommendation!
@biljana_parapid
@mmamas1973
@GoranEBC
@sbrugaletta
@SilCastelletti
@JGrapsa
@chiarabd
@PCRonline
@escardio
@DrPascalMeier
@VijayKunadian
@denisamuraru
@EuroInterventio
Happy bifurcation day...oops birthday
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#EBC2019
Bench and simulation session
@BifurcationClub
: only a combination of POT and asequate KBI were able to correct a flow disturbance at the SB ostium! Question is how to translate this in clinical practice.
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Great success, congratulations! In my opinion, presence of collaterals important for procedural success in such cases. Also, a 4.0 stent seems bigger than LAD landing zone diameter, which created carina shift and LCx ostial compromise, successfuly treated with KISS!
RT.Radial access.. Wired both branches..multiple runs of Tx aspiration ..heavy thrombus load.. predilated LAd with 2.5mm balloon. Could restore flow after multiple Tx aspirations. Stented from LM to LAd with 4X38 DES.. Tx into LCX POT - Kiss -POT
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@DrJosefLudwig1
@sbrugaletta
@MilasinD18
@gabor_gt
@JEscaned
@PCRonline
@escardio
Thank you very much for supporting us
@mirvatalasnag
,
@mmamas1973
@marcoje08410656
@DFCapodanno
@Ortega_Paz
@PCRonline
@NanjingFirst
@BURZOTTA_F
@twj1974
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#bifurcation
Direct link to SINERGY2020online:
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@mmamas1973
@gabor_gt
@DrJosefLudwig1
@dr_mosama
@ajaykirtane
@SVRaoMD
@RodrigoBagur
@DocSavageTJU
@fischman_david
@GreggWStone
@rwyeh
@Hragy
@adityadoc1
@Pooh_Velagapudi
@aayshacader
@NanjingFirst
Thanks, we could discuss it further if you agree at the next
@BifurcationClub
meeting, this year virtual, on October 22-23
@DrthierryL
@flensted_jens
@BURZOTTA_F
@MPAOSS
@twj1974
@Ryvetsprog
@ODarremont
@RemoAlbiero
@sbrugaletta
@mirvatalasnag
@DFCapodanno
@Ortega_Paz
@CCook_MD
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My pleasure! The inventor, Prof. Shaoliang Chen
@NanjingFirst
and his team will be next week in Belgrade at the , to share DK-Crush advanced tips&tricks as a part of
#Bifurcation
education continuum organized with
@BifurcationClub
& PCR NextGen
@gabor_gt
!
@GoranEBC
@PCRonline
@NanjingFirst
@mirvatalasnag
@billgogas
@BifurcationClub
@mmamas1973
@GreggWStone
@sbrugaletta
@Drroxmehran
Thank you for educating!
@PCRonline
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Japanese colleagues will present a registry of cases of DCA+DCB without stenting for distal LM, procedural results and clinical follow-up outcome👍
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The main advantage of kissing is better proximal stent expansion, in addition, kissing places carina (flow devider) in the center.
@Maurici47613939
@GoranEBC
@uribemd72
Kissing aligns struts in the MB & SB without shifting them into either one.. kind of an important step so is POT X2
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@mirvatalasnag
@AntoniousAttall
@drsonyaburgess
@mmamas1973
@Hragy
@IndiaCvt
@mathur_a
@NishithChandra
@drptca
@Dr_AshokSeth
@twj1974
@LAzzaliniMD
@SVRaoMD
@perc_surgeon
@WAboshokka
@fischman_david
@DocSavageTJU
@hect2701
@ncurzen
@DrAnkushG
@ajaykirtane
@rwyeh
@dr_mosama
@mandeep_mayo
@DrRajeshG1
@akbarul
@ShaziaTHussain1
@adityadoc1
2 stent strategy in small, non-clinically relevant SBs will not improve the outcome but may cause the events! Look at the Tryton IDE study
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Bravo👏
"Though we cannot be together in person, we can offer to share our knowledge and that of our community" say William Wijns and Jean Fajadet🤝
Benefit from free open access to EuroIntervention until 30 April! ➡️
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@PCRonline
@MilasinD18
We will also try to answer the most common question at every bifurcation workshop "Should we remove a jailed wire before POT"
@mirvatalasnag
@mmamas1973
@sbrugaletta
@DFCapodanno
@sicigise
@EuroInterventio
@BifurcatioClub
@NanjingFirst
@bgmdphd
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@aymanka
@mirvatalasnag
@APSIC6
@BifurcationClub
@twj1974
@DrPeterOKane
@w_jyg
@NishithChandra
@mathur_a
@DrAnkushG
Left main PCI: are we giving the kiss the attention it deserves?
@EuroInterventio
@MilasinD18
@zlatkombegovic
@sbrugaletta
@DFCapodanno
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@mirvatalasnag
@Zayer_h
@JLVelianou
@DrNataliaP
@DrAlshatti
@xElieAkl
@MatthiasBossard
@Sujay747
@hamedsghamdi
@wagarhabib
No definite answer, according to registry data, in Japan he will receive a stentless procedure, directional coronary atherectomy (DCA catheter registered in Japan) plus DCB. At my knowledge, no available good quality data on cutting/scoring balloon plus DCB for 0,0,1,0 lesions.
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