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)