Invasive imaging follow- up of BRS in bifurca8on lesions

Transcription

1 Invasive imaging follow- up of BRS in bifurca8on lesions Preliminary short term findings in the BIFSORB pilot trial Emil Nielsen Holck 1, Camilla Fox Maule 1, Trine Krejberg Ørhøj 1, Shengxian Tu 2, Lars Jacobsen 1, Jouke Dijkstra 3, Michael Mæng 1, Hans Erik Bøtker, Evald Høj Chris8ansen 1, Niels Ramsing Holm 1 1: Dept. of cardiology, 2: Shanghai Jiao Tong University, Shanghai, China 3: Division of image processing, Leiden University Medical Center, The Netherlands

2 Disclosures Ins=tu=onal research grants: Speaker fees, consul=ng Biosensors Biotronik Boston Scien8fic Cordis Medis medical imaging Medtronic Reva Medical St. Jude Medical Terumo Biotronik Reva Medical St. Jude Medical Terumo

3 Background Embarking on a BRS- in- bifurca8on trial, but:

4 Background GHOST bifurca8on subgroup results 30d ST: 1.5% 6m ST: 3.1% While the benefits of BVS are expected to accrue at late and very late term, clustering of thrombosis within the first 30 days suggests that procedure- related factors are at play Dr. Capodanno, EBC 2014

5 BIFSORB pilot trial BIFSORB pilot Stable AP pa8ents Provisional SB sten8ng DESolve 150 1m OFDI FU

6 BIFSORB pilot trial BIFSORB pilot Stable AP pa8ents Provisional SB sten8ng DESolve 150 1m OFDI FU Methods Predilata8on by NC 1:1 Stent sizing by OFDI Mandatory POT OFDI guided rewiring OFDI guided Expansion Apposi8on

7 Will jailing struts disappear? Baseline Baseline Follow- up One- month follow- up Follow- up

8 Will jailing struts disappear? Baseline One- month follow- up MLA=0.82mm 2 MLA=3.50mm 2 Cut plane analysis by Medis medical imaging

9 Procedural problems?

10 Will thrombus disappear? Baseline Baseline Follow- up

11 Will thrombus disappear? Baseline One- month follow- up Baseline Follow- up

12 Acceptable baseline result? Baseline

13 Acceptable baseline result? Baseline One- month follow- up

14 And the feared fracture? Baseline: bifurca8on segment

15 And the feared fracture? Baseline: bifurca8on segment Baseline: proximal MV

16 And the feared fracture? DES BRS BRS fracture

17 DES for fractures? Baseline: proximal MV

18 DES for fractures? Baseline: proximal MV One- month follow- up

19 And the feared fracture? Baseline: proximal bifurca8on

20 And the feared fracture? Baseline: proximal bifurca8on One- month follow- up

21 And the feared fracture? Baseline: bifurca8on core

22 And the feared fracture? Baseline: bifurca8on core One- month follow- up

23 OCT FU not always possible Baseline: distal MV One- month follow- up

24 Flow and ESS simula8on predicts 1m healing? Follow- up? Work in progress by Shengxian Tu, Shanghai Jiao Tong University

25 What invasive imaging FU offers Follow- up Healing paierns ajer: different BRS different implanta8on techniques different implanta8on results

26 What invasive imaging FU offers Follow- up Healing paierns ajer: different BRS different implanta8on techniques different implanta8on results Class results?

27 Conclusion (preliminary findings) The early healing phase improves the os8al SB area in some pa8ents and reduce it in others Too conserva8ve (Nordic) SB strategy is likely inferior Avoid covering spicula8ng calcium by BRS predilata8on by NC balloon 1:1 - no indenta8ons in 2 projec8ons Avoid advancing s8ff catheters inside BRS Aggressive an8- thrombo8c strategy

28 Thank you for the aien8on Preliminary short term findings in the BIFSORB pilot trial Emil Nielsen Holck 1, Camilla Fox Maule 1, Trine Krejberg Ørhøj 1, Shengxian Tu 2, Lars Jacobsen 1, Jouke Dijkstra 3, Michael Mæng 1, Hans Erik Bøtker, Evald Høj Chris8ansen 1, Niels Ramsing Holm 1 1: Dept. of cardiology, 2: Shanghai Jiao Tong University, Shanghai, China 3: Division of image processing, Leiden University Medical Center, The Netherlands