FFR et bifurcation. FFR et MB avant ATL MB SB ? 1.Intermediate stenoses (Pijls et al. New Engl J Med 1996) (Pijls et al. JACC 2010) 2.Post-myocardial.

Slides:

Advertisements

Similar presentations

Disclosure Statement of Financial Interest

Advertisements

LAD/D1 bifurcation lesion. Crush technique. 35yr old male.

Bifurcation LAD/D2 lesion. Provisional T stenting.

Patient Demographics: AGE: 67 year old Gender: Female Cardiac risk Factors: Hypertension, Diabetes, hypercholesterolemia Clinical Presentation: NSTEMI.

TAVOLA ROTONDA Quale Ruolo Clinico e Quale Rimborso per la Franctional Flow Reserve? Correlazioni anatomo-funzionali FFR vs IVUS Luigi Vignali, Parma Bologna.

FFR & IVUS PRIOR TO REVASCULARISATION Journal review Dr. Sony Manuel M Senior Resident MCH Kozhikode.

FFR & IVUS PRIOR TO REVASCULARISATION Journal review Dr.Sony Manuel M Senior Resident MCH Kozhikode.

ILUMIEN™ PCI Optimization System

Coronary stenting: the appropriate use of FFR Morton J. Kern, MD Professor of Medicine Chief of Cardiology LBVA Associate Chief Cardiology University California.

Bifurcation stenting. Crush technique. LAD / Diagonal 68 yr old male

Www. Clinical trial results.org  Major Endpoints: Death, MI, stent thrombosis, TLR, TVR, MACE, and CKMB >3x nl  Major Endpoints: Death, MI, stent thrombosis,

Bifurcation Overview A comprehensive overview of Bifurcation disease, treatment options and techniques.

Bifurcation coronary stenting: State 0f the Art Mazhar M Khan Consultant Cardiologist Royal Victoria Hospital Belfast, N.Ireland.

BIFURCATION LESIONS Dr. Tahsin.N

Cardiology Morning Report: Revascularization in Stable Ischemic Heart Disease Bobby Mathew, MD LSU Internal Medicine, HO-II.

FFR vs Angiography for Multivessel Evaluation

Pros and cons of FFR in multivessel disease: from FAME to ACS Giuseppe Biondi Zoccai University of Modena and Reggio Emilia, Modena, Italy

FAME 2 year Objective:To investigate the 2-year outcome of PCI guided by FFR in patients with multivessel CAD. Study:Multicenter, single blind, randomized.

To stent or not to stent Clinical Utility of Fractional Flow Reserve.

Journal : Evidence Review PCI : Role of FFR Dr Binjo J Vazhappilly SR Cardiology MCH Calicut.

Randomized Comparison of FFR-guided and Angiography-guided Provisional Stenting for True Coronary Bifurcation Lesions: The DKCRUSH-VI trial Shao-Liang.

29th ANNUAL SCIENTIFIC SESSIONS – SCA&I

Bifurcation Stenting: A primer

Raising the standard in treating bifurcation lesions GENNARO SARDELLA MD, FACC,FESC O.U. of Interventional Cardiology Dept. of.

CORONARY PRESSURE MEASURENT AND FRACTIONAL FLOW RESERVE

FFR in specific circumstances Zsolt Piróth MD Gottsegen György Hungarian Institute of Cardiology.

Is FFR a Substitute For Sound Clinical Judgement ? Jeffrey W. Moses, MD Columbia University Medical Center/ NY-Presbyterian Hospital.

Tips and Pitfalls in Measurement of FFR during Bifurcation Stenting Nanjing first hospital Nanjing cardiovascular hospital Yefei Chenshaoliang Zhangjunjie.

BURZOTTA F. 1, PAN M. 2 (CO-FIRST AUTHOR), TRANI C. 1, MEDINA A. 3, SUÀREZ DE LEZO J. 2, NICCOLI G. 1, ROMERO M. 2, PORTO I. 1, MAZUELOS F. 2, LEONE A.M.

Jie Qian National Heart Center & FuWai Hospitall FFR in Diffuse Multivessel Disease.

Baisc Concept and Technique of FFR FuWai Hospital JieQian.

Pressure Wire Evaluation of the Left Main Stem Dr Phil MacCarthy Consultant Cardiologist King’s Cardiac Centre Left Main 5+ at AA2007, Jan 24 th, 2007.

LM strategy Interventional cardiology dpt Cardiovascular Hospital - Lyon - France Gilles Rioufol MD PhD INSERM U1060 High Tech Marseille, 26 Janvier 2012.

TCT 2012 Revascularization Strategies for Complex Left Main Disease and Left Coronary Ostial Disease Alfredo E. Rodriguez, MD, PhD, FACC, FSCAI Centro.

左主干分叉病变治疗策略的选择 Left main bifurcation: what is the best choice? Lei Ge, MD Department of Cardiology, Zhongshan Hospital, Fudan University.

Cost-Effectiveness of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients with Stable Coronary Disease: Results from the FAME.

Case report of FFR for bifurcation Nanjing first hospital Nanjing heart center Yefei chenshaoliang.

Lianglong Chen MD PhD FACC

OCT findings in bifurcations Nanjing first hospital Chen shaoliang Zhu zhongsheng.

Dedicated Bifurcation Stent Technology: Implications for Everyday Practice Jens Flensted Lassen MD, PH.D., FESC The Heart Centre, Rigshospitalet University.

Date of download: 6/1/2016 Copyright © The American College of Cardiology. All rights reserved. From: 3D Reconstructions of Optical Frequency Domain Imaging.

J Am Coll Cardiol 2008;51:538–45 Acute and Late Outcomes of Unprotected Left Main Stenting in Comparison With Surgical Revascularization Pawel E. Buszman,

Date of download: 7/8/2016 Copyright © The American College of Cardiology. All rights reserved. From: Fractional Flow Reserve Versus Angiography for Guiding.

Date of download: 7/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Severe Neointimal Hyperplasia of Neoplastic Carina.

Date of download: 7/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Kissing Balloon or Sequential Dilation of the Side.

Fractional Flow Reserve: How to use FFR in 2015

FFR DECISION MAKING DURING DIAGNOSTIC PROCEDURES

Bifurcation PCI: Basic Techniques and Data from Clinical Trials

Nico H.J. Pijls, William F. Fearon, Peter Jüni, and Bernard De Bruyne

IVUS, FFR, OCT- Which Should I Use For PCI?

Clinical Usefulness of Post-Stenting FFR

Tubular LMS stenosis. LCx ostial stenosis

(DES)+BVS +DCB for long diffuse LAD disease

Strategy planning in coronary bifurcation stenting

Bifurcation FFR - Helpful or Wasteful?

When IVUS? When FFR? Assessing Intermediate Lesions

Debate: What Does the Future Hold for the Treatment of Unprotected Left Main Disease? More PCI No More Routine Surgery Ron Waksman, MD, FACC Washington.

Fractional Flow Reserve Workshop

SKS Technique Clinical Case

Figure 1 PCI strategies in patients with STEMI and multivessel disease

Ryoji Nagoshi et al. JCIN 2016;9:e107-e109

Bifurcation Disease: Simulation Training Curriculum

Main branch restenosis at 1 year

Incidence and management of restenosis after treatment of unprotected left main disease with drug-eluting stents: 70 restenotic cases from a cohort of.

Fadi J. Sawaya et al. JCIN 2016;9:

Ryoji Nagoshi et al. JCIN 2016;9:e107-e109

Fadi J. Sawaya et al. JCIN 2016;9:

SMART-STRATEGY Trial design: Patients with a bifurcation coronary lesion were randomized to a conservative strategy (n = 128) vs. an aggressive strategy.

APPROACH TO CORONARY BIFURCATION LESIONS

Tanveer Rab et al. JCIN 2017;10:

Presentation transcript:

FFR et bifurcation

FFR et MB avant ATL MB SB ?

1.Intermediate stenoses (Pijls et al. New Engl J Med 1996) (Pijls et al. JACC 2010) 2.Post-myocardial setting (De Bruyne et al Circulation 2001) (Ntalianis et al. JACCInterv 2010) 3.Multivessel Disease (Tonino et al. New Engl J Med 2009) 4.Left main stenosis (Hamilos, Muller et al. Circulation 2009) 5.Proximal LAD stenosis (Muller et al. JACCInterv 2011) The Value of FFR in terms of Clinical Outcome Has Been Validated in patients with

FFR et MB avant ATL MB SB Oui

FFR et SB avant ATL MB SB ?

Mach band in bifurcation

"Mach bands are an optical illusion consisting of an image of two wide bands, one light and one dark, separated by a narrow strip with a light-to-dark gradient. The human eye perceives two narrow bands of different brightnesses either side of the gradient that are not present in the original image."optical illusionhuman eye Lateral Inhibition (or Mach band visual effect)

Mach band in bifurcation

FFR et SB avant ATL FFR overestimates the severity Jailing of a pressure wire between the stent and the vessel wall is not recommended Anatomical changes after MB stenting: carina shift, stent struts 3.

FFR et SB avant ATL MB SB Peu utile

FFR et MB après ATL MB SB ?

FFR et MB après ATL Pijls, Circulation 2002Samady, JACCinterv 2009 Pas d’interet

FFR et SB après ATL MB SB ?

FFR et SB après ATL 1.FFR-guided provisional SB intervention strategy is feasible and effective 2. Functional status of jailed SB lesions after DES implantation does not change significantly during follow-up Koo, European Heart Journal (2008)

FFR Basics for bifurcation BifurcationMBBefore PCIYESAfter PCI(YES)SBBefore PCI (YES and NO) After PCI YES (subset of lesions) FFR

Anatomically significant stenosis is frequently functionally insignificant Among side branch lesions > 75% stenosis after main vessel stenting, only 27% were functionally significant. (Pd/Pa) FFR P d P a = Koo BK, J Am Coll Cardiol 2005

FFR can tell what you have really done…… Before PCIAfter MB stentingAfter kissing balloon

M M Main prox. firstA A Main Accross side firstD D Distal firstS S Side branch first Extended V Skirt PM stenting MB stenting across SB MB stenting + kissing MB stenting + SB balloon Elective T stenting Internal crush CulotteTAP DM stenting Provisional SKS V stenting SKS Trouser legs and seat SB ostial stenting SB minicrush SB crush Syst. T Stenting MinicrushCrush After balloon 2 stents 3 stents 1 st stent Skirt + DM Skirt + SB Y. Louvard, CCI 2008;71(2): Provisional SB Stenting is The Gold Standard !