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

2. MLA 1.65 mm², MLD 1.32 mm LA 6.02 mm ²

3. LA 11.2 mm² MLD 2.48 mm 94 ml Visipaque used

4. Max separation vessel wall-strut 360 µm SA 11.5 mm², LD 3.5 mm SA 8.9 mm², LD 3.1 mm SA 8.1 mm², LD 3.4 mmLA 5.7 mm², LD 2.7 mmLA 3.2 mm², LD 2.0 mm

5. B No struts impending in the ostium of OM1 Max separation distance vessel wall- struts 170 microns Almost Perfect Apposition

6. Segments Analysed with OCT Proximal Bifurcation Distal 2 mm 2 mm Cross-sections analysed at 450 μm intervals Opposite SB Towards SB

7. 28 Bifurcations, 4472 Struts Prevalence Strut Malapposition p = 0.001

8. Vessel wall-stent struts distance assessed by OCT ProximalDistalTowards SB Opposite SB Bifurcation

9. Strut Separation with different Techniques Cross-Over (15) Culotte (13)

10. 6-month after DES

11. After KB 2.5/2.0 mm @ 14 Atm Ibs Numen stent CoCr 65 μm strut thickness

12. 3.95 mm2 Stent MV Balloon SB PRE OM1 DISTAL REFERENCE SEGMENT OM1 OSTIUM AFTER BALLOON 5.27 mm2 + QUANTITATIVE ASSESSMENT OF SB STENOSIS Lumen cross-sectional area (CSA) at the SB ostium. Reference lumen CSA measured distal to the treated ostium in the closest, most normal appearing segments. Success criteria: CSA>50% From Pan et al, EBC meeting SB CSA=75%

13. Basal 2.89 mm2 Post MV stent 1.63 mm2 Post dilation 5.34 mm2 Distal reference 6.59 mm2

14. Stepwise strategy: OCT monitoring First step Second stepThird step BASELINE n=4 POST STENT MV n=9 POST SB DILATION n=20 POST SB STENT n=1 1.7 ± 11.6 ± 063.6 ± 1.253.7 ± 1.2 35 ±1634 ±1178 ±1510081 ± 21 FINAL 21/22 (95%) CSA % CSA mm2

15. Taxus DES Crush technique Taxus DES 9 mths follow-up Crush technique LAD/D1 Buellesfeld L. et al., in-press

16. Taxus DES Crush technique Taxus DES 9 mths follow-up Crush technique LAD/D1 D1 LAD LAD prox to D1 3 layers of stent 1 2 3

17. Taxus DES Crush technique Taxus DES 9 mths follow-up Crush technique LAD/D1 Buellesfeld L. et al., in-press

18. Conclusions Preintervention OCT is unable to provide measurements of EEM-area and repeated OCT assessment requires excessive contrast use Preintervention OCT is unable to provide measurements of EEM-area and repeated OCT assessment requires excessive contrast use After stenting OCT offers the best modality to assess strut apposition and compare different strategies and dedicated stents After stenting OCT offers the best modality to assess strut apposition and compare different strategies and dedicated stents Direct OCT measurements in the SB are feasible and provide critical additional information on area after KB or need of additional SB stenting Direct OCT measurements in the SB are feasible and provide critical additional information on area after KB or need of additional SB stenting