Clinical Implication of Bench Test for Coronary ... - summitMD.com
Clinical Implication of Bench Test for Coronary ... - summitMD.com
Clinical Implication of Bench Test for Coronary ... - summitMD.com
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Left Main & Bifurcation 2009<br />
<strong>Clinical</strong> <strong>Implication</strong> <strong>of</strong> <strong>Bench</strong><br />
<strong>Test</strong> <strong>for</strong> <strong>Coronary</strong> Bifurcation<br />
Yutaka Hikichi, M.D.<br />
Saga University School <strong>of</strong> Medicine<br />
Saga, Japan<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
• the model was made as realistic as<br />
possible using the x-ray machine while<br />
the bench test was operated.<br />
• The bench test was kept in best<br />
condition using all possible devises <strong>for</strong><br />
the clinical practice.<br />
• Never had any negative intentions or<br />
actions that would lead us to make<br />
imperfect model.<br />
• there is no unfair thoughts or<br />
expressions to certain products.<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Kissing balloon technique<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Single stent+KBT: Express2<br />
<strong>Bench</strong> <strong>Test</strong><br />
Endoscopic finding<br />
Tube size:<br />
3.0×3.0mm<br />
3.0mm<br />
Bifurcation angle:<br />
90°<br />
Stent size:<br />
3.0mm<br />
Presented by Pr<strong>of</strong>. Takafumi UENO<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Similar to the real world<br />
The three<br />
dimensional<br />
model<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Single stent+KBT<br />
Cypher TAXUS Express ENDEAVOR<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Side branch<br />
inflation<br />
4.0×4.0<br />
80°<br />
Express2<br />
3.5mm Bal.<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
KBT<br />
4.0×3.5mm<br />
Simultaneous<br />
inflation<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Single stent+KBT: Express2<br />
Tube size:<br />
4.0×4.0mm<br />
4.0mm<br />
Bifurcation angle:<br />
80°<br />
Stent size:<br />
3.5mm<br />
After KBT<br />
4.0×3.5mm<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Single stent+KBT: Liberte<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Conclusion 1<br />
• The limits <strong>of</strong> dilation all depends on the<br />
designs <strong>of</strong> stents.<br />
• When dilation is per<strong>for</strong>med through the<br />
stent strut, the dilation needs to be<br />
done at the same time with main vessel.<br />
• If the both side simultaneous dilation<br />
cannot be per<strong>for</strong>med, then just dilating<br />
the side branch even with any size <strong>of</strong><br />
balloon is not re<strong>com</strong>mended.<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Crush stent<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Crush stenting<br />
Micr<strong>of</strong>ocus CT image<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Crush stenting<br />
LAD-D1: Crush<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Recrossing point <strong>of</strong> GW<br />
÷2=<br />
: Good Position<br />
: Not so good Position<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
XIENCE V×XIENCE V<br />
TAXUS×TAXUS<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
6<br />
16<br />
=37.5%<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
SB ostium after KBT<br />
16atm<br />
×15sec<br />
16atm×60sec<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Conclusion 2<br />
• The variations <strong>of</strong> de<strong>for</strong>mation is<br />
less in “Mini Crush” technique than<br />
conventionally “Crush” technique.<br />
Meaning it is safer.<br />
• The result changes not only by the<br />
pressure, but also by the dilating<br />
time.<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
large vessel diameter and<br />
bifurcation angle<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
NOBORI: Culotte<br />
Liberte: Mini Crush<br />
Saga Univ. Cardiovascular & Renal Medicine
Left Main & Bifurcation 2009<br />
Final conclusion<br />
• Its ablilities and limitations <strong>of</strong> the stents,<br />
techniques, and per<strong>for</strong>mers could be found<br />
out from bench tests results.<br />
• Standardization <strong>of</strong> detailed techniques will<br />
lead us to see positive long-term prognosis.<br />
• Development <strong>of</strong> Dedicate Stent is important,<br />
but until then, studying on the lesion<br />
carefully and finding the best <strong>com</strong>bination<br />
<strong>of</strong> stent and technique will give us good<br />
results.<br />
Saga Univ. Cardiovascular & Renal Medicine
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