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Welcome to the 5 th European Bifurcation Club 16-17 October 2009 - BERLIN

Join the 5th European Bifurcation Club in Berlin to explore the impact of wide angle bifurcations on stenting indication. Discover techniques to avoid and learn about the measurement of bifurcation angles. Gain insights into the influence of wide angles on different stenting strategies.

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Welcome to the 5 th European Bifurcation Club 16-17 October 2009 - BERLIN

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  1. Welcome to the 5th European Bifurcation Club 16-17 October 2009 - BERLIN Bifurcation angles: influence on bifurcation stenting indication?

  2. Dr. Tom AdriaenssensUniv. Hospitals Leuven, Belgium Which techniques have to be avoided for wide angle bifurcations?

  3. Bifurcation angle • Data on BA in published series/trials: scarce • Most often: BA not assessed/ influence not reported • Variable methodology and lack of consensus(1) how to measure cut point high versus low BA (70°) 1. Lansky et al. CCI 2009; 73:258-266.

  4. Bifurcationanglemeasurement 1. Lansky et al. CCI 2009; 73:258-266.

  5. Bifurcationanglemeasurement Dzavik et al. Am Heart J 2006; 152: 759-762.

  6. BA: 3D reconstruction: Siemens Schlundt et al. CCI 2006;68:249-253.

  7. BA: 3D reconstruction: CardiOp-B Dvir et al. EuroInterv. 2007;3:95-99.

  8. Possibleproblemswith a wide BA • Difficulty recrossing into side branch (crush, culotte) • Difficulty in advancing a second stent into the SB after MV is stented • Blood flow turbulence may raise risk for stent thrombosis, especially when using two or more DES • Alteration of BA after stenting: effect unknown

  9. ProvisionalT-stenting Ormiston et al. CCI 2006;67:49-55.

  10. ProvisionalT-stenting • BA assessed: no influence • Kaplan et al.: Culotte vs T(1) • Routledge et al.: provisional T(2) • Brunel et al.: TULIPE: provisional T (3) • Galassi eta l.: mini crsuh vs T4 (4) • Kaplan et al. Am Heart J 2007;154:336-43. • Routledge et al. J Am Coll Cardiol Intv 2008;1:358-365. • Brunel et al. CCI 2006;68:67-73. • Galassi et al. J Am Coll Cardiol Intv 2009;2:185-194.

  11. Crush: influence of wide BA A: BA<50°, KBP B: BA<50°, no KBP C: BA≥50°, KBP D:BA≥50°, no KBP Dzavik et al. Am Heart J 2006;152:762-9.

  12. Influence of wide BA on MACE MV only Crush/culotte ST: all in wide BA : 8.6 vs 0% Collins et al. Am J Cardiol 2008; 68:249-253.

  13. DKCRUSH: Influence of wide BA on MACE Chen et al. Chin Med J 2009;122:396-402.

  14. Influence of wide BA on MACE • Pro • Dzavik et al. (1) • Collins et al.(2) • Contra • Chen et al: DKCRUSH study (3) • Galassi et al. (4) • Dzavik et al. Am Heart J 2006;152:762-9. • Collins et al. Am J Cardiol 2008; 68:249-253. • Chen et al. ChinMed J 2009;122:396-402. • Galassi et al. J Am CollCardiolIntv 2009;2:185-194.

  15. Crush: anatomicalchange Provisional side-branch Crush Dvir et al. EuroInterv. 2007;3:95-99.

  16. Crush: underexpansion at SB ostium Ormiston et al. CCI 2004;63:332-336.

  17. Crush: underexpansion at SB ostium Costa et al. J Am Coll Cardiol 2005;46:599-606.

  18. Culotte: restenosis in the SB Adriaenssens et al. Eur Heart J 2008;29:2868-2876

  19. Culotte: influence of BA Adriaenssens et al. Eur Heart J 2008;29:2868-2876

  20. Conclusion: Wide bifurcationangles • Indications for less favorable results with crush/culotte at wide BA • Provisional T-stenting more suitable • Some dedicated devices can accomodate well to wide BA • Paucity of data, selection bias, non-uniform reporting

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