Left Main Bifurcation Live Case Series

Published: 19 February 2021

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Part 11 | Session 5 of 9
Live Case – Rotational Atherectomy of a Heavily Calcified Lesion – Part 2
James Spratt, Julian Strange, Simon Wilson, Mirvat Alasnag, Joost Daemen, Carlos Collet, Alaide Chieffo

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9m 33s

Part 11 | Session 6 How Crucial Is a Proper Lesion Preparation to Prevent Complications – Presentation by Dr Joost Daemen
James Spratt, Simon Wilson, Julian Strange, Mirvat Alasnag, Joost Daemen, Carlos Collet, Alaide Chieffo
6m 6s

Part 11 | Session 7 Live Case – Post Rotational Atherectomy IVUS Assessment & Cutting Balloon Angioplasty
James Spratt, Julian Strange, Simon Wilson, Mirvat Alasnag, Joost Daemen, Carlos Collet, Alaide Chieffo
11m 52s

Part 11 | Session 8 Choosing the Proper Stent and Stent Technique – Presentation by Dr Carlos Collet
James Spratt, Julian Strange, Mirvat Alasnag, Simon Wilson, Joost Daemen, Carlos Collet, Alaide Chieffo
8m 22s

Part 11 | Session 9 Live Case – Final results
James Spratt, Julian Strange, Simon Wilson, Mirvat Alasnag, Joost Daemen, Carlos Collet, Alaide Chieffo

7m 44s

Part 12 Final Remarks

3m 9s

Part 1 | Session 1 Welcome and Introductions – Prof James Spratt and Dr Thierry Lefèvre James Spratt, Thierry Lefèvre, Simon J Walsh, Joost Daemen, José M de la Torre Hernández, Robert A Byrne, Colm Hanratty, Alaide Chieffo, Barbara Stähli , Olivier Darremont, Nicolas Boudou, Margaret McEntegart

5m 31s

Part 1 | Session 2 Introduction to LM PCI Series – Prof James Spratt James Spratt

7m

Part 1 | Session 3 Clinical Data Overview – Dr Thierry Lefèvre Thierry Lefèvre

23m 28s

Part 1 | Session 4 Live Case from The Royal Victoria Hospital, Belfast Simon J Walsh

5m 42s

Part 2 | Session 1 Live Case 1 Summary – Prof James Spratt James Spratt

6m 44s

Part 2 | Session 2 Basics of IVUS Image Interpretation – Dr Joost Daemen Joost Daemen

13m 18s

Part 2 | Session 3 Vessel Sizing and Optimizing the Results with IVUS – Dr Jose de la Torre

29m 2s

Part 2 | Session 4 Live Case from Mater Private Hospital, Dublin Colm Hanratty, Robert A Byrne

1m 47s

Part 3 | Session 1 Welcome and Introductions – Dr Thierry Lefèvre Thierry Lefèvre

9m 51s

Part 3 | Session 2 Practical Tips to Choose Bifurcation Stent Strategy – Dr Alaide Chieffo Alaide Chieffo

5m 33s

Part 3 | Session 3 Complete Revascularization in MVD – Current Evidence – Dr Barbara Stähli

46m 35s

Part 3 | Session 4 Live Case from Clinique Saint Augustin, Bordeaux

7m 31s

Part 4 | Session 1 Crash Course In IVUS Assessment In Coronary Calcified Lesions – Prof Margaret McEntegart Margaret McEntegart

9m 50s

Part 4 | Session 2 Rotablation – from Zero to Hero – Dr Claudia Cosgrove

22m 41s

Part 4 | Session 3 Live Case from Humanitas Research Hospital, Milan

1m 53s

Part 5 | Session 1 Welcome and Introductions – Prof James Spratt James Spratt

14m 54s

Part 5 | Session 2 Update on EBC-MAIN trial – Dr Alaide Chieffo Alaide Chieffo

7m 45s

Part 5 | Session 3 Design Considerations for Sttents in Bifurcation and Ostial Lesions – Michelle Hannon

43m 9s

Part 5 | Session 4 Live Case from Sahlgrenska Hospital, Sweden

3m 30s

Part 7 | Session 1 Welcome and Introductions – Dr Thierry Lefèvre Thierry Lefèvre, Maciej Lesiak, Nieves Gonzalo

9m 14s

Part 7 | Session 2 How to guide my DK Crush with IVUS? – Nieves Gonzalo Nieves Gonzalo

12m 9s

Part 7 | Session 3 DK Crush: When and How to do it? – Manuel Pan Manuel Pan

43m 37s

Part 7 | Session 4 Live Case from Szpital Kliniczny im. Heliodor Święcicki UM, Poznan, Poland Maciej Lesiak

31m 3s

Part 8 | Session 1 Welcome and Introductions and Live Case – Prof James Spratt James Spratt, Farrel Hellig, Mirvat Alasnag, Jacob Odenstedt

17m 28s

Part 8 | Session 2 T/Tap Technique – Dr Mirvat Alasnag Mirvat Alasnag

9m 13s

Part 8 | Session 3 Imagine – Dr Jacob Odenstedt Jacob Odenstedt

1m 55s

Part 9 | Session 1 Introduction

34m 3s

Part 9 | Session 2 Live case from Hospital Clínic de Barcelona, Spain

16m 42s

Part 9 | Session 3 Physiology in Left Main: Why, When, How – Dr Carlos Collet

15m 36s

Part 9 | Session 4 Physiology or Imaging? The Continuous Debate – Dr Tom Johnson

5m 36s

Part 10 | Session 1 Welcome & Case Presentation – Prof James Spratt and Mubarak Alkabeer Hospital – Cardiac Catheterization & Research Unit, Jabriya, Kuwait James Spratt, Waqar Ahmed, Kalaivani Mahadevan

12m 30s

Part 10 | Session 2 Live Case – Pre-stent IVUS & Lesion Assessment

18m 48s

Part 10 | Session 3 Overcoming Barriers in Left Main Imaging – Dr Kalaivani Mahadevan presentation

19m 16s

Part 10 | Session 4 Live Case – IVUS Guided Stent Deployment

6m 50s

Part 10 | Session 5 Imaging in Left Main: A Practical Approach – Dr Ahmed Waqar presentation

8m 17s

Part 10 | Session 6 Live Case – Post-stenting IVUS & Final Results

6m 29s

Part 11 | Session 1 Welcome & Case Presentation – Prof James Spratt and Live From St. Georges’ Hospital James Spratt, Julian Strange, Simon Wilson, Carlos Collet, Joost Daemen, Alaide Chieffo, Mirvat Alasnag

7m 17s

Part 11 | Session 2 The Importance of Lesion Assessment – The IVUS 123 Framework, Presentation by Dr Mirvat Alasnag James Spratt, Julian Strange, Simon Wilson, Mirvat Alasnag, Carlos Collet, Joost Daemen, Alaide Chieffo

11m 30s

Part 11 | Session 3 Live Case – IVUS Guided Assessment and Rotablation of a Heavily Calcified Lesion – Part 1 James Spratt, Simon Wilson, Julian Strange, Mirvat Alasnag, Joost Daemen, Carlos Collet, Alaide Chieffo

11m 34s

Part 11 | Session 4 Potential Complications in Left Main PCI, Presentation by Prof Alaide Chieffo James Spratt, Julian Strange, Simon Wilson, Mirvat Alasnag, Carlos Collet, Joost Daemen, Alaide Chieffo

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Overview

In this live case series Prof James Spratt and Dr Thierry Lefèvre will guide us through a progressive and comprehensive educational journey around the globe. We will join various live case centres, over 11 months to learn from over 30 expert perspectives on how LMPCI is performed in a contemporary setting.

The aim of the series being, to break down the complexity of the whole procedure into a systematic, algorithmic, step by step approach. Simplified for us by top operators and faculty, through live cases and relevant flash lectures to support the learning.

With LM PCI being the most divisive procedure performed in interventional cardiology currently, the need to stay informed and aware of innovation in products and techniques has become all the more important.

For more information on the Left Main Bifurcation series, and to watch events LIVE, please register by clicking HERE

Now more than ever, Boston Scientific is committed to finding new and innovative ways to support you as you look to provide the very best patient care.

More from this programme

Part 1

The Process Behind the Procedure: An Introduction to Left Main PCI

Brought to you live from The Royal Victoria Hospital, Dr Simon Walsh tackles a surgical turn down Left Main due to COVID restrictions on surgery.

4 sessions
Welcome and Introductions – Prof James Spratt and Dr Thierry Lefèvre	Watch now
Introduction to LM PCI Series – Prof James Spratt	Watch now
Clinical Data Overview – Dr Thierry Lefèvre	Watch now
Live Case from The Royal Victoria Hospital, Belfast	Watch now

Part 2

The Role of IVUS

In this session Prof James Spratt summarizes Live Case 1 from Belfast and is joined by Dr Joost Daemen and Dr Jose de la Torre to discuss IVUS driven strategy and optimization. Dr Colm Hanratty and Prof Robert Byrne take us through an IVUS led left main case from the Mater Private Hospital in Dublin.

4 sessions
Live Case 1 Summary – Prof James Spratt	Watch now
Basics of IVUS Image Interpretation – Dr Joost Daemen	Watch now
Vessel Sizing and Optimizing the Results with IVUS – Dr Jose de la Torre	Watch now
Live Case from Mater Private Hospital, Dublin	Watch now

Part 3

Approach to LMS & Choosing Stent Strategy

This Left Main Live case focuses on the decision making, based on the guidance of the European Bifurcation Club’s latest consensus, around choosing a stent strategy for left main bifurcations. Broadcast live from Clinique St Augustin, Bordeaux, watch how Dr Oliver Darremont and Dr Nicolas Boudou treat a patient with a very tight distal LMS trifurcation and how they used imaging to help their decision making to choose an appropriate stent strategy.

4 sessions
Welcome and Introductions – Dr Thierry Lefèvre	Watch now
Practical Tips to Choose Bifurcation Stent Strategy – Dr Alaide Chieffo	Watch now
Complete Revascularization in MVD – Current Evidence – Dr Barbara Stähli	Watch now
Live Case from Clinique Saint Augustin, Bordeaux	Watch now

Part 4

Lesion Preparation

The fourth live case focussed on lesion preparation with a broadcast from Humanitas Research Hospital in Milan with Dr Bernhard Reimers and Dr Gabriele Luigi Gasparini operating with IVUS commentary by Dr Damiano Regazzoli Lancini. A very complex case was chosen with a subtotal occlusion of a very calcified and tortuous LAD and left main disease with many challenges trying to get into the distal LAD. The left main was assessed with IVUS. Eventually the subintimal track was dilated and the patient will be brought back in a few months for PCI.

3 sessions
Crash Course In IVUS Assessment In Coronary Calcified Lesions – Prof Margaret McEntegart	Watch now
Rotablation – from Zero to Hero – Dr Claudia Cosgrove	Watch now
Live Case from Humanitas Research Hospital, Milan	Watch now

Part 5

Provisional LM Stenting (Single Stent)

In Live Case 5 the operators used both physiology and IVUS to guide their decision making. Comet pressure wire in the circumflex showed negative DFR and FFR readings, and IVUS showed no disease at the circumflex ostium so they decided to go with a stepwise provisional strategy. They systematically used IVUS to plan the stent strategy (pullbacks in both LAD and LCX) and very thoroughly demonstrated how to assess “the 3 L’s – lesion, length, and landing zones”. A second stent was deployed and final angiographic result was excellent. A systematic, planned, clear, concise and expertly delivered case.

4 sessions
Welcome and Introductions – Prof James Spratt	Watch now
Update on EBC-MAIN trial – Dr Alaide Chieffo	Watch now
Design Considerations for Sttents in Bifurcation and Ostial Lesions – Michelle Hannon	Watch now
Live Case from Sahlgrenska Hospital, Sweden	Watch now

Part 6

Culotte Technique

Information pending

0 sessions

Part 7

DK Crush

In this session Dr Thierry Lefèvre summarizes a Live Case from Szpital Kliniczny im. Heliodor Święcicki UM, Poznan, Poland and is joined by Dr Nieves Gonzalo and Prof Manuel Pan to discuss The evidence base for DK Crush. Prof Maciej Lesiak and Dr Sylwia Iwanczyk take us through an DK Crush procedure.

4 sessions
Welcome and Introductions – Dr Thierry Lefèvre	Watch now
How to guide my DK Crush with IVUS? – Nieves Gonzalo	Watch now
DK Crush: When and How to do it? – Manuel Pan	Watch now
Live Case from Szpital Kliniczny im. Heliodor Święcicki UM, Poznan, Poland	Watch now

Part 8

T and TAP Techniques

In this session Prof James Spratt moderates an interesting discussion Live Case 8 from Netcare Sunninghill Hospital, South Africa and is joined by Dr Mirvat Alasnag and Dr Jacob Odenstedt to discuss T and TAP Techniques. Prof Farrel Hellig take us through a T and TAP Techniques procedure.

3 sessions
Welcome and Introductions and Live Case – Prof James Spratt	Watch now
T/Tap Technique – Dr Mirvat Alasnag	Watch now
Imagine – Dr Jacob Odenstedt	Watch now

Part 9

Physiology & the LM

Information pending

4 sessions
Introduction	Watch now
Live case from Hospital Clínic de Barcelona, Spain	Watch now
Physiology in Left Main: Why, When, How – Dr Carlos Collet	Watch now
Physiology or Imaging? The Continuous Debate – Dr Tom Johnson	Watch now

Part 10

The Role of Imaging in the Left Main

Prof James Spratt (St George’s University Hospital NHS Trust, London, UK) moderators a live broadcast on an important topic on Left Main PCI and 'The Role of Intravascular Imaging in the Left Main'.

The broadcast starts with a live case from one of the major centres in Kuwait (Mubarak Alkabeer Hospital – Cardiac Catheterization & Research Unit, Jabriya, KW) where case operators Dr Abdullah Esmaiel, Dr Fahad Alhajri and Dr Ali Alsulaimi present a case with a 49-year-old male patient who has a history of CAD, HTN and HLD,

This expert panel examine their approaches and that they would use imaging, then the live case centre goes on further to discuss what their approach would be using IVUS to map out the case.

Following the live case, Dr Kalaivani Mahadevan (Portsmouth Hospitals University NHS Trust) explains 'Overcoming the Barriers to Intracoronary Imaging in Left Main PCI'

6 sessions
Welcome & Case Presentation – Prof James Spratt and Mubarak Alkabeer Hospital – Cardiac Catheterization & Research Unit, Jabriya, Kuwait	Watch now
Live Case – Pre-stent IVUS & Lesion Assessment	Watch now
Overcoming Barriers in Left Main Imaging – Dr Kalaivani Mahadevan presentation	Watch now
Live Case – IVUS Guided Stent Deployment	Watch now
Imaging in Left Main: A Practical Approach – Dr Ahmed Waqar presentation	Watch now
Live Case – Post-stenting IVUS & Final Results	Watch now

Part 11

Complication Management in Left Main PCI

Prof James Spratt (St George’s University Hospital NHS Trust, London, UK) moderators a live broadcast on 'Complication Management in Left Main PCI.'

The broadcast features a live case from one of the major centres in London (St George's University Hospitals NHS Foundation Trust, London, UK) where case operators Dr Julian Strange and Dr Simon Wilson present a case with an 81-year-old patient who presented with NSTEMI and reduced ejection fraction (37%).

9 sessions
Welcome & Case Presentation – Prof James Spratt and Live From St. Georges’ Hospital	Watch now
The Importance of Lesion Assessment – The IVUS 123 Framework, Presentation by Dr Mirvat Alasnag	Watch now
Live Case – IVUS Guided Assessment and Rotablation of a Heavily Calcified Lesion – Part 1	Watch now
Potential Complications in Left Main PCI, Presentation by Prof Alaide Chieffo	Watch now
Live Case – Rotational Atherectomy of a Heavily Calcified Lesion – Part 2	Watch now
How Crucial Is a Proper Lesion Preparation to Prevent Complications – Presentation by Dr Joost Daemen	Watch now
Live Case – Post Rotational Atherectomy IVUS Assessment & Cutting Balloon Angioplasty	Watch now
Choosing the Proper Stent and Stent Technique – Presentation by Dr Carlos Collet	Watch now
Live Case – Final results	Watch now

Part 12

1 session
Final Remarks	Watch now

Faculty Biographies

James Spratt

Professor of Interventional Cardiology

Prof James Spratt is a Professor of Interventional cardiology. A high-volume Interventional Cardiologist with an international reputation in complex PCI, with a sub-speciality interest in intravascular imaging and CTO. Widely published within this area and has performed live case demonstrations globally. He is interested in medical education and is the Founder of Optima Education. Prof James Spratt is an editorial board member of Interventional Cardiology: Reviews, Research, Resources (ICR3).

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Julian Strange

Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK

Dr Julian Strange is the Director of the Cardiac Catheter Suite at the Bristol Royal Infirmary and Network lead for Acute Coronary Syndromes in Avon, Gloucester and Wiltshire. Dr Strange has experience with specialisation in interventional cardiology, cardiovascular MRI and pulmonary circulation.

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Simon Wilson

Interventional Cardiologist

Dr Simon Wilson is an Interventional Cardiologist at St George's Hospital, London UK.

Dr Wilson is dedicated to improving patient safety and outcomes and in 2021, was appointed the head of governance for cardiology at St George’s. His main focus is to help understand the cause of symptoms and deliver evidence-based treatment to improve quality of life and minimise the risk of future cardiac events.

He is currently the principal or co-investigator for several national and international studies with a focus on improving outcomes in patients with coronary artery disease.

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Mirvat Alasnag

Director of Catheterization Laboratory

Dr Mirvat Alasnag is an editorial board member of Interventional Cardiology: Reviews, Research, Resources (ICR3), joining the board in October 2020 and is also on the editorial board for US Cardiology Review (USC).

Dr Mirvat Alasnag is the Director of the Catheterization Laboratory at the King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia. She was the first female interventional cardiologist in the Gulf region and has since represented women on multiple medical committees, including the Saudi Arabian Cardiac Interventional Society Board & the EAPCI Women’s Steering Committee. She is the current ACCWIC International Working Group Chair and an SCAI WIN member.

Dr Alasnag trained in Clinical Cardiology and Interventional Cardiology at Loma Linda University Medical Center (Loma Linda, California) and Harper University Hospital, Detroit Medical Center (Detroit, Michigan), respectively. Since her graduation in 2009 to date, she has been…

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Joost Daemen

Interventional Cardiologist

Dr Joost Daemen is a senior interventional cardiologist at the Thorax Center, Erasmus MC, Rotterdam, NL. Dr Daemen obtained his degree in medicine at the Erasmus University Medical Center. He is actively involved in several drug-eluting stent trials and is Principal Investigator of four trials focusing on the safety and efficacy of renal sympathetic denervation in hypertension, heart failure, vasospastic angina and heart failure. Dr Daemen is a member of the editorial board of EuroIntervention and the Netherlands Heart Journal, member of Young ICIN, and has completed courses in biomedical statistics and device training.

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Carlos Collet

Interventional Cardiologist

Dr Carlos Collet practices as an interventional cardiologist at Olv Hospital Aalst, Aalst, BE.

Dr Collet earned a doctorate in Cardiovascular Sciences from the University of Amsterdam. During his doctoral studies, he devoted his research to the integration of coronary imaging and physiology in patients with complex coronary artery disease.

He has published over 300 peer-reviewed articles and serves as the co-director of the catheterisation laboratory at the Cardiovascular Center OLV Aalst in Belgium.

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Alaide Chieffo

Clinical Research Director / Interventional Cardiologist

Dr Alaide Chieffo is a Senior Interventional Cardiologist and Director of Clinical Research at San Raffaele Research Hospital, Milan, IT. She is also an adjunct Professor at Vita-Salute San Raffaele University and has authored over 300 peer-reviewed articles on various topics in interventional cardiology. Additionally, she serves as a co-investigator and Principal Investigator in major international clinical trials and studies.

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