Q&A
Q.
The Left Main and proximal LAD lesion and the large diagonal branch were angiographically more severe in just a few weeks from the previous PCI angiograms?
A.
I think left main lesion progressed due to catheter trauma. Proximal LAD was just seen better after IC Nitro and dedicated views. Both were 30-50% on prior Cath few weeks ago and may also represent rapid progression which we have seen few times rarely.
Q.
The diagonal lesion could be explained by plaque rupture?
A.
Yes plaque rupture of the calcified lesion in Diagonal bifurcation may be contributory.
Q.
But the LMCA and LAD had a fixed plaque - would additional vasospasm explain this worsening?
A.
Yes sometimes besides the catheter trauma and spontaneous progression, coronary spasm can
may be contributing but we always give 200-300mcg IC nitro before taking pictures during PCI.
Q.
Do you think upfront imaging would have been a better strategy?
A.
In this case angio showed all lesion details and value of Imagining was minimal. I predicted Diagonal lesion to be calcified and planned possible Rota which we did not do and struggled. But final results with 2 stents in Diagonal with TAP technique were excellent.
Q.
With such multiple lesions including double bifurcation, would the effort be to use similar stent types?
A.
We always try to use the same brand stents in pts with multiple lesions. Only deviation will be if assigned stent brand does not cross despite adequate lesion preparation.
Q.
Do you have a preference for a particular stent to be used in such situations?
A.
Actually no stent preference as both Xience and Synergy are good for bifurcation.
Q.
What is your present use and belief about DCB?
A.
We still do not believe in the DCB fully and our use outside the DCB trials, is 2-3% only.
Q.
Are there 2025 versions of bioresorbable stents?
A.
Yes MiRas-100 of Merrill Lifesciences is good BVS but is not available in USA.
Q.
What would be the contraindications of DCB?
A.
If lesion is not prepped with residual <30% pre DCB and significant dissection pre DCB will be the major contraindications of DCB use. Also DCB cost is prohibitive currently.
Q.
How important is lesion preparation for deploying a DCB - somewhere in between BVS and IVL?
A.
Yes good lesion preparation is very important for the DCB strategy: similar to BVS and IVL use will help us to achieve the optimal lesion preparation.
