Q&A
Q.
Based upon the recent data, and your comprehensive presentation from today, do you feel IVUS should be used for all ULMCA interventions?
A.
I would support the use of routine IVUS in ULM PCI using 2 stents technique.
But I still would not make it a ACC class I indication or recommendation.
Q.
Any situations regarding unprotected LMCA where OCT may be of any help?
A.
There are very little data to support OCT during ULM PCI.
Q.
When will you perform FFR for LMCA interventions?
A.
ULM lesion at ostium alone or ambiguous lesions in dLM are the best lesions for FFR.
Q.
While performing LMCA interventions, do you always wire both the LAD and LCX?
A.
I would recommend routine use of wires in both the branches even with the crossover
technique of 1stent use in ULM PCI.
Q.
If there is no LCX disease in the presence of severe distal LMCA, should have have a preferential strategy of stenting across the LAD?
A.
Aggressive lesion preparation prior to stenting to decrease plaque shift should be routinely done.
Q.
Are you tending away from kissing balloon for LMCA interventions?
A.
Data support that routine kissing balloon inflation after 1 stent technique does not provide any additional benefit during ULM stenting. Kissing balloon inflation after 2 stent technique of ULM should be mandatory.
Q.
Always debulk LMCA prior to stetting
A.
Yes debulking of some sort should be be routine in ULM stenting. We do debulking in over 90% of ULM PCI at Mount Sinai Hospital.
Q.
Any situations to use BMS for LMCA stenting?
A.
Only cases where pt needs non cardiac surgery in less then 3 mths or pt can not take DAPT, will be appropriate for BMS.
Q.
Do you have an algorhythm for debulking with Rotablator, Angiosculpt, Orbital Atherectomy or Cutting Balloon for debulking LMCA?
A.
I recommend Rotational or Orbital atherectomy in heavily calcified lesions and others using Cutting balloon or AngioSculpt will be optimal. Orbital atherectomy should be avoided in the calcified ostial LM lesions
Q.
What do you feel will be the next guideline recommendation for unprotected LMCA?
A.
I strongly believe that PCI of isolated ostial ULM lesions and ULM lesions with Syntax score <33 even if pt is a good surgical candidate, should also get ACC Class I recommendation.
