Q&A
Q.
Which catheter is more trackable - IVUS or OCT?
A.
OCT is more trackable than IVUS.
Q.
In which cases do you prefer IVUS over OCT?
A.
IVUS is the default intravascular imaging technique used in 85-90% of imaging cases at Sinai, rest being OCT. it’s use and easy ability to understand the imaging findings make IVUS as the predominant intracoronary imaging modality (in USA, 75% IVUS and 25% OCT). It gives quick idea about vessel size, plaque volume, composition and calcification. Also post stenting, IVUS provides easily understandable data on stent expansion, intimal dissection and plaque prolapse. OCT is very good to define vulnerable plaque, cap thickness, thrombus and any dissection. It requires contrast use and limited in ostial lesions. OCT can quantify calcium and true stent distortion and optimal expansion.
Q.
And OCT over IVUS?
A.
As explained OCT has very good resolution but has a learning curve. In USA, ratio of IVUS vs OCT is 75:25% as per latest ACC-NCDR data.
Q.
Will there be a payment for the CME?
A.
CCCliveWebcast CME will be free for the registrants.
Q.
It is required to answer the questions to obtain the CME?
A.
No it will not require registrant to answer the questions but participants have to stay until the end of the webcast in order to get the 1.5 hour CME certificate.
Q.
In today’s case, would a more aggressive strut dilation have been a good strategy?
A.
Yes that is correct that more aggressive LAD stent strut dilation was needed as we did use only 2.5-12mm compliant balloon at 16atm to open the LAD stent strut. We needed 2.75mm NC balloon at 16-20 atm.
Q.
Have you found any particular angiographic projection superior for precise deployment of the side branch stent?
A.
Actual angiographic projection to visualize the side branch ostium will depend on the site and vessel of bifurcation. We find that AP cranial view is usually optimal for most bifurcations.
Q.
Would a cutting balloon have been sufficient in today’s case?
A.
Not really. As we observed, 360 degree calcium at Diagonal ostium, hence cutting balloon would have resulted in suboptimal stent expansion and therefore alone would have not been an optimal strategy.
Q.
Any use of the laser to ablate such branch Ostial lesions?
A.
Yes laser can also be used effectively to open the stent jailed side branches, particularly if it can’t be crossed with the balloon. We prefer RA in such cases as shown in the live case today and is very safe and effective.
Q.
Please articulate the strategy of dealing with burr entrapment.
A.
Burr entrapment occurs usually in the angulated lesions and unexpanded stents, where burr cannot be withdrawn or pulled back after crossing the lesions.
Following are the next steps in this situation of burr entrapment;
a) vigorous pull of the Rota burr and Rota wire after well disengaging the guide,
If it fails, then
b) cut the Rota burr and pull the Teflon sheath out and then advance the 6Fr Guideliner all the way up to the burr and then pull the Rota burr vigorously. This movement will be successful in 99% of cases.
If it still fails
c) then call the CT surgeon for surgical exploration for trapped burr removal and possible CABG.
