News from Asian Bifurcation Club · (Master) Camera #2 (Slave) Camera controler Double-pulse Nd:YLF laser 1000Hz Resorvoir. 26. th. Kokura Live 2009. Kiyotaka Iwasaki, Waseda University

News from Asian Bifurcation Club

Yoshinobu Murasato MD, PhD

Dept. Of Cardiovascular Medicine, New Yukuhashi Hospital,

Yukuhashi, Japan

Présentateur

Commentaires de présentation

Good evening, ladies and gentlemen. Thank you, chairman and organizing committee for giving me an opportunity to talk about the Asian Bifurcation Club (ABC).

Asian Bifurcation Club (ABC)

• Founded in China in 2007• President: Run-Lin Gao (China)• Purpose of establishment To hold international meetings focusing on bifurcation

intervention Education of bifurcation intervention therapy in the

Asian – Pacific area Elevation of the therapeutic level Friendly communication among Asian – Pacific

countries Collaboration with EBC

Présentateur


ABC was founded in China in 2007. The president is Dr. Gao. Purpose of establishment To hold international meetings focusing on bifurcation intervention Education of bifurcation intervention therapy in the Asian – Pacific area Elevation of the therapeutic level Friendly communication among Asian – Pacific countries Collaboration with EBC

1st Coronary Bifurcation Summit

• Course director– Run-Lin Gao (China)– Yves Louvard (France)

• Executive director– Shaoliang Chen (China)

• Collaboration with EBC• EBC members

– Louvard, Sheiban, Hildrick-Smith, Ferrenc, Lassen

• Live transmission• Educational session

November 27 -29, 2008, Nanjing, China

Nanjing

Australia

Présentateur


In November, 2008, 1st coronary bifurcation summit was held in Nanjing in China. Course directors were Drs. Gao and Louvard and the executive director was Dr. Chen. This meeting was coordinated with the EBC and many EBC members contributed. Drs. Louvard, Sheiban, Hildrick-Smith, Ferrenc, Lassen, Pan. The consensus and some presentations were summarized in the Journal of Interventional Cardiology.

Asian Bifurcation Club at CIT Part IModerators Yean-Leng Lim, Haichang Wang

2:00 PM Understanding the Basics: A New Glossary of Terms for Bifurcation LesionsAngela Hoye (UK)

2:12 PM The European Bifurcation Club Consensus Strategy of Provisional Side Branch Bifurcation Stenting: Concept, Rationale, and TechniqueImad Sheiban (Italy)

2:24 PM When Should Two Stents Be Used During Bifurcation Stenting? From Clinical Trial to Clinical PracticeShaoliang Chen (China)

2:36 PM Insight of Various Bifurcation Stenting Techniques from Bench TestingYutaka Hikichi (Japan)

2:48 PM Moderated Discussion with Audience Q&APanel Moderators: Yean-Leng Lim, Haichang WangDiscussants: Shaoliang Chen, Yutaka Hikichi, Angela Hoye, Imad Sheiban

3:00 PM Adjourn

Asian Bifurcation Club at CIT Part II - IIIPresented by many Chinese faculties and some international specialists with discussion continuing for over 8hrs.

Présentateur


Recently, the number of PCI in China was more than 100,000 and it has been growing at a 30% annual rate. China Interventional Therapeutics is the biggest conference and the ABC had a special focus session. Drs. Hoye and Sheiban presented the basic and the EBC consensus, Dr. Chen, DK-crush stenting, and Dr. Hikichi, Bench testing. The consecutive sessions were presented by many Chinese faculties and some international specialists with discussion continuing for over 8hrs.

http://amanetairako.sakura.ne.jp/kokiA16_1.htm�

Bifurcation Disease: The Step-by-Step Approach I (Sponsored by the Asian Bifurcation Club)

Wednesday, September 23, 200912:15 PM - 1:45 PMRoom: 115Wednesday

Case PresenterYunDai Chen, PhD; Yoshinobu Murasato, MD, PhD;Sunao Nakamura, MD, PhD; John A. Ormiston, MB, ChB

Case Presenter/ModeratorShao Liang Chen, MD; Imad Sheiban, MD

Présentateur


In the next step, the ABC had a session in the TCT meeting held in San Francisco last month. The session was called the step-by-step approach based on the case discussion. The session was modulated by Drs. Chen and Sheiban and Drs. Yun-Dai Chen, Nakamura, Ormiston and I presented several interesting cases.

Bifurcation Club in Kokura 30-May-09, 13:30-17:30

1. Basic research Chair: Hikichi Y, Murasato Y, Kinoshita Y, Jepson N1-1. Opening remark Hikichi Y Japan1-2. Anatomy, Physiology Kajiya F Japan1-3. Pathology Inoue K Japan1-4. Flow study Iwasaki K Japan1-5. Bench study Hikichi Y Japan

2. Clinical research Chair: Murasato Y, Yamashita T, Nakamura S, Ferrenc M

2-1. Recent EBC consensus, MADS classification Ferrenc M Germany2-2. NORDIC, BBC-One, CACTUS Murasato Y Japan2-3. BBK Ferrenc M Germany2-4. Insight from Asian multicenter study Nakamura S Japan2-5. LM studies from Korea Kim YH Korea2-6. DK crush stenting Ye F China2-7. Shunt technique Jepson N Australia2-8. Culottes stenting Kadota K Japan2-9. Provisional T-stenting Choo GH Malaysia2-10. Debulking Kinoshita Y Japan

3. Imaging and physiological assessment Chair: Hikichi Y, Iwabuchi M, Kim YH3-1. IVUS Yamawaki M Japan3-2. OCT Shinke T Japan3-3. Multi-slice CT Yamada S Japan3-4. FFR Nam CW Korea

4. Future and complication Chair: Hikichi Y, Murasato Y, Nakamura S, Kadota K 4-1. Dedicated device Ferrenc M Germany4-2. Stent thrombosis Yamashita T Japan

5. Take home message Murasato Y

• Planned by Yoshinobu Murasato and Yutaka Hikichi• Collaboration with EBC and ABC• Ferrenc (Germany), Kim, Nam (Korea), Jepson

(Australia), Choo (Malaysia), Ye (China)• First attempt of the long-time session focused on the

bifurcation intervention from basic research to clinical study in Japan

Présentateur


In Japan, we are still in the process of the organization of the bifurcation club. Kokura Live demonstration has the oldest history and Dr. Hikichi and I planned the focus session collaborated with the EBC and the ABC. Dr. Ferrenc and other Asian-Pacific Drs. contributed. This was the first attempt of the long-time session focused on the bifurcation intervention from basic research to clinical study in Japan and we had a good response from the audience.

LMT

LADLCx

3.5mm

4mm

3mm80°

150°

120°

130°LMT

LADLCx

LMT～LAD:60% Stenosis LCx:

50% Stenosis

3.5mm

4mm

3mm

80°

150° 130°

Three-dimensional LMCA model

Normal model Stenosis model

Courtesy of Iwasaki K (Waseda Univ)

Présentateur


Let me introduce a few interesting studies from this meeting. The first one is the basic study based on Japanese high technology. Iwasaki from Waseda University made a 3-dimensional LMCA model made of silicone tube with similar elasticity to human coronary artery. The model with some stenosis in the bifurcation was also prepared.

Resistance

ResistanceAir compliance

Pulsatile Pump

Compliance tube

Flow probe

Systemic circulation

Coronary circulation

Preload tank

Pressure Transducer Laser light

sheet

High speed camera

Pneumatic driver

Octagonal acrylic tank45°

Lasercontroler

Functiongenerator #2

Functiongenerator #1

Camera #1(Master)

Camera #2(Slave)

Camera controler

Double-pulse Nd:YLF laser

1000Hz

Resorvoir

26th Kokura Live 2009. Kiyotaka Iwasaki, Waseda University

Time-Resolved 3D Stereo PIV Analysis of Bifurcation Flow using Pulsatile Coronary Circulatory System

Présentateur


They succeed in the visualization of the blood flow in the bifurcation model using pulsatile coronary circulation system.

High Speed Flow Visualization during Peak Phase [ Low Magnification]

Normal model Stenosis model

Courtesy of Iwasaki K (Waseda Univ)

Présentateur


This slide shows high speed visualization of the pulsatile flow. In the normal model, there was mild flow retardation in the lateral area. In the stenosis model, the flow was accelerated toward the carina, while low and oscillatory flow was apparent in the lateral area neighboring the stenosis.

OCT for Bifurcation

6month 12month

Attached withneointima

Stent strut at branch site

Case . 72M

Courtesy of Shinke T (Kobe Univ)

Présentateur


Shinke from Kobe university investigated the fate of the jailed strut in the SB ostium using OCT. Here you can see there was no tissue in the jailed strut 6month after stent deployment, whereas the tissue on the strut was observed 12months after.

Average neointimal thickness at the jailed struts

17struts

34.0±

17.0

79.0±

26.0

P＜0.001（μm）

Courtesy of Shinke T (Kobe Univ)

Présentateur


Average neointimal thickness at the jailed struts is shown in the slide. The thickness increased significantly in the 12month period compared to 6month. Now he is investigating a larger number of cases and longer term F/U.

Friday,June 26 Room C

09:00-10:35

Strategy according to lesion morphology: Left main, bifurcation and multivessel disease Part-1 -Left main and bifurcation-

Chair School of Medicine, Saga University Yutaka Hikichi

New Tokyo Hospital Sunao Nakamura

Institut Hospitalier Jacques Cartier-ICPS, France Yves Louvard

Opening remark

School of Medicine, Saga University Yutaka Hikichi

S6-1-1 Anatomy and Physiology of Coronary Bifurcation

New Yukuhashi Hospital Yoshinobu Murasato

S6-1-2 Bench study

School of Medicine, Saga University Yutaka Hikichi

S6-1-3 Consensus in EBC, provisional stenting vs. 2-stent

Institut Cardiovasculaire Paris Sud, France Thierry Lefévre

S6-1-4 How to treat LM Bifurcation lesion: Technical tips and tricks

Asan Medical Center, Korea Seung-Jung Park

S6-1-5 Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents) Study

Columbus Hospital/San Raffaele Hospital, Italy Antonio Colombo

• Planning: Yoshinobu Murasato• Main moderator: Yutaka Hikichi• Lefevre, Louvard (France), Serryus (Netherland),

Colombo (Italy), Grube (Germany), Hoye (UK), Kurkoff (USA), Park (Korea), Chen (China)

• There were so many attendees that we ran out of seating. It was an amazing experience to have such an enthusiastic atmosphere as well as in the CTO session in Japan.

Présentateur


This has already been a memorable year for Japan, because two opposite interventional societies were unified to one association, CVIT. In the first meeting, Dr. Hikichi and I planned the bifurcation and multi-vessel disease session. The guest speakers were Drs. Lefevre, Louvard Serryus, Colombo, Grube, Hoye, Kurkoff, Park, Chen. What a great group! There were so many attendees that we ran out of seating. It was an amazing experience to have such an enthusiastic atmosphere as well as in the CTO session in Japan.

http://www.cvit.jp/index.html�

• Course director– Seung-Jung Park (Korea), Martin B Leon

(USA), Antonio Colombo (Italy) • 1st meeting (2007): Jeju• 2nd meeting (2008): Seoul• 3rd meeting (2009): New York • It has been changed to a global and

comprehensive conference.

Présentateur


Korea has also had some dramatic changes in recent years. The left main and bifurcation summit was established in 2007 and first meeting was held in Jeju in Korea, 2nd was in Seoul, and this year’s meeting was moved to New York. The course directors were Drs. Park, Leon, and Colombo. It has been changed to a global and comprehensive conference.

Korean Bifurcation Club

• President: Hyeon-Cheol Gwon• Executive director: Bon-Kwon Koo• Organization in Jan, 2008, two meetings• 3rd meeting: November, 2009• Dr. Gwon wrote in our personal communication,

“Fortunately, now I have Dr. Koo to work with. On the third meeting, we hope to rejuvenate the club and expect it to be activated further.”

Présentateur


Korean Bifurcation Club was organized in 2008 and the president is Dr. Gwon. Two meeting were held last year. 3rd meeting is planned next month. Dr. Gwon wrote in our personal communication, “Fortunately, now I have Dr. Koo to work with. On the third meeting, we hope to rejuvenate the club and expect it to be activated further”

http://amanetairako.sakura.ne.jp/kokiA16_1.htm�

Korean Coronary Bifurcation Stenting Registry (COBIS)

• 16 hospitals in Korea• 1691 bifurcation

lesions, 1668 patients• Risk factors for MACE

– PES in MV1.87 (1.18-2.97)p=0.007

– MV length ≧ 30mm2.17 (1.37-3.44)p=0.001

– FKB1.74 (1.02-2.98)p=0.043

Gwon HC ACC 2009

Présentateur


I would like to introduce an interesting topic from Korean Coronary Bifurcation Stenting Registry (COBIS). The study was conducted in the multicenter and about 1700 bifurcation lesions were analyzed. Significant risk factors for the MACE were PES in the MV, more than 30mm in the MV stent length, and FKB. In particular, ineffectiveness of FKB was prominent in the 1-stent group.

Unsolved issue in the ABC organization

• Weak international organization among Asian countries

• Confusion between domestic educational conference and the meeting for the specialists

• Independent opening of the conferences in each country due to lack of coordination

• Difference in the therapeutic level caused by economic reasons among the countries

• Sponsorship

Présentateur


Unsolved issue in the ABC organization are summarized in this slide. Weak international organization among Asian countries Confusion between domestic educational conference and the meeting for the specialists Independent opening of the conferences in each country due to lack of the communication Difference in the therapeutic level caused by economic reason among the countries Sponsorship

What should we do for the ABC?

• To nurture our friendship among Asian Pacific area.

• Establishment of strong international organizing committee and regular meetings for good communication.

• Development of each domestic organization.• Round opening of the specialist meeting

among the participating countries.• Building consensus and sending a message

to the world

Présentateur


Then, what should we do for the ABC? To mature our friendly ship among Asian Pacific area. Establishment of strong international organizing committee and regular meeting for good communication. Development of each domestic organization. Round opening of the specialist meeting among the participating countries. Making a consensus and sending a message to the world

2nd Coronary Bifurcation Summit

• November 27-29, 2009• Nanjing, China• Director: Shao-Liang Chen,

Yves Louvard• Many EBC members will

come.• Unfortunately, we could not arrange

Japanese conference held in the same period this year, because of the difficulty in changing the reservation of the venue.

• We will contact closely to decide the schedule of the conferences in the next year.

Présentateur


This is the announcement of the next Coronary Bifurcation Summit. It will be held in Nanijing next month and with collaboration with the EBC.

http://www.natural-plus.jp/siryousitu/taiken/fuzumiao.htm�

We appreciate the cooperation of the EBC and hope to continue our close relationship

bringing together Eastern and Western worlds!

Etude of “Oiran” by GoghVincent van Gogh loved Japanese “Ukiyoe”. Original “Oiran”

Présentateur


We appreciate cooperation of the EBC and hope close relationship between Eastern and Western worlds! Thank you for your attention.

Documents

News from Asian Bifurcation Club · (Master) Camera #2 (Slave) Camera controler Double-pulse Nd:YLF laser 1000Hz Resorvoir. 26. th. Kokura Live 2009. Kiyotaka Iwasaki, Waseda University