JIM Today 2018 - Friday - page 2

2
JIM today
Issue 2 
Friday
 23 February 2018
Live cases from Milan, Italy 
Main Hall Washington 
Thursday 
10:30
Programme
Friday, February 23 2018
Main Hall Washington
Chairperson: Carlo Di Mario
Co-chairperson: Roxana Mehran
08.00
LIVE CASES FROM BONN, GERMANY
University Hospital
Commentators: Giuseppe Musumeci, Bernard
Prendergast, Horst Sievert, Corrado
Tamburino, Ron Waksman
Guest operators: Paul Hsien-Li Kao,
Marco Wainstein
Online factoids relevant to the cases presented:
Francesco Giannini (Coordinator),
Gianmarco Iannopollo, Antonio Mangieri
09.45
Discussing the case
10.00 Coffee break
10.30
LIVE CASES FROM MILAN, ITALY
Columbus Hospital
Commentators: Michael Haude, Jeffrey W.
Moses, S.K. Reddy, Gennaro Sardella,
Francesco Versaci
Online factoids relevant to the cases presented:
Francesco Giannini (Coordinator),
Gianmarco Iannopollo, Antonio Mangieri
12.15
Discussing the case
12.30
Incathlab presentation
Max Armor
12.45 Lunch Symposia
Room Manzoni
DES 2 AND NEW BRS
Continued on page 4
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Martin B. Leon, MD
Carlo Di Mario, MD
Jeffrey W. Moses, MD
Gregg W. Stone, MD
Nicolas Van Mieghem, MD
Associate Directors
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Seung Jung Park, MD
Stephan Windecker, MD
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The operative plan comprised protected PCI
using the Impella 2.5 heart pump (Abiomed, USA)
– which was already implanted prior to the live
portion of the case – and rotational atherectomy
(RA) in the LAD and CX with a 1.5-burr Rotablator
device (Boston Scientific, USA).
Before proceeding with the
case, session Chair Gregg W
Stone interjected to note that
both he and the panel agreed
that vessel preparation, such as
RA, would be beneficial in such a
case. “I can see a lot of calcium,”
said Dr Stone, adding: “It’s amaz-
ing how many people try to get
away without using [rotablation].
We call it ‘rotor regret’… you wish
you had done it in retrospect.”
Dr Colombo advanced the Ro-
tablator into the LAD, the brake
was removed, and RA performed.
Following RA, Dr Colombo and
the team retracted the device,
switched wires, and dilated the septum due to
it being compromised. Dilation of the LAD was
performed with a 2.5, non-compliant, high-pressure
balloon.
A 2.5 mm AngioSculpt semi-compliant Scoring
Balloon Catheter (Spectranetics, USA) was uses,
followed by IVUS. “I think we have prepared this
lesion sufficiently,” said Dr Colombo, noting that
IVUS was able to guide subsequent sizing and
pressure selection for additional balloons across the
length of the lesion, for instance the proximal part
of the lesion, in which a 3.5 mm balloon was used.
Two Cre8 EVO stents (Alvimedica, Turkey) were
then placed.
At this stage, the operative team paused to
decide whether they would
rotablate the CX. “You can see
there is diffuse calcium,” com-
mented Dr Stone, adding: “You
certainly wouldn’t be criticised
for running a 1.5-burr down
there … I think rotablating the
CX is prudent.”
Agreeing to proceed with
rotablation in the CX, the wire
was advanced, and rotablation
began. However, the brake was
not removed at the correct time,
which caused a problem with
the wire, which then had to
be replaced.
Advancing the new wire,
Dr Colombo was met with significant challenge,
and both the panel and the operators were not
confident that the true lumen was reached. The
operators continued to struggle with the wire, but
further rotablation was eventually abandoned. “You
can see the price you pay for a mis-attention of the
brake,” commented Dr Colombo.
Dr Stone added: “I don’t know it if was re-
Continued from page 1
“It’s amazing how
many people try to
get away without
using [rotablation].
We call it ‘rotor
regret’… you wish
you had done it in
retrospect.”
Gregg W Stone
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