JIM Today 2018 - Thursday - page 11

Issue 1 
Thursday
 22 February 2018 
JIM today
11
Looking at alternative approaches
to left ventricular support
C
arlo Briguori is Chief of the
Laboratory of Interventional
Cardiology at the Clinica
Mediterranea in Naples, Italy. He plans
to use his presentation tomorrow
afternoon to talk about the use of left
ventricular support during transradial
percutaneous coronary intervention
(PCI) for complete revascu-
larisation. “Although there is
no uniform definition as to
what constitutes a high-risk
PCI, patients with severe
three-vessel disease, left main
disease, a single remaining
patent vessel or depressed
left ventricular [LV] function
are considered to represent
a high-risk population,” he
explained. “In this setting,
percutaneous mechanical
circulatory support [MCS] devices
have been developed to facilitate
procedural safety, and to improve out-
comes.”
The most widely used MCS
devices are the intra-aortic balloon
pump (IABP) and Impella (Abiomed,
USA), said Dr Briguori. “They serve to
maintain coronary perfusion pressure
and reduce myocardial workload, al-
lowing the operator sufficient time to
optimally complete the procedure,”
he explained.
According to the literature, the
use of the femoral arteries in high-
risk PCI has been associated with an
increased rate of bleeding complica-
tions, explained Dr Briguori. “The
femoral access has been historically
preferred to the radial one in these
complex procedures,” he said. “There
is much data in the literature about
the efficacy and safety of the use
of left ventricular support devices
in high-risk procedures performed
through the transfemoral approach;
in the same way, many trials and
studies show the superiority of
radial over femoral access in reducing
bleeding complications, mostly for
PCI performed in patients with acute
coronary syndromes.”
The same cannot be said for the
use of left ventricular devices, con-
tinued Dr Briguori, as there is a lack
of data regarding the use of left ven-
tricular support devices in transradial
PCI for complete revascularisation.
Dr Briguori will discuss a case
of complex transradial PCI
using the Impella device as
left ventricular support at his
clinic in Naples. “They are
restricted to a few clinical
cases, followed by an inter-
esting case report,” he said.
That case report details a 71
– year-old man with unstable
angina, a poor left ventricu-
lar ejection fraction (28%),
three-vessel disease – includ-
ing a left anterior descending
artery chronic total occlusion – and
severe mitral valve disease. “We
opted for a percutaneous strategy: a
multivessel high-risk transradial PCI
Innovative Technologies 
Club 
Friday 
12:45
Stent optimisation: be careful with the edges
T
his afternoon’s session on intracoronary
imaging will feature the latest results of
recent studies carried out with intravascular
ultrasound (IVUS) and optical coherence tomogra-
phy (OCT). Francesco Prati (San Giovanni Hospital,
Rome, Italy) is an interventional cardiologist who
has spent over 20 years in the clinical and research
fields of intravascular imaging. “Looking at the
arteries from the inside is very important indeed
in order to understand the adequacy of results
obtained with coronary intervention – particularly
stents,” he told
JIM Today
.
Professor Prati will talk about precautions that
must be taken during such procedures. “When we
deploy a stent,
we must be very
careful at the
edge of the scaf-
folds,” he said.
“Sometimes, de-
spite the fact that
the final coronary
angiography
looks good, there
may be problems
along the stent,
at the edges and
also the segments close to the stented segment.”
It’s not uncommon to see
irregularities at the edge, Pro-
fessor Prati continued: “The
presence of residual stenosis at the stent edge, or
the presence of a dissection of the residual plaque,
convey a worse clinical outcome,” he said, adding
that in reality there may be something far more
serious at play. “These features, in fact, may cause
a stent thrombosis, as well as major cardiovascular
events such as myocardial infarctions.”
That’s where imaging can help, said Professor
Prati, noting that it is imperative to interrogate
stents with imaging modalities like OCT or IVUS
when performing complex interventions such as
left main, bifurcations, or very long lesions. “Also,
these intracoronary imaging techniques should be
used any time coronary angiography raises doubts,
when there are irregularities, or in times of ‘hazi-
ness’,” he said.
“Our CLI-OPCI project
1
showed the usefulness
of an OCT-guided approach,” he said, noting that
other large IVUS meta-analyses have consistently
shown the clinical impact of an IVUS-guided ap-
proach. “My hope is to see a higher penetration
of intracoronary modalities in my country, and in
Europe, to improve the clinical results of coronary
interventions,” he concluded.
References
1. Prati F, et al. Clinical Impact of OCT Findings During PCI:
The CLI-OPCI II Study. JACC Cardiovasc Imaging. 2015
Nov;8(11):1297-305
Intracoronary Imaging 
Parini 
Thursday 
12:45
“My hope is to see a higher
penetration of intracoronary
modalities in my country, and
in Europe, to improve the
clinical results of coronary
interventions.”
Francesco Prati
“Although there is no uniform definition as to what
constitutes a high-risk PCI, patients with severe three-
vessel disease, left main disease, a single remaining patent
vessel or depressed left ventricular [LV] function are
considered to represent a high-risk population.”
Carlo Briguori
Continued on page 12
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