Fundación EPIC _ Transient atrioventricular block after TAVI, what to do?Fundacion EPIC
Presentación de la ponencia "Tratamiento anticoagulante/antiagregante al alta en TAVI" Por la Dra. Ureña en los Diálogos EPIC_Retos Clínicos en Válvulas Transcatéter/ Clinical Challenges in TAVR today, el 10 de Mayo de 2018 en Barcelona (España)
15th Experts Live CTO: Opening Session - Emanuele BarbatoEuro CTO Club
15th Experts "Live" CTO: Auditorium Zubin Mehta - Friday 08:00
15th Experts Live CTO: Opening Session
PLENARY - OPENING SESSION
08:05
CTO in the Revascularization Guidelines
Emanuele Barbato (Rome)
___________________________________________
PLENARY - OPENING SESSION
Auditorium Zubin Mehta - Friday 8:00 - 9:00
Chairpersons:
Antonio Colombo (Milan),
Giovanni Esposito (Naples)
Discussants:
John Davies (Basildon - UK),
Marco Hautmann (Essen - D),
Aravinda Nanjundappa (Cleveland - USA)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
If you want to know all the details of the event, click on the image below to download the final program, where you will be able to orient yourself on the day, time and place of a specific video recorded at 15th Experts Live CTO.
Imaging for Predicting and Assessing Patient Prosthesis Mismatch after AVRJunhao Koh
Echocardiographic evaluation to prevent, detect and intervene on patient prosthesis mismatch in aortic valve replacement, including TAVR / TAVI and valve-in-valve cases.
Linee guida e timing chirurgico insufficienza aorticaICARDIOLOGI
Linee guida e timing chirurgico dell’insufficienza valvolare aortica: che cosa attende migliore definizione. Dr. Antonio Federico - Villa Maria Cecilia Hospital - Maggio 2009
15th Experts Live CTO - Carlo Di Mario: ConclusionsEuro CTO Club
PLENARY SESSION
Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages
Auditorium Zubin Mehta - Saturday 16:00 - 17:00
Speakers:
Daniela Benedetto (Rome),
Francesco Burzotta (Rome),
Carlo Di Mario (Florence),
Roberto Garbo (Turin),
Rocco Stio (Rome)
Challengers:
Stelios Pyxaras (Furth - D),
Sudhir Rathore (London - UK)
Discussants:
Shunsuke Matsuno (Tokyo - J),
Alexander Nap (Amsterdam - NL),
Masahisa Yamane (Tokyo - J)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Francesco Burzotta: Wrap up Gemelli CasesEuro CTO Club
PLENARY SESSION
Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages
Auditorium Zubin Mehta - Saturday 16:00 - 17:00
Speakers:
Daniela Benedetto (Rome),
Francesco Burzotta (Rome),
Carlo Di Mario (Florence),
Roberto Garbo (Turin),
Rocco Stio (Rome)
Challengers:
Stelios Pyxaras (Furth - D),
Sudhir Rathore (London - UK)
Discussants:
Shunsuke Matsuno (Tokyo - J),
Alexander Nap (Amsterdam - NL),
Masahisa Yamane (Tokyo - J)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Jonathan Hill: Role of mechanica support in CTO recanalizationEuro CTO Club
10:42
Role of mechanica support in CTO recanalization
Jonathan Hill (London - UK)
___________________________________________
PARALLEL SESSION
Challenges And Opportunities In Cto Recanalization
Auditorium Zubin Mehta - Saturday 10:00 - 11:10
Chairperson:
Jonathan Hill (London - UK)
Discussants:
Lesnek Bryniarski (Krakow - PL),
Ugo Fabrizio (Vercelli),
Paul Knaapen (Amsterdam - NL),
Eugenio La Scala (Ollioiouls - F)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Gregor Leibundgut: Role of DEB in CTO-PCIEuro CTO Club
10:35 Role of DEB in CTO-PCI
Gregor Leibundgut (Basel - CH)
___________________________________________
PARALLEL SESSION
Challenges And Opportunities In Cto Recanalization
Auditorium Zubin Mehta - Saturday 10:00 - 11:10
Chairperson:
Jonathan Hill (London - UK)
Discussants:
Lesnek Bryniarski (Krakow - PL),
Ugo Fabrizio (Vercelli),
Paul Knaapen (Amsterdam - NL),
Eugenio La Scala (Ollioiouls - F)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...Euro CTO Club
AUDITORIUM ZUBIN MEHTA
08/09/2023 04:30 - 05:20
PLENARY SESSION - INTERVENTIONAL CTO & CHIP RESEARCH Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...Euro CTO Club
16:53
CTO PCI Outcome associated with poor quality of the distal target vessel
Emmanouil Brilakis (Minneapolis - USA)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...Euro CTO Club
16:33
EuroCTO Consensus on Guide Catheter Extensions JACC Cardiovasc Interventions
Mario Iannaccone (Turin)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
EAPCI & complex lesions
1. EAPCI documents on Complex Lesions
Interventions
Emanuele Barbato, MD, PhD, FESC
EAPCI President-elect
Co-Director, Cardiovascular Center Aalst, Belgium
Professor of Cardiology, University Federico II, Italy
21. Plaque
Modification
Single, small burr
(1.25mm to 1.50mm)
Facilitate balloon
dilatation
and stent
implantation
Smoothen the lumen
and
disconnect the calcified
coronary ring
Barbato E et al. Eurointervention 2015
Main objectives of contemporary RA
22. Guide Catheter
Selection
• Single curve with strong support
• Most procedures can be performed with a 6 FR Guiding
Catheter
Guidewire Selection
• Most procedures can be performed with the Rotawire Floppy
• Use of regular wire placement, exchange using microcatheter
placement often required
• It is important to shape the ROTAWIRE tip smoothly
Barbato E et al. Eurointervention 2015
Pre-procedural recommendations
23. Burr Selection
• Single, small burr (1.25 or 1.50 mm) works for the majority of
lesions.
• Consider a burr-to-artery ratio of 0.6
Pacing
Considerations
• Positioning a temporary pacemaker should be considered
when treating the right coronary artery or dominant left
circumflex
Barbato E et al. Eurointervention 2015
Pre-procedural recommendations
24. Between 135,000 and 180,000 RPM
ABLATION SPEED
Short duration: individual runs < 30 secs
RUN TIME
Pecking motion should be used to
minimize deceleration
BURRING
TECHNIQUE
Barbato E et al. Eurointervention 2015
Procedural recommendations
25. Cocktail with verapamil, nitrates and heparin in
saline
Sufficient plaque modification to achieve optimal
balloon dilatation and stent implantation
Should be < 5,000 RPM
DECELERATION
If the lesion cannot be crossed after several
passes
DOWNSIZING
BURR
ROTABLATION
FLUSH
WHEN TO STOP?
Barbato E et al. Eurointervention 2015
Procedural recommendations
27. Emanuele Barbato, MD, PhD
Emanuele Gallinoro, MD
Flavio Luciano Ribichini, MD, PhD
Contemporary management strategies of patients
with heavily calcified coronary stenoses
An EAPCI position paper in collaboration with EURO4C-PCR working group
31. Agenda
a) Role of IV imaging
b) PCI in Complex Lesions
c) Unmet needs
32.
33.
34. • EAPCI is actively engaged to generate scientific and consensus
documents in order to provide guidance to the interventioncal
cardiology community
• Implementation of novel diagnostic strategies and therapies is
now constantly monitored by EAPCI in order to identify areas of
unmet needs deserving particular attention from the relevant
stakeholders
Conclusion
Thank you very much for the kind introduction. I’d like to start thanking both Prof. Di Mario and Tarantini, respectively on the EuroCTO side and on the GISE side for the kind invitation to this joint symposium. After a supplement of reflection with Carlo, we agreed to reshuffle a bit the title of my presentation such that I would be able to share what has been the scientific contribution of EAPCI to the magament of complex coronary lesions through the publication of several position papers and consensus documents ...
… the topic has been tackled at different levels, starting from the role of IV imaging ...
… this is the first part of the EAPCI consensus document on the role of intracoronary imaging in guiding and optimizing coronary interventions ...
... Where a strong emphasis has been given to its role a tool to further improve clinical outcomes when used to guide and optimize PCI. This is the meta-analysis published whitin the consensus document showing a significant reduction of MACE and TLR with imaging-guided PCI vs. Angiography-guided PCI ...
… and this is the updated analysis with the inclusion of the 12 months follow-up of the ULTIMATE trial that was published in the meantime where also CV mortality resulted significantly reduced when PCI was guided by IV imaging ...
… of interest this advantage was particulary clear in challeging lesion settings like MVD, CTO, bifurcation, calcified lesions. In fact, despite the p for interaction is not significant, it is clear that in the challenging lesion settings the gain in terms of improved clinical outcomes after PCI is more pronounced.
… perhaps the field is more mature to lead to a revisitation of the latest ESC GLs that still give a class IIa LOE B to IVUS not only to assess LM stenosis severity but also to guide PCI in ULM stenosis. IVUS and OCT both receive a class of recommendation IIa with LOE B to optimize stent implantation in selectied patients. Additional guidance is provided ...
… by the EAPCI consensus document where IV imaging is recommended for diagnostic assessment each time we are in presnce of angiographically unclear or ambiguos findings, in case of LM stenosis severity assessment, complex bifurcation lesion or suspected culrpit lesions of ACS patients. For PCI guidance and optimization, IV imaging is recommended for long lesions, CTO (based on evidences coming from RCTs), while it is expert opinion that IV might be very useful in ACS, LM, complex stenting strategy, in pts with renal dysfunction. And finally, IV imaging is a must for the identification of mechanisms of stent failure ...
… additional considerations are given to calcified lesions like for example ... (read) ...
… this information can be readily implemented in clinical practice considering the contermporary algorithm derived from the application of AI to our OCT software that is returning in numbers the extent and severity of lesion calcification to refine more and more PCI guidance ...
… that should strive to achieve given targets for optimal stent implantation as highlighted in this nice figure integrating key elements like what should be the final MSA, the unacceptable edge dissections, malapposition degree etc.
… in the second part of the EAPCI consensus document on IV imaging ...
… Tom Johnson and colleagues focused among other topics on ACS and interestingly on the identificaiton of this novel entity which is the calcified nodule responsible of less than 10% of the ACS cases. The importance of the detection of CN is clear on the KM to the right showing how it is often associated with smaller post-PCI MSA and with lower TLR-free survival ...
… next point on the agenda is the role of PCI in complex lesions ...
… EAPCI contributed to the development of the latest GLs on myocardial revascularization ...
… that tried to provide some guidance on which are the clinical and anatomical characteristics favouring PCI over CABG. Beyond the previous considerations on the role of IV imaging to guide and optimize PCI there is very limited space though dedicated to complex procedures ...
… for CTO we even have one recommendation of class Iia LOE B in patients with angina resistant to MT or with a large area of documented ischemia in the territory of the occluded vessel, Now, it is easy to think that this recommendation, like more in general the indication to revascularization in CCS patients, might be challenged by the publication of the ISCHEMIA trial ...
… yet we should not be so pessimistic and I would agree with what recently stated by Bernie Gersh in his recent editorial. There will be no impact of ISCHEMIA trial result on the indications to CAG and revascularization based on the severity of symptoms, as in this case there will a demonstrated improvement in quality of life of the patients, there will be no impact on patients showing severe ishemia on imaging test in addition to stress test features of high risk like for example those indicating the presence of LM disease or LM equivalent. Likewise no consequences in patients with reduced LV function. There might well be consequences on the indication to CAG and revasc based only on positive imaging test alone where ISCHEMIA would first recommend an attempt to OMT, an in case of refractory symptoms still would support revascularization. Finally the results of ISCHEMIA do not apply to patients who have already undergone to CAG where we can still apply anatomic and/or hemodynamic based indications to revascularizations ...
… for calcified lesionswe don’t have any recommendations but just a small text mentioning to the importance of lesion preparation especially in heavily calcified lesions with more aggresive tools and devices like cutting or scoring balloons or rotatational atherectomy ...
… here we have our EAPCI consensus document on rotational atherectomy that has clarified the ...
... the main objecives of RA that are to achieve good plaque modification and not any longer systematic calcium debulking. This means smoothening the lumen and disconnecting the calcified coronary ring. Something that can be achieved in most of the cases with a single small burr of 1-25 or 1.5 mm, in order to facilitate further balloon dilatation and optimize stent implantation. Technical aspects on how to safely and easily perform plaque modification are further illustrated ...
… in the consensus document where we also provided some procedural recommendations, I will not go thriugh all of them ...
… but some are worth to be mentioned, like the selection of the burr size that should follow a burr-to-artery ration of 0.6 more or less. Temporary pacemaker should be considered when treating RCA or dominant LCX, even though it’s not absolutely mandated if you’re confident to manage the situation with a little bit of atropine ...
… ablation speed should be in the range of 135 to 180 K RPM, and individual runs should be short, preferably below 30 sec each. Burr movement should aim at minimizing possible decelaration of the burr within the lesion, therefore the pecking motion was proposed.
… deceleration will occur anyhow, but in case this should not exceed more than 5000 rpm, finally when to stop, when we think that sufficient plaque modification was achieved in order to further perform optimal balloon dilatation and stent implantation ...
… ever since new tools became available like OA, IVL that prompted the preparation of a second EAPCI consensus document ...
… which is this time dedicate to the contemporary management strategies of pts with calcified coronary stenoses broadening the objectives to different tools and techniques but also the the importance of invasive and non-invasive imaging and some consideration to training and education. This paper is currently ongoing and will become available at the occasion of EuroPCR2022.
… in this overview I also like to include this old EAPCI consensus document on transradial approach. It was back into 2013, and you can recoqgnize in the authorship 5 EAPCI presidents ...
… at that time transradial approach was not as much adopted as it is today, neverthless the consensus was that this approach was safe and effectve to be adopted in all-comers PCI including complex procedures, with level 2 dofficulty, being level 3 the ACS patients considered as the most diffcult ones to be catheterized transradially. Now this is a historical slide ...
… nevertheless it is intriguing to see that after 6-7 years more that 50% rotablator procedures are performed transradially in the countries surveyed in the EURO4C registry, with peaks aroung 80% in countries like France, Spain, or Poland ... Much like in this registry ...
… EAPCI is also actively enganged to monitor contemporary interventional cardiology practice in order to identify unmet needs that deserve attention from the learned societies, payers, and industry ...
… we launched in 2018 the EAPCI Atlas with the intent to systematically map and monitor our practice in Europe ...
… the first results were published in 2020 where interesting insights were provided in our infrastructures, n and type of procedures with related clinical outcomes. The second edition of the EAPCI Atlas with increased n of countries i currently ongoing and will be published by EuroPCR 2022.
... Few months ago the 3 years follow-up of the ULTIMATE trial was published at TCT 2020, confirming the superiority of imaging-guided PCI on TLF ...