200 - CALAMITY LEADING TO CLARITY: THE EVOLVING APPROACHES TO LEFT MAIN PCI

Saturday, October 29, 2022

3:15 PM – 4:00 PM EDT

Location: Room 210

Target Audience: Clinical cardiologists, Trainee (clinical)

Co-Chair(s)

ES

Erick Schampaert

Head, Division of Cardiology, Professor of Medicine, University of Montreality
Hôpital Sacré-Coeur de Montreal, CIUSSS NIM / Université de Montréal
University ofMontreal
Montreal, Quebec, Canada
Andrea J. Lavoie, MD FRCPC FACC

Assistant Professor
Regina General Hospital
University of Saskatchewan
Regina, Saskatchewan, Canada

Presenter(s)

Kevin R. Bainey, MD

Interventional Cardiologist
University of Alberta
University of Alberta
Edmonton, United States
Andrew Czarnecki, MD, MSc, FRCPC

Interventional Cardiologist
Sunnybrook Health Sciences Centre
University of Toronto
Toronto, Ontario, Canada

Planning Committee Member(s)

Debraj Das (he/him/his)

INTERVENTIONAL CARDIOLOGY
Royal Alexandra Hospital & CK Hui Heart Centre
Royal Alexandra Hospital & CK Hui Heart Centre
Edmonton, Alberta, Canada
Mina Madan, MD MHS FRCPC

Interventional Cardiologist, Heart & Stroke Polo Chair in Cardiology,Associate Professor of Medicine
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
University of Toronto
Toronto, Ontario, Canada
Natalia Pinilla, MD, MSc

Assistant Professor/Interventional Cardiologists
McMaster University
McMaster University
St. Catharines, Ontario, Canada
Alexandra Bastiany, MD, FRCPC

Interventional Cardiologist
Thunder Bay Regional Health Sciences Centre
Thunder Bay, Ontario, Canada
Allison B. Hall

Interventional Cardiologist, Co-Director CTO/CHIP Program, Clinical Assistant Professor of Medicine
Eastern Health/Memorial University of Newfoundland
Eastern Health/Memorial University of Newfoundland
Portugal Cove-St. Philip's, Newfoundland and Labrador, Canada
BB

Bradley Brochu, MD, FRCPC

Fellow, Interventional Cardiology
Hamilton, Ontario, Canada

Learning Objectives:

At the conclusion of this session, participants will be able to:

distinguish the appropriate indication for provisional versus two-stent stent techniques in left main intervention;
summarize and compare the most common two-stent bifurcation strategies in left main intervention, including DK Crush, Culotte, and T-stent and protrusion;
reflect on the benefits and necessity of intravascular imagining in the preparation of left main intervention. Specific imaging modalities include intravascular ultrasound and optical coherence tomography;
troubleshoot through common problems encountered in left main intervention, including ostial stent placement;
select the appropriate antiplatelet duration for patients undergoing left main intervention; and
summarize key messages from the most recent clinical trial evidence in left main versus CABG specifically pertaining to EXCEL and NOBLE trials.

Although the eternal struggle between left main intervention versus coronary bypass grafting continues, the evolution of percutaneous approaches has allowed interventional cardiologists to perform higher risk and more complex cases. As our population ages, the portion of robust patients eligible for surgical revascularization has diminished, leaving a space that must be filled by interventional cardiology. Even with advances in technology, consensus on strategies and techniques in the realm of left main intervention remains elusive. We commonly turn to international leaders and recommendation documents outside of Canada to help guide us in the management of these patients.

With varying practices across the country, this workshop on left main intervention would aim to cover contemporary approaches, troubleshooting techniques, and current literature highlighting Canadian expertise. Using case base examples from Canadian key opinion leaders, we aim to highlight important concepts including appropriate patient selection, anatomic considerations (lesion length, plaque distribution, side-branch angle), Medina classification, angiographic views, strategy choice, and rationale. Provisional and important two-stent strategies (double-kiss crush, culotte, and T-stent and protrusion) would be discussed. The troubleshooting portion would illustrate common pitfalls and effective strategies to overcome complications particularly focusing on ostial left main disease. Important concepts such as proximal optimization, side-branch rewiring, and the necessity for intra-coronary imaging (intravascular ultrasound and optical coherence tomography) would be reviewed. Peppered throughout the two presentations would be discussion points on landmark trials in the field including extended follow-up results from the EXCEL, NOBLE, and SYNTAX trials.

Our goals through this workshop would be to increase knowledge in all aspects of left main intervention, streamline Canadian practice patterns and simplify decision-making using contemporary strategies and effective troubleshooting techniques.