novel tools and techniques: co-registration and resting ...€¦ · ifr/ ifrco-registration ivus...
TRANSCRIPT
JasvindarSinghMD,FACCAssociateProfessorofMedicineWashingtonUniversityinSt.LouisDirector,CardiacCatheterization
LabBarnes-JewishHospital
Bifurcation stenting –Physiologic guidance
Novel Tools and Techniques: Co-registration and Resting Indexes
……Novel Tools and Techniques: Co-registration and Resting Indexes
Jasvindar Singh,MD
DisclosureResearch/Grantsupport:VolcanoCorp.,Abbott
Vascular,MedtronicVascular ,Boston-ScientificConsulting:VolcanoCorp,TriremeMedicalBoston-Scientific,AbbottVascular,MedtronicVascular,Spectranetics
Angiography
iFR /iFR Co-registration
IVUS(?OCT)&Co-registration
1.Tonino P,DeBruyneB,etal(2009).FractionalFlowReserveVersusAngiographyforGuidingPercutaneousCoronaryIntervention.NewEnglandJournalofMedicine.Volume360,Number3:213-224.2.ClaessonBE,MehranR,etal,ImpactofIntravascularImagingonEarlyandLateClinicalOutcomeFollowingPCIwithDrug-ElutingStents.J.Am.Coll.Cardiol.Intv.2011;4;974-981
AdvancedImagingAlgorithm
601-0103.109/001 48
Angio +
• Lesscontrast• Lessradiation• Preciseandlessstenting?• Betterpatientoutcomes• Cost-effective
2016------------------
AdvancedImagingSolutionFunctionalityiFR andIVUSCo-RegistrationandAngiographicEnhancement
Angio+EnhancedAngiographyiFR Co-Registration IVUSCo-Registration
• LocalizationofIVUSwithangiography
• Easylength/area/diametermeasurementswithmanualpullback
• iFR dropisdisplayedonangio• Lengthmeasurementwithoutpullbackdevice
• VesselEnhancement• QCA&DeviceDetection
Angio +• DiagnosticPhase
– QCA– VesselEnhancement(VE)
• TherapeuticPhase– StabilizedandEnhancedImageStream– DevicePositioning– MaximumInflation– EnhancedStent
600-0100.144001
Real-timeIVUSCo-registrationwithAngio+simplifiessizing
Easy length measurement with manual pullback
Area & diameter measurements
600-0103.144/0016Volcano, the Volcano logo, Eagle Eye Platinum, Revolution, and SyncVision are registered trademarks of Volcano Corporation. Angioare propert
iFR Co-RegistrationWithiFR co-registrationthereisnoneedforhyperemicdrugs,noneedfortimeconsumingpullbackdevicesandnoneedforguesswork
7
• Makelengthmeasurementswithoutacumbersomepullbackdevice
• Planyourprocedurewithphysiologicguidance
CASE1
JasvindarSinghMDBarnesJewishHospitalofWashingtonUniversity
RK
• 78yearoldwomanwithPMHsignificantfor:– HTN– Hyperlipidemia– DMII– CADs/pMIwithangioplastytothediagonalandOMin1999
• Duringpreoperativeevaluationforbilateralkneereplacement,shecomplainedofrecentchestdiscomfort(squeezingchestdiscomfortwithexertionforseveralweeks,relievedwithrest,similarinnaturetothatofpriorangina).
• GivenherknownhistoryofCADwithtypicalchestpain,shewasbeenreferredforinvasiveassessment.SheunderwentCardiacCatheterization.
Management?
• MedicalRx
• ComplexPCIvsCABGbasedonAngio alone?
• HemodynamicandanatomicassessmentwithiFR/FFRandIVUS?
Hemodynamic&AnatomicAssessments
• Complexcalcified50-60%lesionindistalLeftMainextendingintoproximalLADwith60-70%diseasewhichwashemodynamicallyassessedwithiFR andfoundtobesignificantat0.73.
• iFR pullbackdemonstratedsignificantstepupinboththedistalLMainandprox-midLAD.
• HemodynamicassessmentofOstial CXwithiFR whichwasnon-significant(0.98).
• HowdoesmanagementapproachchangewiththeaddedinformationfromiFR,FFR,andIVUS?
• Whatisthepotentialrevascularizationstrategy?
CircumflexAssessment
Conclusions
• iFR Co-registrationpreciselyprovidedcontributionofeachlesioninthesignificantzones
• IVUScoreg providedsizing,plaquedistributionandcharacteristic,choiceoftherapyandstentoptimization
• PostiFR Circumflex- noaddedstentneeded• Savedtime,lesscontrastuseandradiation,lessstentandexcellentPCIoptimization.
• Samedaydischarge,avoidingCABG,betterpatientsatisfaction