Percutaneous coronary intervention in complex bifurcation lesions is prone to suboptimal implantation results and is associated with an increased risk of subsequent clinical events including restenosis, thrombosis, and risk of other adverse ischemic events versus PCI of non-bifurcation lesions.^1-4

Operators

• Sean Gallagher (MD, PhD)
• Tom Johnson (MD, PhD)
• Elliot Smith (MD, PhD)

Site

• Catheterization laboratory of the University Hospital of Wales

Patient Characteristics

• 60 years old male
• Left ventricular dysfunction
• Symptoms of exertional breathlessness and fatigue
• No signs of typical angina

FFR Pre-PCI Functional Evaluation

• Ascertainment of lesion significance
• Severity of ischemia

OCT Pre-PCI Imaging Evaluation

• Plaque characterization
• Assessment of vessel diameter and lesion length
• Selection of landing zones and stent length and diameter
• 3D Bifurcation view highlights the side branch ostia of a vessel
• 3D Navigation allows the user to move throughout and within the 3D rendering

OCT Post-PCI Imaging Evaluation

• Evaluation of stent edges for dissection and residual stenosis
• Evaluation of Stent expansion, apposition, and necessity of further optimization

FFR + Pullback Post-PCI Functional Evaluation

• Functional result of PCI
• Assessing residual focal pressure losses requiring additional treatment
• Prognostic stratification

Guidewire choice matters, especially in complex PCI where 1-to-1 torque and control are important. The HI-TORQUE TURNTRAC™ Workhorse guide wire provides great support in complex anatomy.

In the absence of proven ischemia upfront, Intracoronary physiology can identify ischemia and guide your revascularization decision-making.

Pre-PCI assessment with AptiVue™ Software co-registration: The MLD-MAX algorithm is used to assess vessel morphology and to define the stent length and diameter.

The first stent (XIENCE™ 2.5x48mm) was deployed successfully to the Mid LAD as planned.

The second stent was implanted (XIENCE™ 3.5x18mm) to cover the distal LM / proximal LAD.

Additional stent (XIENCE™ 4.0x18mm) was deployed to the main branch.

Post-PCI OCT optimization using the MLD-MAX algorithm to check for medial dissection, malapposition, and expansion of the stent struts.