Antegrade CTO

Date & Time: Saturday, October 30 9:00-10:30 (JST)
Channel: Coronary Theater II

Coordinator: Kenya Nasu (Toyohashi Heart Center)

Antegrade approach is the basic procedure on CTO-PCI. The success rate of CTO-PCI has improved dramatically with the advent of the retrograde approach but the success rate of antegrade approach itself has not made significant progress over the years. The selections of catheter systems such as guiding catheters, and selections of guidewires and microcatheters are also important, but the operation of guidewire has the greatest effect on its success or failure.

In this session, we will focus on how to operate guidewires in the antegrade approach, and plan a discussion aiming at a logical and highly reproducible procedure.

Calcified lesions

Date & Time: Friday, October 29 17:30-19:00 (JST)
Channel: Coronary Theater I

Coordinator: Masaru Yamaki (Nayoro City General Hospital)

Highly calcified lesions are still one of the limitations of PCI. It is known that the risk of stent restenosis and stent thrombosis will be increased if a stent which has been placed in a highly calcified lesion is poorly dilated. Even if a stent is post-dilated with a balloon after the stent has been placed in a highly calcified lesion, it is very difficult to improve the stent dilation failure due to calcification outside the stent, and an effective solution has not been found. On the other hand, in recent advances in imaging devices, it has been started to prove that OCT/OFDI is effective for calcified lesions. In this session, we will offer a lecture on the evaluation and treatment of calcified lesions using these imaging devices, and finally, we will offer a lecture on the shock wave therapy, which is expected to be used in clinical use in Japan.

Clinical IVUS course

Date & Time: Saturday, October 30 11:30-13:00 (JST)
Channel: Coronary Theater I

Coordinator: Tomoko Kobayashi (Kyoto Katsura Hospital)

IVUS brings us a lot of information during coronary intervention. For both simple and complex lesions, IVUS is useful to perform safety operations and get optimal results. Atherectomy needs to read plaque characteristics and distribution. IVUS gives on-line information to perform wire manipulation in CTO and bifurcated lesions. In this session, we will show clinical IVUS usage in complex cases.

DCA Video Live

Date & Time: Saturday, October 30 14:00-15:30 (JST)
Channel: Coronary Theater I

Coordinator: Yuji Oikawa (The Cardiovascular Institute)

Directional Coronary Atherectomy (DCA) is now being used in combination with Drug-Eluting Stent (DES) and Drug Coated Balloon (DCB), giving a different view of the endpoint as compared to the previous endpoint. Previously, DCA was implemented with the idea of minimizing the area of residual plaque. Due to the favorable outcomes in chronic phases of a DES or a DCB implantation, DCA has become an adjunct tool for the simple treatment on bifurcations, so we need to rethink in regards to the endpoint of DCA.

In this session, we would like to discuss with you regarding the DCA endpoint with DES and DCB through a video live demonstration.

Fellow Course

Date & Time: Thursday, October 28 - Friday, October 29 (JST)
Channel: Coronary Theater II

Coordinator: Kenya Nasu (Toyohashi Heart Center)

CCT2021 will hold a Fellow Course. In this year's Fellow Course, we are going to have the courses of FFR, OCT/OFDI, CTO, bifurcation lesions, calcified lesions, and complication during PCI. For the treatment of such complicated coronary artery lesions, it is important to prevent and cope with complications as well as understanding the characteristics of lesions and treatment methods. We hope that the courses will be an opportunity for participants to deepen their understanding of treatments for various lesions.

LMT PCI

Date & Time: Thursday, October 28 17:30-19:00 (JST)
Channel: Coronary Theater I

Coordinator: Takafumi Tsuji (Kusatsu Heart Center)/ Shunsuke Matsuno (The Cardiovascular Institute)

Left Main Trunk (LMT) lesions are a crucial lesion subset that can be directly linked to patients’ prognosis. Needless to say, the indications for revascularization should be determined carefully. Furthermore, even during the present heyday of drug-eluting stents, it is necessary to perform PCI that guarantees long-term efficacy and safety, not limited to the release of ischemia in acute phase, taking into consideration the lesion characteristics and patient background.

In this session, we would like to focus on how to make LMT PCI more effective and safer.

Mechanical Circulatory Support for Cardiogenic Shock in ACS: IMPELLA video live

Date & Time: Saturday, October 30 9:00-10:30 (JST)
Channel: Coronary Theater I

Coordinator: Hiroyuki Tanaka (Kurashiki Central Hospital)

The use of mechanical circulatory support (MCS) devices is considered for cardiogenic shock in acute coronary syndrome (ACS). In recent years, IMPELLA has been approved in Japan, and the efficacy of the IMPELLA for cardiogenic shock will be expected. Currently, the percutaneous MCS devices such as IABP, IMPELLA and ECMO have been available as a bridge to recover in patients with cardiogenic shock in ACS, and it is required to properly use each support device according to several pathological conditions.

In this session, we would like to discuss cardiogenic shock in ACS through the IMPELLA video live, the pathological conditions that each support device can be adapted to, the best timing for the introduction of various support devices, and the combinations according to pathological conditions.

Retrograde

Date & Time: Saturday, October 30 11:30-13:00 (JST)
Channel: Coronary Theater II

Coordinator: Takafumi Tsuji (Kusatsu Heart Center)

The PCI treatment with the retrograde approach for CTO was introduced as an innovative technology, enabling the treatment of complex CTO lesions that had been unsuccessful until then, and seems to have contributed the most to the improvement of the success rate of CTO-PCI.

Nowadays, with the development of various new devices and more sophisticated technologies, it has been incorporated into the algorithm for CTO-PCI as a safe procedure and it has become a standardized therapeutic procedure.

On the other hand, to be familiar with this procedure, it is essential to gain sufficient knowledge and develop careful procedures even under the present circumstances. It is still considered dangerous for a procedure to be done by an operator without enough experience and knowledge. We have planned this session as an opportunity for operators with insufficient experience to be able to learn the basic and practical knowledge of the retrograde approach from the CTO-PCI experts. This year, we are providing the opportunity to learn how to choose procedures depending on situations through lectures and video live demonstrations.

Thorough verification of failed CTO-PCI cases using cardiac CT information
- How predictable is it from preoperative CT information?

Date & Time: Friday, October 29 13:00-14:30 (JST)
Channel: Coronary Theater I

Coordinator: Tomohiro Kawasaki (Shin-Koga Hospital)

The success rate of CTO PCI has improved with the development of imaging technology, device performance and advances in PCI techniques such as the retrograde approach. In particular, the morphological analysis of CTO lesions by cardiac CT plays a major role, and the morphological information of CTO lesions obtained from cardiac CT can provide the surgeon with significant clues to the success of CTO PCI.

The aim of this session is to review the findings of cardiac CT and to discuss the causes of failure in cases where CTO PCI was not successful. This session will be based on the cardiac CT findings of two actual cases of unsuccessful CTO and will discuss with the discussants about how the operator understood the morphology of the lesion, what caused the PCI to fail and how the operator should treat the lesion. We will also discuss about how to overcome CTO failures. If we can get some hints on how to overcome CTO failures, we will be able to apply them to our own CTO-PCI in the future.