Greeting

Thank you for your continued and significant support to Complex Catheter Therapeutics (CCT).

With the change of CCT directors, I, Junji Yajima, would like to extend my brief greeting to all of you, as I have been appointed as a new chairperson.

Unfortunately, the CCT2020 was forced to cancel because of worldwide pandemic of the COVID-19. Although we made a judgement not to hold the CCT2021 onsite, we are getting ready to hold a virtual meeting this year. As you know, even under the COVID-19 pandemic situation, the PCI for complex coronary lesions is not decreasing, and the complexity of lesions is increasing with the aging of patients. In addition, peripheral vascular diseases, and structural heart diseases such as aortic stenosis, are steadily increasing with the aging of patients. This is the situation not only in Japan but all over the world. We consider that it is necessary to improve devices, develop the treatment technology and raise the awareness of physicians all over the world regarding these essentials. Therefore, CCT has continued to perform small-scale live case transmissions even under the current difficult situation. CCT2021 which is scheduled for this October, will be held by webcasting for the first time. This virtual meeting is not all bad because it has the advantage that viewers can watch it on demand without worrying about the capacity of the venue. It may be difficult to completely wind down this COVID-19 pandemic during my term as a chairperson. However, I promise to continue the inheritance of treatment technology and the dissemination of device information through the CCT. I would like to ask for your continued support of the CCT.

(June 22, 2021)

Board Chairperson of the General Incorporated Association CCT
Junji Yajima (The Cardiovascular Institute Hospital)

CCT policy of live sessions

Statement regarding Coronary Live Case Transmissions

CCT2021, which was held online by considering the situation of COVID-19, has recorded around 3,000 attendees and 13 prepared PCI cases have successfully treated without any complication. We have been making surveys for participants every time and had opportunities to receive a variety of opinions. However, we have not published CCT policy regarding live case transmissions until now. Therefore, by using my appointment to the Board Chairperson of the General Incorporated Association CCT as an opportunity, we decided to release the universal CCT policy which has been shared among live session chairs and commentators of the past CCT meetings.

CCT Coronary has consistently pursued the best approach to perform a precise complex PCI in a live case transmission since its foundation. We would like to maintain the tradition in future CCT meetings.

In the live case transmissions, the chair will be the center of communication and information in order to minimize the disadvantages of patients by removing the interference, and instead mainly focus on discussions to provide the maximum educational value to participants and audiences. In this trial, chairs will always perform the leading role of live case transmission while operator will perform a supporting role to provide a part of information. For fulfilling this CCT policy, it is necessary for chairs to clarify what should be conveyed to the audience through the case by having detailed knowledge of the angiography and CT, to say nothing of information of patients, and to understand the issues of the cases beforehand.
During the live session, the chair should explain the history of the case by offering angiography findings and CT images in the past, as well as lesion information by angiography on the day, an explanation of collateral circulation, information on lesions by CT scans and other issues during the procedure such as kidney function or left ventricular function, in order to make the audience understand the case information. For some situations, chairs may develop a different view to the operator’s strategy or procedure. We cordially ask them to bear in mind that the operator is the only doctor who is responsible to the patient, and to play a supporting role of the operator so that the procedure will be successful without complications.

Commentators are required, as well as chairs, to understand the patient information beforehand and to expand the discussions with chairs which would provide educational information to attendees. Commentators should minimize the direct discussion with operators and mainly hold discussions with chairs in order to advance the operators’ procedure smoothly. We cordially ask the commentators to keep in mind to avoid comments similar with others and to make comments resulting in improvement of the attendee’s knowledge.

Cath lab imaging commentators are in the position which is able to understand the situation of on-site next to the operators as well as to send information influencing the strategy. Through imaging findings, they are responsible to provide precise information for the session venue and attendee, in addition to give advice from imaging findings and constant support for the operators.

Operators are not the main role in the live case transmissions, but they must make efforts in presenting the basics of the strategy educationally. Namely, they have to present information regarding the strategy decided by themselves and the information available only to the operator (such as using devices or functionality of a guidewire for the lesion), by keeping safety of the patient and minimizing effects to the procedure. Furthermore, they are always requested to explain their own strategy logically and continue the procedure in order to deepen the discussion at the venue. As it is mentioned above, we cordially ask the operators to bear in mind that the operator is the only doctor who is responsible to the patient and they might refer to the opinion from others but should avoid being manipulated by that to the maximum degree. Therefore, it is their duty to try their best to lead to a successful procedure by considering the safety of the patient as a top priority.

We have introduced practical attempts of CCT Coronary live case transmissions. We always strive to embody live sessions following the CCT policy as above and your kind cooperation is very much appreciated.

Board Chairperson of the General Incorporated Association CCT
Junji Yajima (The Cardiovascular Institute)

---

ライブセッションにおける CCT policy

CCT Coronary ライブデモンストレーションに関するステートメント

CCT2021 は COVID-19 感染症の状況を鑑み Web 開催となりましたが、3000名ほどの参加が得られ、準備した13例のPCIも合併症無く成功いたしました。毎回、参加者アンケートを行い、様々なご意見をいただく機会はありましたが、我々 CCT のライブデモンストレーションに対する考え方についてお伝えする機会はありませんでした。そこで、私が理事長を拝命いたしましたことを機に、以前より座長およびコメンテーターで共有していた普遍の CCT policy について公開することといたしました。

CCT Coronary では創設当初から、一貫して complex PCI を如何に的確に行うかをライブ形式で問うてきました。今後の CCT においても、その主旨からぶれることなくライブを行いたいと考えております。

ライブにご協力いただく患者さんの不利益を最小限に抑え、会場での議論を中心に参加者が最大限の教育的情報を得られるライブを行うため、座長が中心となり情報発信を行います。この取り組みの中では座長がライブの中心であり、術者はあくまでも一つの情報源となります。こうした主旨（CCT policy）を実現するために、座長は患者情報、詳細なアンギオ情報、CT 情報を熟知し、また当該症例の問題点を把握し、症例を通じて参加者に何を伝えるのかをライブに先立って明確にしておきます。ライブ当日、座長が過去の造影所見、CT 情報、さらには当日の造影における病変情報、側副血行路の解説、CT による病変情報、その他手技施行時の問題点（腎機能や左室機能、その他データ等）を参加者が把握できるように解説します。ときには、術者とは異なるストラテジーや手技を議論することもありますが、術者が患者に対し唯一責任を有する医師であることを認識し、合併症無く手技を成功に導くための術者のサポーターの一人としての役割を担っていただくこととなります。

コメンテーターも、座長と同様、術前に患者情報を把握し、座長とともに参加者に教育的な情報提供ができるような議論を展開する必要があります。術者の手技を円滑に進めるため、コメンテーターは術者との直接の議論は最小限にし、座長との討論を中心に行っていただきます。同じようなコメントの繰り返しは避け、参加者の知識向上に結びつくようなコメントを心がけていただきます。

カテ室内イメージングコメンテーターは、術者の次に現場の状況が把握できる存在であり、さらにストラテジーを左右するような情報発信ができる立場にあります。画像所見を通して会場や参加者に対し正確な情報提供を行い、さらに術者に対しては、画像所見からのアドバイスを伝え、常に手技をサポートする義務があります。

術者は CCT ライブデモンストレーションにおいては、主役ではありませんが、手技の基本について教育的な提示に努める必要があります。すなわち、自身で決定したストラテジーや手技中、術者しか知り得ない情報（使用デバイスや当該病変に対するガイドワイヤーの操作性など）に関して、患者さんの安全を確保し、手技への影響を最小限に抑えつつ、情報提供をする必要があります。また会場での議論が深まるよう、常に自身の決定したストラテジーを理論的に説明し、手技を継続していただきます。前述したとおり術者が患者さんに対し唯一責任を有する医師であることを認識し、他の意見を参考にすることがあっても、振り回されることは最大限避けるべきであり、患者さんの安全を第一に手技成功へ導く最大限の努力をすることを術者の責務といたします。

CCT Coronary ライブデモンストレーションの具体的な取り組みについて紹介させていただきました。上記 CCT policy に準拠したライブデモンストレーションを具現化していきたいと思いますので、ご協力いただければ幸甚です。

CCT 理事長　矢嶋 純二