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European Bifurcation Club Update and Provisional S ...
Discussion: Part 1
Discussion: Part 1
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Video Transcription
<v ->Thank you so much, Azeem.</v> So I'm going to invite Yves to co-moderate this with me. Both Yves and, and Francesco, if you have any comments on the before we go into the cases about these two publications that we are both part of. And, and John please choose one or two questions to ask. Okay. Go ahead. Either or Francesco, whoever wants go first. <v ->Franscesco.</v> <v ->So on, on my side</v> I think that Azeem really summarized the concept. His final advices are those that are shared by the BBC group. That is mainly let's try to prevent trying to have the sequences of procedures that are anticipated to have higher chances of success. And in the case something got wrong during our procedure we should, we should understand what's going wrong before reacting. Most of the time the link between understanding and properly reacting comes from imaging. So this is probably the only thing I can add. I mean, on the basis of bench test, everything is clear. However, we should now having in mind all the tests all the examples that Azeem has summarized and that can be found into the PC consensus documents. We should really rely using the imaging modalities inside our cath lab and what's going wrong? And I was and those CT are those that are routinely advocated. Honestly, I think that sometimes also looking carefully at angiography, for example using stent magnifications tool like stent be or stent boost can sometimes be very efficient. So we should really select according to the ability we have and capability we have at that time. <v ->Yves any comments</v> or should we just wait for the chat question? <v ->Oh, just, just about, the makings.</v> So in my country we are using minimal amount of imaging and this is related to the fact that we are not, we have not yet reimbursed. I understand from the government that we have reimbursement if we have a randomized trial proving that this is better to use to use emerging instead of RG only. So this explain why for, during the during all these years, we were we trying to develop alternative way to analyze the picture. It was one was was said by by Francesco is stent announcement. Also trying to calculate the diameter when using the formulas, the fitness formulas of MRI to know what will be the optimal optimal diameter of any segment. So this and many other topics. So I think objectively I learn a lot of things doing imaging also bench also simulation. We, we, when we are working on a patient we can have this in your in your mind and use all this demonstration like what was done in Minneapolis. All this demonstration have very important to to take decision even if you don't use imaging. But this year maybe we'll have an answer about this. <v ->The good news</v> in the US we're actually reimbursed for imaging now. So we are doing more imaging now in our cases. John, one or two pertinent questions. Audience, we can't answer all questions but we'll try to finish out the ones we think of pertinent. Go ahead John. <v ->Yeah, thanks Dr. Rab. So there chat is pretty active</v> with some some practical questions. The first being, how do you manage your side branch wire after a high pressure pot? And are you ever having problems with that being jailed or unremovable? And the other is do you have a specific stent brand choice when you're using a provisional strategy? <v ->I can answer on the wire.</v> It's also recommended in a in a previous consulted site, I think by by Francesco is recommended to use hydrophilic wire which is even jailed. They can be removed without damage. And Manuel Pan in Spain has shown damaged on non hydrophilic wire. When they are jailed, they're really strongly in the same hydrophilic... Keep in your mind that these wires also can be dangerous. So keep them in the regular field. <v ->If, if I can add something</v> there are some tricks that can be applied in order to make gel wire technique a little bit safer. In particular, we should, when we perform a POT it is exactly the time in which the the wire really become entrapped potentially. So this is important. It is important not to have the wire relying very distal. So keep attention at the tip of the wire at in the moment of final drilling with the POT. And also most of the time you may pull a little bit in order to avoid that there is any wrapping around the stent. So these are, I mean, something, some I mean a specific trick that can make jailed wire honestly very safe. Finally, I mean, a POT cannot can also be performed stepwise. I mean if you have a specific lesion and you are afraid about entrapping the wire, the wire between calcium and understand you may avoid the perform high pressure POT since the beginning. And you have also the possibility to optimize at the end of the procedure by re-POT the after running wired luminary instead of having the dread wire.
Video Summary
In this video, Azeem, Yves, Francesco, and John discuss various aspects of medical procedures and the importance of imaging in cath labs. They emphasize the need to prevent complications and understand the reasons behind any errors. They suggest using imaging modalities like CT and angiography, as well as tools like stent magnification, to enhance diagnostic capabilities. Yves mentions the minimal use of imaging in their country due to reimbursement issues, while John mentions that the US now allows reimbursement for imaging. The video also addresses questions about managing side branch wires and stent brand choices. They provide tips for safely performing high-pressure post-dilation and suggest a stepwise approach to avoid wire entrapment between calcium and stents.
Keywords
medical procedures
imaging
cath labs
complications prevention
CT
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