Webinar 1 | Bifurcation Imaging-Webinar 1

Video Transcription

Video Summary

The webinar focused on <strong>bifurcation PCI and the role of intravascular imaging</strong>. Dr. Arasi Moran emphasized that angiography alone often misclassifies bifurcation anatomy and plaque location, and that <strong>IVUS helps determine whether a provisional single-stent strategy or a two-stent strategy is needed</strong>. She explained that most bifurcations should be treated provisionally, while true complex lesions with long, severe side-branch disease may require a planned two-stent approach such as <strong>DK crush</strong>. Her case illustrated how IVUS guided vessel sizing, lesion assessment, and strategy selection in a calcified distal left main bifurcation. She also discussed when <strong>drug-coated balloons</strong> may be reasonable in side branches.

Dr. Daniel Shami presented several <strong>OCT-guided bifurcation cases</strong>, showing how OCT can define plaque morphology, carina behavior, stent sizing, and landing zones. His cases highlighted how side-branch compromise may result from <strong>carina shift or plaque shift</strong>, and how 3D OCT reconstruction can help decide whether further kissing balloon inflation or a second stent is truly needed. He also shared a learning case where a vessel fold-over (“accordion phenomenon”) mimicked disease and led to unnecessary ballooning and dissection.

Dr. Megha Prasad concluded with an <strong>ultra-low/near-zero contrast PCI</strong> case in an elderly patient with CKD and complex left main trifurcation disease. She reviewed how contrast harms the kidneys, described strategies to minimize contrast use, and demonstrated a workflow using hemodynamic assessment, IVUS guidance, atherectomy, careful stent placement, and final kissing balloon inflation. Her case underscored the importance of vigilance for non-angiographic signs of instability, and the value of imaging in high-risk, kidney-sparing PCI.

Asset Caption

closed captions are computer-generated

Keywords

bifurcation PCI

intravascular imaging

IVUS

OCT-guided bifurcation

provisional stenting

two-stent strategy

DK crush

drug-coated balloons

carina shift

near-zero contrast PCI