DR. DEVANG M. DESAI DR. DEVANG M. DESAI D M (CARDIOLOGY); M D (MED ); D M (CARDIOLOGY); M D (MED ); D.M. (CARDIOLOGY); M.D. (MED.); D.M. (CARDIOLOGY); M.D. (MED.); FSCAI(USA); FCSI (INDIA); FACC (USA). FSCAI(USA); FCSI (INDIA); FACC (USA). INTERVENTIONAL CARDIOLOGIST / INTERVENTIONAL CARDIOLOGIST / INTERVENTIONAL CARDIOLOGIST / INTERVENTIONAL CARDIOLOGIST / CARDIOVASCULAR SPECIALIST CARDIOVASCULAR SPECIALIST DIRECTOR OF CARDIOLOGY DEPARTMENT DIRECTOR OF CARDIOLOGY DEPARTMENT - SHRI B.D. MEHTA MAHAVIR HEART INSTITUTE, SURAT. SHRI B.D. MEHTA MAHAVIR HEART INSTITUTE, SURAT. P P SAVNI HEART INSTITUTE SURAT P P SAVNI HEART INSTITUTE SURAT - HARIA L.G. ROTARY HOSPITAL, VAPI. HARIA L.G. ROTARY HOSPITAL, VAPI. [INDO AMERICAN CARDIOLOGY UNIT] [INDO AMERICAN CARDIOLOGY UNIT] - P. P. SAVNI HEART INSTITUTE, SURAT P. P. SAVNI HEART INSTITUTE, SURAT
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DR. DEVANG M. DESAIsummitmd.com/pdf/pdf/2010_Desai.pdfThe Ultimate Goal of the SYNTAX Score CreateCreate a aprospectiveprospective angiographicangiographic tooltool toto graderade
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DR. DEVANG M. DESAIDR. DEVANG M. DESAID M (CARDIOLOGY); M D (MED );D M (CARDIOLOGY); M D (MED );D.M. (CARDIOLOGY); M.D. (MED.);D.M. (CARDIOLOGY); M.D. (MED.);
CARDIOVASCULAR SPECIALISTCARDIOVASCULAR SPECIALISTDIRECTOR OF CARDIOLOGY DEPARTMENTDIRECTOR OF CARDIOLOGY DEPARTMENT
-- SHRI B.D. MEHTA MAHAVIR HEART INSTITUTE, SURAT.SHRI B.D. MEHTA MAHAVIR HEART INSTITUTE, SURAT.
P P SAVNI HEART INSTITUTE SURATP P SAVNI HEART INSTITUTE SURAT-- HARIA L.G. ROTARY HOSPITAL, VAPI.HARIA L.G. ROTARY HOSPITAL, VAPI.
[INDO AMERICAN CARDIOLOGY UNIT][INDO AMERICAN CARDIOLOGY UNIT]
-- P. P. SAVNI HEART INSTITUTE, SURATP. P. SAVNI HEART INSTITUTE, SURAT
C fli t f I t tC fli t f I t tConflicts of InterestConflicts of Interest
NoneNone
Treatment of Left main Bifurcation Treatment of Left main Bifurcation lesion using new NILE PAXlesion using new NILE PAX® ® Drug ellutedDrug ellutedlesion using new NILE PAXlesion using new NILE PAX®® Drug elluted Drug elluted bifurcation stent systembifurcation stent system
BACKGROUNDBACKGROUNDBACKGROUNDBACKGROUND8484 yearsyears malemale gentlemangentleman whowho isis havinghaving riskriskf tf t ff HTHT AA G dG dfactorfactor ofof HT,HT, Age,Age, Gender,Gender,Hypercholesteareamia,Hypercholesteareamia, NoNo DMDM admittedadmitted
ithith L ftL ft t i lt i l f ilf il ECGECG l dl dwithwith LeftLeft ventricularventricular failurefailure.. ECGECG revealedrevealedSignificantSignificant STST depressiondepression inin VV11 –– VV66 && ‘Q’‘Q’ii IIIIII ff E hE h h dh d LVEFLVEF 3535 %% RWMARWMAinin IIIIII avf,avf, EchoEcho showedshowed LVEFLVEF == 3535 %% RWMARWMA+,+, GradeGrade II MRMR.. CoronaryCoronary AngiogramAngiogram
l dl d L ftL ft ii di t ldi t l bif tibif ti l il irevealedrevealed LeftLeft mainmain distaldistal bifurcationbifurcation lesionlesioninvolvinginvolving CADCAD && LCXLCX originorigin.. PatientPatient waswasefe edefe ed fofo CABGCABGreferredreferred forfor CABGsCABGs..
The Ultimate Goal of the The Ultimate Goal of the SYNTAX ScoreSYNTAX Score
CreateCreate aa prospectiveprospective angiographicangiographic tooltool totogradegrade complexitycomplexity ofof coronarycoronary diseasediseasegg p yp y yy–– AA semisemi--quantitative,quantitative, visualvisual scorescore willwill helphelp
ObtainObtain evidenceevidence--basedbased guidelinesguidelines forfor selectingselectingl i til i ti t h it h i (( PCI)PCI)revascularizationrevascularization techniquetechnique (surgery(surgery oror PCI)PCI)
The SYNTAX Score will be retroactively weighted based The SYNTAX Score will be retroactively weighted based on MACCE at 1 and 5 years to optimize its prognosticon MACCE at 1 and 5 years to optimize its prognosticon MACCE at 1 and 5 years to optimize its prognostic on MACCE at 1 and 5 years to optimize its prognostic
valuevalue
SYNTAX S M h d lSYNTAX S M h d lSYNTAX Score MethodologySYNTAX Score Methodology
PriorPrior toto treatment,treatment, atat thethe locallocal HeartHeart TeamTeamff (( dd i t ti li t ti lconferenceconference (surgeon(surgeon andand interventionalinterventional
cardiologist),cardiologist), thethe SYNTAXSYNTAX ScoreScore waswasl l t dl l t d ff llll i ifi ti ifi t l il i iicalculatedcalculated forfor allall significantsignificant lesionslesions inin
TWO WIRE CROSS ACROSS TWO WIRE CROSS ACROSS DISTAL LAD & LCXDISTAL LAD & LCX
02 AVI
NILE PAX® STENT WITH 5 MARKERS NILE PAX® STENT WITH 5 MARKERS CROSS ACROSS LMCA CROSS ACROSS LMCA –– LAD LESIONLAD LESION
O3 AVI
22NDND MARKER WAS PLACED MARKER WAS PLACED AT THE LCX ORIGINAT THE LCX ORIGIN
O4 AVI
STENT DEPLOYED AT 15 STENT DEPLOYED AT 15 ATMOSPHERE PRESSUREATMOSPHERE PRESSURE
O5 AVI
33 XX 1515 MMMM PROXIMALPROXIMAL BALLOONBALLOON WASWAS CROSSEDCROSSEDININ LCXLCX SUCHSUCH AA WAYWAY THATTHAT PROXIMALPROXIMAL MARKERMARKERININ LCXLCX SUCHSUCH AA WAYWAY THATTHAT PROXIMALPROXIMAL MARKERMARKERMATCHESMATCHES 22NDND MARKERMARKER OFOF LMCALMCA –– LADLAD BALLOONBALLOON
O6 AVI
KISSING BALLON DILATATION KISSING BALLON DILATATION OF BOTH LAD & LCX ORIGINOF BOTH LAD & LCX ORIGIN
O7 AVI
RESULT AFTER KISSING RESULT AFTER KISSING BALLOONBALLOON
O8 AVI
RESULT AFTER KISSING RESULT AFTER KISSING BALLOON BALLOON
O9 AVI
LMCA bif ti t tiLMCA bif ti t tiLMCA bifurcation stentingLMCA bifurcation stenting
RESULTSRESULTSNILENILE PAXPAX®® PaclitaxelPaclitaxel ellutedelluted balloonballoonwithwith bifurcationbifurcation stentstent systemsystem allowedallowedwithwith bifurcationbifurcation stentstent systemsystem allowedallowedSimultaneousSimultaneous balloonballoon dilatationdilatation ofof sidesideb hb h [LCX][LCX] ith tith t di t tidi t ti ffbranchbranch [LCX][LCX] withoutwithout distortiondistortion ofofstentstent wirewire structurestructure.. ThisThis resultedresulted ininsmoothsmooth resultresult ofof kissingkissing postpost stentstentballoonballoon dilatationdilatation && TIMITIMI 33 flowflow ininballoonballoon dilatationdilatation && TIMITIMI 33 flowflow ininbothboth vesselsvessels..
FOLLOWUP ANGIO AFTER FOLLOWUP ANGIO AFTER 6 MONTHS.6 MONTHS.
ADVANTAGESADVANTAGES OFOF NILENILE PAXPAXSTENTSTENT [d di t d[d di t d bif tibif tiSTENTSTENT [dedicated[dedicated bifurcationbifurcationStentingStenting]]StentingStenting]]EASEEASE ofof performanceperformance ourour procedureprocedure waswas
l t dl t d ii h th t i di dcompletedcompleted inin shortshort periodperiod..NoNo needneed toto recrossedrecrossed wirewire inin bifurcationbifurcation lesionslesionsControlledControlled kissingkissing balloonballoon dilatationdilatation ofofbifurcationbifurcation lesionlesion resultingresulting inin lessless andand uniformuniformggmetalmetal structurestructure atat carinacarina..ThisThis mightmight reducereduce MACEMACE afterafter bifurcationbifurcationThisThis mightmight reducereduce MACEMACE afterafter bifurcationbifurcationstentingstenting andand improveimprove resultsresults.. YetYet largelargerandomisedrandomised trialstrials areare requiredrequired toto proveprove thisthisrandomisedrandomised trialstrials areare requiredrequired toto proveprove thisthisbenefitbenefit..