Ep. 17 Update in Intravascular Imaging for Optimal PCI with Dr. Erik Rafflenbeul

Intravascular imaging can provide invaluable intel on the coronaries, with OCT supplying bright ideas and IVUS giving sound judgement. Light-based and soundwave-based, respectively, mastery of these two imaging modalities can help you streamline routine PCI cases and overcome challenging ones. In this episode of BackTable Cardiology, the esteemed Dr. Erik Rafflenbeul from Schön Klinik in Hamburg, Germany joins host Dr. Hady Lichaa from Tennessee’s Ascension St. Thomas Heart to discuss intravascular imaging techniques for percutaneous coronary interventions. --- SYNPOSIS The conversation covers a wide range of topics, including the importance and benefits of using intravascular imaging, the differences and applications of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) systems, recent intravascular clinical studies to know, and practical aspects of integrating these technologies into daily practice. Dr. Rafflenbeul emphasizes the value of proactive imaging and shares comprehensive insights for both seasoned and early-career interventional cardiologists. --- TIMESTAMPS 00:00 - Introduction03:52 - Current State of Intravascular Imaging in Germany and Europe05:26 - Importance of Intravascular Imaging in PCI09:08 - Challenges and Adoption of Intravascular Imaging13:30 - IVUS vs. OCT: Which to Choose?17:06 - Practical Insights on IVUS and OCT Systems28:50 - Pre-Procedural Measurements and Techniques30:36 - Choosing Stent Diameters32:22 - Practical Aspects of Stenting36:40 - Post-PCI Assessment and Algorithm40:35 - Recent Intravascular Imaging Studies43:07 - Case Studies and Practical Tips47:16 - Advice for Early Career Interventionalists 51:54 - Concluding Thoughts and Wisdom --- RESOURCES Dr. Hady Lichaahttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Erik Rafflenbeulhttps://www.pcronline.com/Physicians/Erik-Rafflenbeul European Association of Percutaneous Cardiovascular Interventions (EAPCI)https://www.escardio.org/Sub-specialty-communities/European-Association-of-Percutaneous-Cardiovascular-Interventions-%28EAPCI%29# Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Diseasehttps://www.jacc.org/doi/10.1016/j.jacasi.2022.12.009#:~:text=The%20OPTIVUS%20(Optimal%20IntraVascular%20Ultrasound)%2DComplex%20PCI%20study,infarction%20*%20Stroke%20*%20Any%20coronary%20revascularization Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysishttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02454-6/abstract Orbital Atherectomy vs. Conventional Balloon Angioplasty in Severely Calcified Coronary Arteries Prior to DES Implantation - ECLIPSEhttps://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2024/10/25/04/32/eclipse A Revised Optical Coherence Tomography–Derived Calcium Score to Predict Stent Underexpansion in Severely Calcified Lesionshttps://www.sciencedirect.com/science/article/abs/pii/S193687982401817X#:~:text=Lesions%20with%20severe%20calcium%20as,higher%20risk%20for%20stent%20underexpansion. Intravascular Imaging vs Angiography Guidance for PCI of Severely Calcified Lesions: The ECLIPSE Trialhttps://pubmed.ncbi.nlm.nih.gov/41093451/#:~:text=The%20primary%20clinical%20outcome%20was,tomographic%20guidance%20and%20IVUS%20guidance. Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents - ADAPT-DEShttps://www.acc.org/latest-in-cardiology/clinical-trials/2012/10/25/11/12/adapt-des