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Friday, April 24, 2009   
Lessons from Four Late-Breaking Clinical Trials
Yesterday, there were 4 best abstract presentations at the Late-Breaking Clinical Trials session from 11:50 AM to 12:30 PM at the Main Arena.

Randomized Comparison of Primary Percutaneous Coronary Intervention with Combined Proximal Embolic Protection and Thrombus Aspiration versus Primary Percutaneous Coronary Intervention Alone in ST-segment Elevation Myocardial Infarction.
Dr. Karel Koch

Embolization during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) may result in microvascular obstruction, reduced myocardial per fusion, and impaired prognosis. Dr. Karel Koch from Academic Medical Center, University of Amsterdam, Netherlands, introduced a
novel approach of preventing embolization, the Proxis system (St. Jude Medical, St Paul, MN, USA), which combines proximal embol ic protect ion and thrombus aspiration during primary PCI.
Following urgent angiography, Dr. Karel Koch, et al, randomized 284 patients between pr imary PCI wi th the Proxis system or primary PCI alone. The primary endpoint was complete (70%) ST-segment resolution(STR),
evaluated in a blind-ed manner at an independent core laboratory.
Complete STR at time of last contrast occurred in 66% of patients receiving combined proximal embolic protection and aspiration and in 50% of control patients (absolute difference, 16.3% [95% confidence interval, 4.3% to 28.2%]; P=0.009).The difference between the 2 groups in the rate of complete STR was statistically significant. The mean percent STR at last contrast in both arms was also stat ist ical ly signi ficant ly different (73.2% vs. 63.4%, respectively; P=0.009) . A signi f icant ly lower STsegment curve areaI........
Case Presentation with Experts Review
This year, the Challenging case competition with experts' review session has more extended to give opportunities for physicians at the Coronary and Endovascular arena and will be held from 8:30 AM-4:30 PM on April 24 and there will be presented about 80 cases from all over the world.

A Retrograde Approach for the RCA CTO Lesion with Severe Calcification
Dr. Tadashi Kikuchi

A 52-year old male presented with a 1-month history of chest pain on effort. Echocardiography revealed normal left ventricular contractility without RWMA. Stress electrocardiography showed 2-3mm ST depression in leads V3 to V6 leads during low workload. Left coronary angiogram (LCA) showed a 90% stenosis of the mid LCX. Right coronary angiogram (RCA) showed 99% stenosis of the proximal RCA and CTO of the mid RCA with severe calcification, but with good collateral flow from the LAD. Dr. Kikuchi recommended CABG. The patient and his family however refused CABG. In order to overcome the severe LCX calcification, Rota-ablation was performed
with the 1.5mm burr. Pre-dilatation was performed with 2.5mm balloon, after which a Cypher stent (3.0X33mm; 20atm) was deployed in the calcified LCX lesion.
Seven days later, PCI for CTO of the RCA by antegrade approach; Rota wire was placed into the mid RCA. Rota-ablation to the proximal RCA was performed with 1.5mm
burr. Pre-dilation was performed with 2.5 X 15 mm Maverick, after which a Cypher stent (3.5 X 23 mm) was deployed at the proximal RCA lesion. Subsequently, antegrade CTO recanalization was attempted. But, an antegrade guide wire (Miracle 3g) was introduced into the subintima space. So the antegrade approach was abandoned and a
retrograde approach was tried.
PCI for CTO of the RCA by retrograde approach; A Fielder FC wire with microcatheter was successfully introduced into the distal RCA through the collateral channel between the septal branch and the RCA. The microcatheter was pulled......