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April 26, 3:00 pm ~ April 27

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The most prominent faculty of the ANGIOPLASTY SUMMIT-TCTAP 2010 will share their experience and opinion in the interventional vascular field.

Bernard Chevalier, MD
Institut cardio-vasculaire Paris-Sud, France

Q > 1. Cardiologists are looking forward to seeing next generation DES with biodegradable polymer. Would you tell us about the strength of bioresorbable PLA and biolimus A9 polymers which have been used in Nobori Biolimus A9-eluting stent?
  2. NOBORI 1 follow-up data have demonstrated that Nobori stent is not inferior to Taxus Express and Liberte stent especially in regard to restenosis and late stent thrombosis rate. Do you have more updated data regarding NOBORI 1 trial?
  3. Cardiologists have high expectations with DES using biodegradable polymer. Do you think biodegradable DES including NOBORI stent would succeed in the future?
  4. Clinical trials such as BBC-ONE and CACTUS have been presented. Based on these trials, what do you think is the optimal treatment strategy for bifurcation lesions?

Antonio Colombo, MD
EMO Centro Cuore Columbus, San Raffaele Hospital, Italy

Q > 1. Would you tell us about your tips and tricks for side branch coronary intervention?
  2. Simple stenting strategy showed better results than two stent technique in CACTUS and BBC ONE trials. When do you think we should use two stent technique in patients with bifurcation lesion?
  3. Side branch kissing balloon dilatation did not improve the outcomes in one-stent approach of NORDIC Bifurcation study III. What do you think about this result?
  4. Do you think using IVUS in bifurcation stenting would improve clinical outcomes?

Alain G. Cribier, MD
Hôpital Charles Nicolle, France

Q > 1. Edwards SAPIEN XT transcatheter valve obtained CE mark last month. Would you explain about the improvement in Edwards SAPIEN XT transcatheter valve when compared to the old version?
  2. As delivery catheter size decreases in trans-femoral TAVI, more cardiologists prefer trans-femoral approach. What do you think about the role of trans-apical TAVI?
  3. As more clinical trials progressed from REVIVE study to SOURCE registry, success rate increased and mortality rate decreased. Would you tell us about the PARTNER US study and your expectations from that study?
  4. TAVI has been performed mostly in Europe and in the US. Since the learning period is relatively long, many cardiologists undergo trial and error. What do you think about making a well-organized training program to reduce the learning curve?

Donald E. Cutlip, MD
Beth Israel Deaconess Medical Center, USA

Q > 1. What are your indications for using DES instead of BMS in patients with STEMI?
  2. From SIRIUS, TAXUS IV, and ENDEAVOR trials, we also found patients with very late stent thrombosis after BMS implantation. What is your long-term anti-platelet treatment strategy for patients with BMS implantation?
  3. Anti-platelet drug dose and duration has been an issue after coronary stenting. What is your dual anti-platelet treatment dose and duration for patients after either BMS or DES implantation?
  4. Would you tell us about the ongoing dual-antiplatelet trial in the US?

Stephen G. Ellis, MD
The Cleveland Clinic Foundation, USA

Q > 1. Could you please tell us the result and its clinical implications of FINESS trial?
  2. Even though the FINESSE trial has not shown any advantages of facilitated reperfusion over PCI alone, there is some intriguing data to suggest a possible benefit of lytic and abciximab combination therapy in the high risk groups. Do you have any plans of study for facilitated PCI trial again in high risk patients?
  3. In TRANSFER-AMI trial, the result has shown that transferring STEMI patients for PCI within 6 hours of receiving thrombolysis is superior to standard wait-and-see strategy. Considering the ASSENT-4 trial which was stopped early with high mortality after treated with PCI too soon after thrombolysis, what do you think is the ideal window time to do PCI after thrombolysis?
  4. As much as the research for which drug regimen is better, it would also be important to set up the efficient system which can minimize door-to-balloon time, transferring AMI patients to PCI hospital. Could you please introduce the emergency system in Cleveland, Ohio where you work?

William F. Fearon, MD
Stanford University Medicine Center, USA

Q > 1. In the TCT 2009 meeting, you presented 2-year data on FAME trial. Could you please make a brief comment on the result of FAME trial?
  2. Over the past few years, FFR use has been rapidly increasing. Based on the result of FAME trial, FFR guided PCI showed good outcome. But still it is not clear which lesion should we use FFR. Could you please tell us the indication of FFR?
  3. If there are any potential pitfalls to pay attention in the use of FFR, please let us know about it.
  4. There are two FDA approved FFR guide wires, that is St.Jude and Volcano. The cost of each guide wire is 600$ which is somewhat expensive. What do you think about the cost effectiveness of FFR?

William A. Gray, MD
NewYork-Presbyterian Hospital, CUMC, USA

Q > 1. Could you please tell us the result of EVEREST II trial briefly and its clinical implication?
  2. According to statistics of United States, only 20% of patients with significant mitral regurgitation actually undergo surgery, with most being managed medically. Do you expect clip device will be therapeutic option in the future which can replace surgery in the severe MR?
  3. Increasingly, Endovascular repair has been doing as a treatment option for AAA in Asia, even though the cases are relatively small compared to western countries. Could you please give any tips of your own for successful procedure of EVAR?
  4. Gradually, endovascular treatment technique and devices for the below knee lesion has been improved. Could you please tell us several options of endovascular treatment for the below knee lesion? And are there any current ongoing endovascular clinical trials for this lesion?

Eberhard Grube, MD
Elisabeth Hospital Heart Center Rhein-Ruhr, France

Q > 1. Based on Siegburg Core Valve experience, 30-day mortality rate dropped from 40% in 2005 to 4.8% in 2008. What is the secret behind this reduction in mortality rate?
  2. Experience is extremely important in successful TAVI procedures. What do you recommend to many interventional cardiologists in order to reduce the learning curve?
  3. Patient selection is also important in successful TAVI procedures, and aortic valve with severe calcification is considered unsuitable for TAVI. What do you think is the acceptable aortic valve calcification level for TAVI?
  4. Since the introduction of CoreValve in 2004, many clinical trials are ongoing right now. With respect to the PARTNER US trial with Edward valve, do you have plans for a randomized controlled trial for CoreValve?

Larry F. Hamm, MD
The George Washington University Medical Center, USA

Q > 1. Many interventional cardiologists have a great interest in the revascularization itself, but not in the cardiac rehabilitation fields. Could you please tell us what is your opinion on this issue?
  2. In the real world, it is not easy to apply and maintain rehabilitation program to the patients with the matter of cost. Do you have a good way to overcome this problem?
  3. What do you think is the role of rehabilitation in the patients of peripheral artery disease?

Ziyad M. Hijazi, MD
Rush University Medical center, USA

Q > 1. Percutaneous pulmonary valve implantation has not been popular until now. Could you please tell us the indication of percutaneous pulmonary valve implantation? Most patients needed this procedure are children, because most pulmonary valve diseases are congenital disease. For the delivery system of these valves, do you have any criteria in terms of body weight?
  2. Currently, MELODY and SAPIEN valves which got CE approval are under clinical study. Could you please tell us what are the differences between these two valves and how many patients have got this procedure until now?
  3. What do you think about the merits of hybrid procedure in congenital heart disease? Could you please tell us your experiences of hybrid procedure? What patients were operated with this?
  4. It seems that there would be many problems in the case of post infarct VSD with percutaneous closure. For successful procedure, the sufficient rim of tissue will be needed and sometimes device could be migrated by expanding of infarction territory. Do you have any indications for successful device closure in the patients of post infarction VSD?

David Richard Holmes, MD
Mayo Clinic, USA

Q > 1. Even though PCI has been rapidly advanced, current guideline in the treatment of multi-vessel and LM disease is CABG, so far. Could you please give us your opinion in which cases PCI can be replaced to CABG in multi-vessel and LM disease?
  2. Could you please tell us your views on optimal timing of angioplasty in NSTEMI patients?
  3. The number of Diabetes patients is steadily increasing and is predicted to be double within 20 years. Could you please tell us the result of BARI-2D trial? And what do you think the clinical implication of this trial?
  4. As shown in BARI 2D trial, the number of distal anastomoses per patient in the CABG was 3 versus 1.5 in the PCI. How important is this difference and do you think this difference might have given any influence on the result?
  5. Please comment briefly on the ongoing FREEDOM study. What other results can be (more) expected compared to BARI-2D trial?

Adnan Kastrati, MD
Deutsches Herzzentrum München, Germany

Q > 1. After widespread use of DES in recent years, stent thrombosis has emerged as a clinical issue. Do you think second generation DES such as Endeavor and Xience are safer than first generation DES such as Cypher and Taxus?
  2. ISAR-DESIRE 2 trial has been presented recently. Would you tell us more about the results?
  3. Clinical trials using GP IIb/IIIa inhibitors in STEMI patients have been presented recently. Do you think that GP IIb/IIIa inhibitors should be used in all STEMI patients? And which GP IIb/IIIa inhibitors should be used in STEMI patients?

John R. Laird, Jr., MD
UC Davis Medical Center, USA

Q > 1. You will give a lecture on ¡®multi-point lessons for successful sub-intimal angioplasty in SFA CTO¡¯. Could you share any tips of your own for successful endovascular treatment of SFA- CTO?
  2. Could you please give us some tips on the treatment of complex arch and carotid anatomies during carotid artery stenting?
  3. Even though EVAR has been proven as an effective and safe treatment of option in AAA, several problems still remain which have not been solved yet. Among them, Endoleak after EVAR have been reported up to 10-50%. Do you have life-long surveillance strategies to prevent and to early treat for this problem?

Martin B. Leon, MD
NewYork-Presbyterian Hospital, CUMC, USA

Q > 1. Many interventional cardiologists and surgeons are waiting for the result of PARTNER trial with Edward Sapien valves. Could you please introduce the PARTNER, U.S. trial to us? How do you expect the result of study would be and when could we get the results?
  2. According to PARTNER, EU and SOURCE registry, trans-catheter Edward valves implantation to the patients with high surgical risk have been shown good clinical outcomes until now. At the CRT meeting in this year, experts agreed that this percutaneous procedure could be eventually be used in patients with lower surgical risk. Do you have any plan of clinical study with lower surgical risk patients?
  3. How do you expect that the way TAVI will evolve into? And do you think that it will be possible in the future that TAVI will be the first-line treatment option of aortic replacement?
  4. In recent years, DES has been developed very rapidly and also, new technical trials are ongoing now. Which way do you think the DES would grow into in the future and how do you expect the clinical results would actually influence the real practice?

Roxana Mehran, MD
NewYork-Presbyterian Hospital, CUMC, USA

Q > 1. While being concerned with the safety of DES, the introduction of new anti-platelet agent like Prasugrel and Ticagrelor is a very good news to cardiologist. Could you please tell us how do you expect these drugs will change treatment strategy of PCI with DES?
  2. Last year, FDA raised serious concerns that Prasugrel heightened mortality in the patients with NSTE ACS. They reported that there were several shortcomings with TRITON trial. What are your views on this matter?
  3. Even though high proportions of CKD patients have coronary disease in the real word, there had not been many data of the renal impairment patient subset because these patients were usually excluded in coronary artery disease clinical trials. Could you tell us clinical studies on renal impairment patients till now? And are there any other plans of clinical trials for CKD subset?
  4. Many clinical trials are now actively going on in many Asian countries including South Korea. Is there anything to be improved and asked about? We’d appreciate your valuable advice or comments to improve the quality of the trials.

Bernhard Meier, MD
Swiss Cardiovascular Center Bern, Switzerland

Q > 1. Short-term complication rate was higher in Watchman group than warfarin group in PROTECT-AF trial. How can we reduce the learning curve for LAA closure procedure?
  2. Do you think left atrial appendage closure would be the first-line therapy in patients with no valvular atrial fibrillation?
  3. What are the advantages of using Amplatzer cardiac plug when compared to Watchman system?
  4. The results of Amplatzer cardiac plug trial will be presented soon. Would you tell us about the trial design and background?
  5. Who will and who should perform LAA closure among interventional cardiologists and electrophysiologists?

Gary S. Mintz, MD
Cardiovascular Research Foundation, USA

Q > 1. What are the imaging tools which have been proven to optimize PCI outcome? And please also explain the invasive and non-invasive imaging tools which are expected to be the next generation imaging technique.
  2. These days left main coronary artery (LMCA) intervention is gradually getting better evidences as a treatment option. Please tell us what is the IVUS criteria of significant stenosis which needs PCI in LMCA? And what is the role of IVUS during LMCA intervention?
  3. What do you think the role of IVUS to evaluate the mechanism of ISR? Could you explain about the predictors of IVUS findings which can make more ISR and please recommend the IVUS criteria to reduce ISR?
  4. PROSPECT study has recently published and the result of the study is very exciting. However, it is not easy when it comes to applying this result to a real practice. In case we find the vulnerable plaque in non-culprit lesion, should we treat them to prevent future cardiovascular events? Do you have any treatment strategy on this case?

Marie-Claude Morice, MD
Institut Hospitalier Jacques Cartier, France

Q > 1. Would you tell us more about SYNTAX 2-year follow-up data?
  2. In spite of SYNTAX trial, the standard treatment of left main disease is considered to be bypass surgery. With regard to LM disease patients, why do you think that interventional cardiologists should discuss the treatment options with the cardiac surgeons?
  3. What do you expect from currently ongoing EXCEL trial?

Nicolaus J. Reifart, MD
Main Taunus Heart Institute, Germany

Q > 1. Euro CTO club has presented excellent data recently. Would you tell us about future research issues in Euro CTO club?
  2. Patient selection is one of the most important factors in successful CTO intervention. Would you tell us about favorable anatomical factors for easy collateral channel crossing in retrograde approach?
  3. CART (controlled anterograde and retrograde subintimal tracking) registry has been presented recently, and what do you think about the efficacy and safety of bilateral approach in CTO intervention?
  4. Would you please tell us about new techniques and new devices for CTO intervention?

Dierk Scheinert, MD
Heart Center Leipzig, Germany

Q > 1. Bypass surgery has been regarded as the standard treatment for critical limb ischemia. What are the indications for endovascular revascularization in patients with critical limb ischemia?
  2. Common femoral artery (CFA) is important since it supplies blood to entire lower extremity, and what is your treatment strategy for patients with symptomatic common femoral artery stenosis?
  3. Not many clinical trials have been conducted regarding patients with below knee diffuse stenosis. Do you think DES or drug eluting balloon could be a treatment option in these patients?
  4. Do you have any experience with transpedal or transcollateral approaches as alternative access techniques in patients with below knee stenosis?

Horst Sievert, MD
Sankt Katharinen Hospital, Germany

Q > 1. In comparison to conventional PFO closure devices, what are the advantages of using in-tunnel PFO closure device?
  2. Recently presented Migrane Intervention with Starflex Trial (MIST) revealed that PFO closure has no effect on reducing headache frequency. What do you think about this result?
  3. Radiofrequency application or bio-absorbable device could be a new treatment option for PFO closure in the future. What do you think about these new treatment options?
  4. Since you have started percutaneous LAA occlusion in 2001, many clinical trials such as PROTECT AF trial have been conducted. Watchman device has been demonstrated to be non-inferior to warfarin therapy regarding safety and efficacy. Since there are wide variations in LAA morphology, how do you select your patients for percutaneous LAA occlusion?

Gregg W. Stone, MD
NewYork-Presbyterian Hospital, CUMC, USA

Q > 1. In comparison to previous left main clinical trials such as MAIN-COMPARE and SYNTAX, what is the purpose of EXCEL trial?
  2. Would you tell us about the clinical design of EXCEL trial?
  3. Would you tell us about the results of PROSPECT study? And what are the IVUS findings for vulnerable plaque which increases cardiovascular event rate?
  4. How can we apply the results of PROSPECT trial into real clinical practice? Do you think we need to perform routine three-vessel invasive imaging screening? How do you treat vulnerable plaque in non-culprit lesion?

David Paul Taggart, MD
University of Oxford, United Kingdom

Q > 1. Many registry data and randomized clinical data regarding multi-vessel coronary disease have been published. At least 15 trials showed that PCI was not inferior to bypass surgery in patients with multi-vessel disease. In what patient population should we recommend bypass surgery instead of PCI?
  2. Why do you think bypass surgery has superior survival benefit than PCI?
  3. Recently published BARI 2D trial revealed that there was no mortality difference between bypass surgery and PCI. What do you think about the result?
  4. Please tell us about the multi-disciplinary team approach system in your hospital for patients with multi-vessel coronary disease or left main disease.

Paul S. Teirstein, MD
Scripps Clinic & Research Foundation, USA

Q > 1. Even though PCI has been rapidly developing, current guideline in the treatment of multi-vessel and LM disease is CABG, so far. Could you please tell us your opinion in which cases PCI can be replaced to CABG in multi-vessel and LM disease?
  2. Last year the meta-analysis which compared 5-year mortality of CABG and PCI in multi-vessel disease patients was published in the Lancet. (by Dr. Mark Hlatky, Stanford University). From the result, CABG showed better outcome for older patients over 65 years-old. But we should be cautious to apply this result to real practice because the population over 75 years old was less than 5%. What are your treatment options for over 75 years-old patients?
  3. After development of DES, efficacy and safety is getting improved very fast. But safety is emerging as a major issue such as stent thrombosis. Could you please tell us your perspectives how we can solve this problem in the future?
  4. Anti-platelet treatment is another important factor for DES safety. Currently there is ongoing large clinical trial ¡®DAPT¡¯, do you think the result of this study will give us the appropriate guideline for anti-platelet treatment?
  5. I know that you are currently carrying out the clinical research, SEASIDE trial which evaluate DAPT for 6 months to the patients treated with Endeavor stent. Could you please give your views on individualized anti-platelet therapy?

Renu Virmani, MD
CV Path Institute, Inc., USA

Q > 1. As DES is being widely used, safety issue is considered the most important in the field of interventional cardiology lately. From a pathologist's perspectives , Which point you are skeptical about? And What is your point of view about the safety of the 2nd generation DES like Endeavor?
  2. Please tell us in order to improve safety of DES, in what ways should those DES factors like stent platform, polymer, drugs be developed?
  3. In the case of biodegradable NOBORI stent, on which you have been researching lately, what kind of result does it show on pathology?
  4. Could you please tell us the merits of the platinum-Chromium alloy, the new stent platform and the pre-clinical data up to now?

Ron Waksman, MD
Washington Hospital Center, USA

Q > 1. The one of the major talking point in interventional cardiology is to develop an ideal stent with rapid vascular healing and low re-stenosis rate. Do you expect Nanoparticle DES to play such a role as an ideal stent?
  2. As you know, how to control glucose in hyperglycemic AMI patients has always been a concern to physicians. However, unlike to expectation, NICE-SUGAR study recently published that there was not any benefit with intensive glucose control compared to conventional control. Could you please share your perspectives about how we could apply this result to a real practice?
  3. Interventional cardiologists have been gradually expanding their territory in the fields of structural heart disease. Which way do you think the structural heart disease intervention would grow into?
  4. As a chairman of CRT which is one of the most important interventional cardiology associations in U.S, please give us your valuable comments or advices for TCT-AP.