The speaker from Johns Hopkins University School of Medicine and Frederick Health Hospital discusses what to do with side branches during PCI in a 50-year-old woman with hypertension, presenting with classic angina symptoms and anterior ischemia. The provisional stenting approach in the mid LED segment of the LAD is planned, but there is a dilemma on whether to wire the diagonal branch. The speaker provides personal rules of thumb for when to wire or leave the side branch alone, and cites evidence supporting these rules. The speaker also presents a recent study discussing benefits of wiring the side branch in particular instances. The case leads to the observation that the benefit of wiring the side branch is amplified: when the main and side branches have stenosis of 60% or more, the side branch is at a higher risk of occlusion if the side branch is not wired, and the lesion in the main branch is longer than 10mm at the bifurcation.
Sure, here are the key facts extracted from the provided text:
1. The speaker is Charlie Huang from Johns Hopkins University School of Medicine and Frederick Health Hospital.
2. The discussion is about what to do with side branches during PCI (Percutaneous Coronary Intervention).
3. The case involves a 50-year-old woman with hypertension and angina symptoms.
4. The RCA (Right Coronary Artery) is small and non-dominant, and the Circumflex artery has mild disease.
5. There are two severe lesions in the mid LED (Left Anterior Descending) artery.
6. The decision is made for provisional stenting for the mid LED.
7. The dilemma is whether to wire the diagonal branch.
8. There are benefits to wiring side branches, including preserving access and marking their position.
9. Dissecting side branches is a common drawback.
10. The decision to wire a side branch depends on its size, the presence of osteo stenosis, and the complexity of the main branch lesion.
11. There's a retrospective study from 2022 showing the likelihood of side branch occlusion when wired or not in bifurcation cases.
12. Wiring the side branch is beneficial when the main branch has more than 60% stenosis at the bifurcation.
13. Lesion length of the main branch also plays a role in the decision to wire the side branch.
14. The speaker provides several take-home messages regarding when to wire side branches during PCI.
These are the factual points extracted from the text without including opinions or interpretations.