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TCTAP 2025

Novel Insights of Preventive PCI for Non-flow-limiting Vulnerable Plaques

Seung-Jung Park Asan Medical Center, Korea (Republic of) A recent PREVENT trial suggests that local modification of vulnerable plaques provides additional efficacy with systemic treatment. This multicenter, open-label, randomized trial enrolled a total of 1,606 patients with non-flow limiting (fractional flow reserve > 0.80) vulnerable coronary plaques identified intracoronary imaging, randomly assigning them to either preventive percutaneous coronary intervention (PCI) plus optimal medical treatment or optimal medical treatment alone. The primary outcome was a composite of death from cardiac cause, target-vessel myocardial infarction, ischemia-driven target-vessel revascularization, or hospitalization for unstable or progressive angina at 2 years (Figure 1). Figure 1. In the PREVENT trial, local preventive PCI combined with optimal medical treatment results in a lower incidence of major adverse cardiac events compared with OMT alone in patients with non-flow limiting vulnerable plaques (Figure 2). These findings are particularly significant in lesions with a higher degree of angiographic diameter stenosis (DS, DS ≥ 55%) and lipid-rich plaques (maxLCBI4mm>315). Preventive PCI using current drug-eluting stents is sufficient to reduce the primary composite outcomes. Although bioresorbable vascular scaffolds demonstrate a significant preventive effect at 2 years, this benefit diminishes during long-term follow-up. Concomitant preventive PCI for non-target vessel PCI may improve short- and long-term clinical outcomes (Figure 3). Figure 2. Figure 3. These key findings provide novel insights into the potential benefits of preventive PCI for non-flow-limiting vulnerable plaques. The addition of PCI to optimal medical therapy significantly reduces major adverse cardiac events, particularly in patients with high-risk plaque features. The effectiveness of preventive PCI is further enhanced by careful patient selection based on imaging and lesion characteristics. These results support a personalized approach to managing coronary artery disease beyond traditional flow-based assessments. Vulnerable Plaque Treatment 2025 Friday, April 25, 10:00 AM-11:20 AM Coronary Theater, Level 1 Check The Session

April 25, 2025 259

TCTAP 2025

Interventional Cardiology at Crossroads: A Bright Future of Collaboration; From Intervention to Prev...

Roxana Mehran Icahn School of Medicine at Mount Sinai, USA As the recipient of the 15th TCTAP Master of the Masters Award, Roxana Mehran, MD (Icahn School of Medicine at Mount Sinai, USA), delivered a message on the transformative future of interventional cardiology—one defined not only by technical excellence in the cath lab but also by long-term, personalized prevention and cross-disciplinary collaboration. Despite significant declines in coronary artery disease (CAD) and myocardial infarction (MI) mortality over the past two decades (Figure 1), cardiovascular disease remained the leading global cause of death. Figure 1. Declining mortality trends in CAD and MI (2000-2025), reflecting gains through procedural, pharmacological, and preventive approaches. Residual Risk: The Next Frontier Post-PCI patients often face continued risk despite successful revascularization. These residual risks fall into three main categories—thrombotic, inflammatory, and metabolic. Thrombotic risk will demand precision beyond standard dual antiplatelet therapy (DAPT). AI-guided tools and individualized strategies will help balance bleeding and ischemic profiles. Novel anticoagulants targeting Factor XI may offer effective protection with lower bleeding risk. Inflammatory risk will gain prominence as trials such as CANTOS and ARTEMIS reinforce the role of cytokines in atherothrombosis. High-sensitivity CRP will guide risk assessment, and therapies targeting IL-1β and IL-6 will likely be integrated into long-term management of high-risk patients. Metabolic risk will remain multifaceted. LDL-C will continue as a key target, with inclisiran and PCSK9 inhibitors offering sustained control. A new focus on lipoprotein(a) will emerge with RNA-based therapies under investigation in the HORIZON and OCEAN(a) trials. The role of metabolic agents—such as SGLT2 inhibitors, GLP-1 receptor agonists, and tirzepatide—will expand significantly, demonstrating cardiovascular benefits even in non-diabetic populations. Imaging-Driven Precision Future care will rely heavily on advanced imaging for diagnosis and treatment planning. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) will be standard in PCI for optimizing outcomes. Non-invasive tools will enable comprehensive anatomical and functional evaluation, especially coronary CT angiography (CCTA) combined with CT-derived fractional flow reserve (FFR). AI-powered plaque characterization and emerging biomarkers like perivascular fat attenuation—validated in the ORPHAN study—will support early identification of vascular inflammation and risk stratification (Figure 2). Figure 2. AI-enhanced CCTA and perivascular fat attenuation imaging will advance personalized risk prediction and early intervention. Redefining the Interventionalist’s Role As the field evolves, interventional cardiologists will take on expanded roles—leading in acute care and long-term cardiovascular prevention. Armed with next-generation therapeutics, advanced imaging, and digital tools, they will deliver care that is as much preventive as it is interventional. This new model defines success by restoring coronary patency, reducing future events, and improving long-term outcomes—ensuring patients leave the hospital with an open artery and a personalized strategy for lifelong cardiovascular health. 15th TCTAP Master of the Masters Award Thursday, April 24, 11:10 AM-11:35 AM Main Arena, Level 3 Check The Session

April 25, 2025 217

TCTAP 2025

[New RCTs from AMC] Antithrombotic Therapy for AF and CAD: EPIC-CAD Trial and More

Min Soo Cho Asan Medical Center, Korea (Republic of) In patients with coronary artery disease (CAD), the prevalence of atrial fibrillation (AF) is significantly high. However, optimal antithrombotic therapy for managing both conditions is challenging. Previous clinical trials suggested the preferred use of direct oral anticoagulants (DOAC) and dual antithrombotic therapy (DOAC + clopidogrel), followed by the short-term use of triple therapy (DOAC + dual antiplatelet). However, beyond the first year, there remains limited evidence regarding the best long-term management strategy, especially in patients with stable CAD and AF. The EPIC-CAD trial, presented at ESC 2024 and published in the New England Journal of Medicine, tested the hypothesis that standard-dose Edoxaban monotherapy would be superior to dual antithrombotic therapy (Edoxaban plus a single antiplatelet agent) in terms of the primary net clinical outcome in patients with high-risk AF (CHA2DS2-VASc score ≥2) and stable CAD (for those with prior revascularization: ≥12 months for acute coronary syndrome and ≥6 months for chronic CAD; for those on medical therapy only: coronary artery stenosis ≥50%). The primary endpoint was a composite of all-cause mortality, stroke, systemic embolism, myocardial infarction, unplanned revascularization, and major or clinically relevant non-major bleeding at 12 months. (Figure 1) Figure 1. 1,040 patients were randomized 1:1 to receive either Edoxaban monotherapy (60 mg or 30 mg based on dose-reduction criteria) or dual antithrombotic therapy. The mean age was 72, 22% were women; the mean CHA2DS2-VASc and HAS-BLED scores were 4.3 and 2.1, and 66% had undergone previous revascularization. At 12 months, Edoxaban monotherapy significantly reduced the risk of the primary endpoint by 56% compared to dual antithrombotic therapy (6.8% vs. 16.2%; hazard ratio [HR] 0.44; 95% confidence interval [CI] 0.30-0.65; p

April 24, 2025 303

TCTAP 2025

[New RCTs from AMC] Most Updated Perioperative Antiplatelet Strategy Post-PCI: ASSURE-DES and More

Jung-Min Ahn Asan Medical Center, Korea (Republic of) The management of antiplatelet therapy in patients who need non-cardiac surgery after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) requires consideration, including the risk of stent thrombosis with cessation and bleeding with continuation. Despite current guidelines recommending the continuation of aspirin perioperatively if the bleeding risk allows, there is limited data on the continuation of aspirin in patients with prior PCI with DES who are undergoing non-cardiac surgery. In subgroup analysis of the POISE-2 trial, continuation of aspirin in patients with prior PCI reduced the risk of death or non-fatal myocardial infarction (MI) (hazard ratio [HR] 0.50; 95% confidence interval [CI] 0.26-0.95). Perioperative Antiplatelet Therapy in Patients With Drug-Eluting Stent Undergoing Non-cardiac SURgEry (ASSURE-DES) trial is an investigator-initiated, prospective, multicenter, randomized controlled trial comparing the safety and efficacy of aspirin cessation or continuation in the perioperative period of non-cardiac surgery in patients who have undergone PCI with DES for more than 12 months (Figure 1,2). Key exclusion criteria include recent acute coronary syndrome (ACS) (within 1 month), severe left ventricular dysfunction (EF ≤ 30%), severe valvular heart disease, emergent operation, or high bleeding risk operation (e.g., intracranial, intraspinal, or retinal surgery). The primary endpoint was a composite of all-cause death, stent thrombosis, MI, and stroke from 5 days before to 30 days after surgery. Figure 1. Figure 2. A total of 1,010 patients were randomized. Among 926 patients in the modified intention-to-treat population, the primary composite outcome occurred in 3 patients (0.6%) in the aspirin monotherapy group and 4 patients (0.9%) in the no antiplatelet group (difference, -0.2 percentage points; 95% CI: -1.3 to 0.9; p > 0.99) (Figure 3). There was no stent thrombosis in either group. The incidence of major bleeding did not differ significantly between groups (6.5% vs. 5.2%; p = 0.39), whereas minor bleeding was significantly more frequent in the aspirin group (14.9% vs. 10.1%; p = 0.027) (Figure 4). Figure 3. Figure 4. In conclusion, withholding antiplatelet therapy for 5 days before surgery may be a safe alternative to continuing aspirin in this patient population, especially when undergoing lower-risk procedures. While the event rates were low, and the study was underpowered to detect slight differences, these results could inform more flexible perioperative management strategies in future clinical practice. Best and Novel Medical Therapy in Interventional Cardiology: What Are New in 2025? Thursday, April 24, 3:30 PM - 5:00 PM Presentation Room 2, Level 1 Check The Session

April 24, 2025 269

TCTAP 2025

AI in Coronary Imaging: On the Brink of Mainstream Adoption

Bon-Kwon Koo Seoul National University Hospital, Korea (Republic of) Artificial intelligence (AI) is rapidly redefining the landscape of cardiovascular medicine, particularly in coronary imaging. As it evolves from a niche innovation to a potentially mainstream tool, its role in enhancing image acquisition, interpretation, and individualized treatment planning continues to expand. In an upcoming session at TCTAP 2025 titled "AI in Coronary Imaging: Mainstream or a Niche Research Tool?" Dr. Bon-Kwon Koo (Seoul National University Hospital) will provide insight into the transformative impact of AI on invasive and non-invasive coronary imaging modalities. In recent years, AI—especially through machine learning (ML) and deep learning (DL)—has emerged as a critical adjunct in coronary imaging. Its applications span multiple domains, from optimizing image quality to automating lesion assessment and even simulating physiology from image data. AI's integration into imaging workflows has become mainstream in several aspects, such as artifact reduction and automated segmentation. A notable example of AI's clinical utility is seen in the EMERALD II study, where AI-enabled Quantitative Coronary Plaque and Hemodynamic Analysis (AI-QCPHA) demonstrated superior predictive value for future acute coronary syndromes compared to conventional imaging analysis (Figure 1). Figure 1. Such tools offer clinicians improved risk stratification and data-driven support for treatment decisions. Another emerging application is the use of explainable machine learning methods that analyze lesion-specific data, enabling precision risk prediction and tailored treatment strategies for individual patients. Figure 2. However, despite these encouraging advancements, several challenges persist before AI can be fully integrated into everyday clinical practice. AI models depend heavily on large, diverse, and high-quality datasets. Their generalizability across different patient populations and imaging protocols remains a concern. Furthermore, the lack of standardization and the complexity of regulatory pathways pose significant hurdles. Prospective validation in multicenter, real-world settings is critical. Moreover, achieving regulatory clarity and developing user-friendly interfaces will determine how quickly and effectively AI can transition from academic research to routine bedside use. Dr. Koo emphasizes the importance of cross-disciplinary collaboration—among clinicians, engineers, and regulatory agencies—to guide the responsible deployment of AI in coronary imaging. He notes that with ongoing validation studies and regulatory adaptation, AI is poised to become an indispensable adjunct in cardiovascular diagnostics. As this technological frontier advances, TCTAP 2025 attendees will gain valuable foresight into the promise and limitations of AI in coronary imaging and how it might soon shape the future of cardiovascular care. MedTech Innovation Thursday, April 24, 3:20 PM - 4:30 PM Valve & Endovascular Theater, Level 1 Check The Session

April 24, 2025 249

TCTAP 2025

DM and Three-Vessel Disease: Why We Need New RCTS- DEFINE-DM Trial

Duk-Woo Park Asan Medical Center, Korea (Republic of) At TCTAP 2025, Dr. Duk-Woo Park (Asan Medical Center, Seoul, Korea) will present an important lecture titled “DM and Three-Vessel Disease: Why We Need New RCTs-DEFINE-DM Trial.” His presentation will highlight a bold initiative to redefine the revascularization strategy for diabetic patients with multivessel coronary artery disease (CAD) through a rigorously designed trial incorporating contemporary interventional advances. Why DEFINE-DM Is Needed For decades, landmark trials such as FREEDOM, BARI 2D, SYNTAX, and BEST have consistently supported coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (T2DM) and multivessel CAD. However, most of these studies were limited by outdated technologies-first generation drug-eluting stents (DES), minimal use of physiologic or intravascular imaging guidance, and lack of contemporary guideline-directed medical therapy (GDMT). Dr. Park will emphasize that the evolution in interventional cardiology now demands a reassessment. With second generation DES, widespread use of IVUS/OCT and FFR/iFR, and robust cardiovascular and antidiabetic therapies—including SGLT2 inhibitors and GLP-1 receptor agonists—the treatment landscape has transformed. DEFINE-DM will aim to answer whether modern PCI can now stand shoulder to shoulder with CABG in diabetic patients with complex coronary disease. Trial Design and Objectives The DEFINE-DM (Diabetes-Centered Evaluation of Revascularization Strategy of Functional and Imaging-CombiNEd State-of-the-Art Percutaneous Coronary Intervention or Coronary-Artery Bypass Grafting in Patients with Diabetes Mellitus and Multivessel Coronary Artery Disease) trial will be a multicenter, international, randomized controlled trial, powered to test the non-inferiority of PCI compared with CABG. 1,360 patients with T2DM and angiographically confirmed three-vessel CAD (≥50% stenosis in all three major epicardial arteries) will be enrolled, excluding those with left main disease. Patients will be randomized in a 1:1 fashion to either modern PCI or standard CABG, with revascularization decisions made by an independent heart team. The primary endpoint will be a composite of all-cause death, myocardial infarction (MI), or stroke at 2 years. Secondary endpoints will include each component of the primary composite outcome, a composite of death or MI, a composite of death, MI, stroke or repeat revascularization, stent thrombosis, symptomatic graft occlusion or stenosis, bleeding events, and patient-reported outcomes, including quality of life and angina class. Interventions in Each Arm In the PCI arm, lesion selection will be guided by FFR (≤0.80), or adverse imaging features and all procedures will require post-stent optimization using IVUS or OCT. Only second-generation DES will be used. In the CABG arm, surgery will be performed within 30 days of randomization, with internal mammary artery grafting to the LAD and complete revascularization strongly encouraged. Dr. Park will highlight the strict standardization of procedures across both arms and the protocol’s insistence on contemporary medical therapy. Endocrinology consultations during hospitalization and follow-up will be implemented to ensure optimized diabetic care, including the recommended use of SGLT2 inhibitors or GLP-1 RAs. Eligibility Criteria Participants must be ≥20 years old, have established T2DM, and be deemed suitable for PCI and CABG. Key exclusion criteria will include left main disease, STEMI within 5 days, EF

April 24, 2025 193

TCTAP 2025

Redo-TAVR From Planning to Execution: Tips and Tricks

Gilbert H. L. Tang Mount Sinai Health System, USA At TCTAP 2025, Dr. Gilbert H. L. Tang (Mount Sinai Health System) will present a comprehensive framework to streamline Redo-TAVR procedures through simplified planning and standardized technical execution. As the number of patients receiving transcatheter aortic valve replacement (TAVR) increases, the need for effective and reproducible strategies for Redo-TAVR becomes crucial, especially in lifetime valve management. In his talk, titled "Redo-TAVR From Planning to Execution: Tips and Tricks," he will share a practical approach that enables operators to safely navigate various TAV-in-TAV scenarios while maintaining optimal hemodynamic outcomes and ensuring coronary access. He will begin by categorizing Redo-TAVR procedures based on the interaction between the index and the second transcatheter heart valve (THV). The four possible combinations include: Short-in-Short, Short-in-Tall, Tall-in-Short, and Tall-in-Tall. This classification sets the stage for further procedural planning by determining the anatomical interaction and associated risks. By simplifying these into two scenarios based on the design of the second valve (TAV #2 – short or tall), he will guide the audience through tailored decision-making pathways. Each combination presents unique challenges related to valve positioning, coronary risk, and THV expansion. The planning process will start with a detailed evaluation of four key anatomical and procedural concepts. First, understanding the fluoroscopic markers and structural landmarks of the existing valve is essential for the successful positioning of TAV #2. Second, the neo-skirt plane (NSP), which represents the new functional skirt level after redo, is determined by the commissural post of the index valve (for tall TAV #2) or the outflow level of TAV #2 (for short TAV #2). Third, the coronary risk plane (CRP), the lowest margin of the coronary orifice, sets the lower boundary of the coronary risk zone (CRZ). Lastly, he will emphasize evaluating the CRZ by measuring the virtual to annulus (VTA) distance, which should ideally be greater than 4 mm to minimize obstruction risk. These concepts will be visualized using frame alignment views on fluoroscopy, offering an intuitive method to identify NSP and CRP for optimal TAV #2 implantation. He will then outline a procedural strategy that translates anatomical insights into actionable techniques, beginning with identifying the index TAV and evaluating the CRZ. Next, he will focus on determining the appropriate implant position for TAV #2, which will depend on its design and the anatomical environment. Pre-dilatation of the index TAV will be highlighted as a critical step, especially in underexpanded or stenotic valves, to optimize the seating of TAV #2 and reduce the risk of HALT. During the implantation of TAV #2, he will recommend slow and controlled deployment to maintain coaxiality and avoid unintended valve movement, particularly in short-in-short or short-in-tall configurations. Post-dilatation will be the final optimization step to ensure adequate expansion of TAV #2, minimize perivalvular leak, and improve overall hemodynamic performance. Throughout the presentation, he will illustrate real-world case examples involving valve pairs, such as SAPIEN 3 Ultra RESILIA, in Evolut PRO or Navitor Vision. He will highlight the importance of coaxial alignment, stiff wire manipulation, and the role of coronary protection in borderline CRZ measurements, such as those with VTA between 2 and 4 mm. He will stress that post-dilatation alone cannot correct underexpanded index valves, reinforcing the importance of aggressive pre-dilatation to optimize long-term outcomes. The proposed Redo-TAVR strategy will also emphasize the value of standardization. With pamobile tools such as the "Redo TAV" app (developed by Vinnie Bapat, Miho Fukui, et al.), operators can access procedural checklists and visualize anatomical landmarks in real-time. By demystifying the Redo-TAVR workflow, he aims to provide a reproducible roadmap that reduces variability in outcomes while ensuring safety across complex anatomical subsets. He will conclude by emphasizing that Redo-TAVR can be simplified through structured planning and meticulous execution. Frame alignment fluoroscopy will be critical to determine NSP and CRP. Pre-dilatation will remain essential for procedural success and long-term valve durability. Positioning of TAV #2 should prioritize coaxiality and depth control, while slow inflation during deployment will reduce the risk of valve migration and coronary obstruction. As Redo-TAVR becomes a more frequent necessity in lifetime valve care, his approach is expected to shape procedural standards and provide clarity for interventional cardiologists navigating this evolving field. Figure 1. NSP and CRZ Evaluation with Frame Alignment View TAVR: Key Issues in 2025 Thursday, April 24, 8:10 AM-9:50 AM Valve & Endovascular Theater, Level 1 Check The Session

April 24, 2025 218

TCTAP 2025

Lessons and Future Challenges in Transcatheter SHD Therapies

Martin Bert Leon NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, USA At TCTAP 2025, Dr. Martin B. Leon will deliver a focused lecture titled “Lessons and Future Challenges in Transcatheter SHD Therapies.” The presentation will explore how structural heart disease (SHD) therapies have evolved and what critical developments will define the future of transcatheter valvular intervention. Dr. Leon will first address the ongoing global crisis in under-diagnosis and under-treatment of valvular heart disease (VHD) despite the development of less-invasive therapies. He will emphasize that key systemic barriers—limited procedural capacity, imaging infrastructure, and inadequate reimbursement policies—continue to restrict access to care. These limitations will need to be addressed to extend the benefits of SHD interventions more broadly, particularly in low-resource settings and among underserved populations. He will underline the enduring importance of the multidisciplinary Heart Valve Team. While this model has proven effective in TAVR programs, it will require adaptation for more complex procedures such as mitral and tricuspid valve repair or replacement. Dr. Leon will highlight that heart failure specialists, electrophysiologists, and imaging experts will become essential partners in the care of patients undergoing mitral and tricuspid interventions, where anatomical variability is high, and device positioning is more demanding. A major focus of the lecture will be the principle of procedural and device simplification. Dr. Leon will assert that ease of use, reproducibility, and anatomical adaptability are essential features for future SHD devices. Drawing from the global adoption of TAVR, which succeeded due to intuitive device deployment, simplified imaging requirements, and favorable safety profiles, he will state that similar criteria must be met for next-generation mitral and tricuspid therapies to gain clinical and commercial traction. He will also reference data showing that nearly 50% of patients referred for transcatheter mitral interventions are excluded due to anatomical mismatch, underscoring the urgent need for technologies that can accommodate complex and varied anatomies. In discussing trial design, Dr. Leon will review the shift from traditional endpoints such as mortality and stroke to more complex composite endpoints and patient-reported outcomes. He will explain how statistical approaches like the WIN ratio and Bayesian modeling are increasingly used in SHD trials, particularly in the context of mitral and tricuspid valve therapies. However, he will caution that these evolving methodologies can complicate interpretation and may limit the generalizability of trial findings unless adequately powered and pragmatically designed. Dr. Leon will also present an overview of current investigational platforms such as Evoque, AltaValve, M3, and CardioValve. These devices will be characterized by enhanced deliverability, improved leaflet design, and adaptability to anatomical variations. He will describe how future development will be supported by adjunctive tools including three-dimensional imaging, artificial intelligence-guided planning, and real-time intraprocedural feedback systems. The topic of valve durability will be addressed with reference to the expanding population of younger, lower-risk patients undergoing TAVR. Dr. Leon will emphasize the need for long-term follow-up data—spanning at least 10 years—for all transcatheter devices, especially as valve-in-valve procedures and surgical explants become more common. He will present findings related to structural valve deterioration, hemodynamic performance, and reintervention rates as key metrics for future studies. Finally, Dr. Leon will call for broader systemic readiness to support innovation. He will advocate for the incorporation of real-world data, revised consensus definitions, and flexible regulatory pathways that can accommodate the dynamic nature of SHD technologies. He will stress that success in this field will depend on technological progress and meaningful clinical endpoints, inclusive patient access, and health system adaptability. Dr. Leon’s lecture will provide a critical, evidence-based framework for understanding how transcatheter SHD therapies will evolve over the next decade. By focusing on access, anatomical compatibility, simplified delivery, and long-term durability, the field will be better positioned to meet the complex needs of patients with valvular heart disease. (Figure 1.) 30 Years Special Keynote Lectures Thursday, April 24, 11:35 AM-11:59 AM Main Arena, Level 3 Check The Session

April 24, 2025 197

TCTAP 2025

How Art and Science Work Together to Advance New Device Technology

Ian Penn Vancouver General, Canada At TCTAP 2025, Dr. Ian Penn, MD, MFA (Vancouver General, Canada), will present a compelling exploration of the intersection between art and science, framed through problem-solving. His journey from leading innovations in interventional cardiology to creating thought-provoking visual art embodies the belief that transformative solutions arise not from chasing answers but from deeply understanding the problem. Describing science and art as the “Yin and Yang of understanding,” Dr. Penn emphasizes how these disciplines complement each other, grounded in curiosity, creativity, and a shared commitment to exploration. This unified mindset of “loving the problem” has guided his approach to stent design and artistic expression. Dr. Penn contributed to advances in coronary bifurcation stenting, addressing the technical dilemma of balancing stent deliverability with complete lesion coverage. Collaborating with leaders like Marty Leon and Richard Schatz, he later extended these principles to neurovascular interventions, drawing inspiration from natural forms such as feathers to tackle the complexities of bifurcation aneurysms. The lecture will also explore how a crisis can serve as a powerful catalyst for reinvention. An occupational spinal disease, a common affliction among interventional cardiologists, ended Dr. Penn’s time in the lab. Dr. Penn’s transition into art school began a second journey. Through a problem-solving lens, he explored new media and storytelling forms. In portraiture, he addressed the challenge of authentically capturing identity by engaging deeply with subjects, recording conversations, and creating animated images that distilled their essence. In landscape work, particularly during COVID-19 isolation, he painted clouds from a fixed vantage point, capturing the emotional weight of the pandemic, political upheaval, and global conflict reflected in the ever-changing sky (Figure 1). Figure 1. Selected artwork of Dr. Ian Penn, a visual reflection on collective uncertainty and resilience during the COVID-19 pandemic. His artistic pursuits also found purpose in public service. Through the IDEA award, he helped bridge medicine and art by integrating creative works into clinical environments, demonstrating art’s therapeutic role and potential to humanize healthcare spaces. Dr. Penn’s work reminds us that innovation emerges through persistent engagement with complexity. By embracing both the analytical rigor of science and the emotional depth of art, his career demonstrates how a shared problem-solving ethos can advance technology, deepen empathy, and transform practice. 30 Years Special Keynote Lectures Thursday, April 24, 11:35 AM-11:59 AM Main Arena, Level 3 Check The Session

April 24, 2025 206

COMPLEX PCI 2024

Advanced Techniques for Managing Severe Coronary Calcification

Takashi Akasaka Nishinomiya Watanabe Cardiovascular Cerebral Center, Japan Severe coronary calcification poses significant challenges in percutaneous coronary intervention (PCI), requiring advanced imaging and innovative procedural strategies to improve patient outcomes. At the Complex PCI 2024 conference, Takashi Akasaka, MD, delivered a comprehensive presentation detailing the latest techniques and tools for addressing this difficult subset of patients. Challenges of Severe Coronary Calcification Dr. Akasaka emphasized that severe coronary calcification significantly increases the risks of stent under-expansion, vessel damage, and restenosis. Lesions with circumferential calcium exceeding 180 degrees are particularly difficult to manage, necessitating a systematic approach involving imaging and calcium modification techniques. The Role of Advanced Imaging Intravascular imaging plays a crucial role in the successful treatment of calcified lesions. Optical coherence tomography (OCT) is particularly effective for visualizing calcium thickness and distribution, while intravascular ultrasound (IVUS) provides higher sensitivity in detecting calcium. Dr. Akasaka recommended a dual-modality approach combining OCT and IVUS for comprehensive lesion assessment and procedural planning. Innovative Calcium Modification Techniques Dr. Akasaka presented recent advances in lesion preparation, highlighting the importance of calcium modification techniques to facilitate optimal stent deployment. Tools such as rotational atherectomy, orbital atherectomy, intravascular lithotripsy (IVL), and scoring or cutting balloons were discussed as key options for addressing heavily calcified lesions. IVL, in particular, was noted for its ability to fracture thick calcium layers exceeding 500 microns, which are often resistant to traditional balloon dilation. This technique has shown promising results in improving stent expansion and reducing the risk of restenosis. Challenges with Calcified Nodules Calcified nodules, particularly the "elapsed" type, remain a significant challenge in PCI. These lesions are associated with worse clinical outcomes and higher target lesion revascularization rates. Dr. Akasaka noted that while current treatment options such as drug-eluting stents (DES) and drug-coated balloons (DCB) have shown limited success, further innovation is required to address this unmet need. Key Takeaways Dr. Akasaka concluded the presentation with several take-home messages: Intravascular imaging with OCT and IVUS is essential for accurate assessment and treatment planning. Calcium modification techniques, such as IVL and atherectomy, are critical for procedural success in severely calcified lesions. The management of calcified nodules remains a pressing challenge, requiring continued research and innovation. The insights shared at Complex PCI 2024 underscore the importance of combining advanced imaging with innovative procedural strategies to optimize outcomes in patients with severe coronary calcification. As the field continues to evolve, these advancements pave the way for better care and improved prognoses in this challenging patient population. Live Case 3: Imaging and Physiology / Calcification Friday, November 29, 12:40 PM ~ 2:30 PM Main Arena Check The Session

January 03, 2025 15252

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