Multimodal Imaging of Coronary Bifurcation TAP Procedures Utilizing Visible Heart® Methodologies: EBC Recommended Steps and Bailout Procedures

In some cases it is critical to clinically perform coronary bifurcation stenting to minimize the potential risk for restenosis and/or stent thrombosis. The European Bifurcation Club (EBC) has provided guidelines for optimally performing such procedures. Yet, sometimes such procedures do not go as planned, and in some cases bailout procedures are required. Here we utilized Visible Heart® (VH) methodologies and multimodal visualizations to better understand each step for optimally performed T and small protrusion (TAP) procedures, as well as those in which complications occurred. These studies were performed within reanimated swine hearts in which endoscopes, fluoroscopy, and optical coherence tomography (OCT) could readily be used. Additionally, because these procedures were performed in reanimated hearts, one could intentionally cause complications, so to perform bailout procedures. Finally, following these procedures each specimen was micro CT scanned, and high resolution computational models (~40 microns) were reconstructed of the final outcomes.