The Take Home

The Take Home: C3

From June 28 to July 1, interventional cardiologists, interventional radiologists, vascular surgeons and clinicians from other disciplines attended the 12th annual Complex Cardiovascular Catheter Therapeutics (C3) Advanced Endovascular and Coronary Intervention Global Summit in Orlando, Florida. Discussing sessions of interest with Cardiology Today’s Intervention are Nilesh Balar, MD, MBA, chairman, department of surgery at St. Michael’s Medical Center, Newark, New Jersey; Bryan W. Kluck, DO, co-course director for the event and interventional cardiologist at Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania; and Gautam Kumar, MBBS, MRCP, FASE, FACC, FSCAI, associate professor of medicine at Emory University and director of the echocardiography laboratory at Atlanta VA Medical Center.

NILESH BALAR, MD, MBA

Once again, this year was spectacular in terms of the number of legends that were there. The depth and breadth of the topics covered was outstanding. Also important is the global perspective that I get from being there, especially from the Chinese faculty, who bring a lot to the table in terms of the sheer number of cases they do and the clinical material they have. It was important for me to see management of some scenarios which we don’t get to see that often. The total number of cases that they do is probably 10 times more than we have in the United States. So that was a big plus for us.

Venous Sessions

Photo: C3 Conference 2016; reprinted with permission.

The venous sessions were a new component this year. Particularly interesting was a discussion of the treatment of deep venous diseases and presentations from some very fine faculty. There were a large number of cases with in-depth discussion of management for the venous disease, as well as of use of IVUS. Difficult clinical scenarios for managing the venous obstructive disease were addressed.

Nilesh Balar

PAD Cases

Regarding peripheral artery disease, the highlight was live cases with our European colleagues, in which they performed pedal artery reconstruction. There were two such cases and they were totally outstanding. They were comprehensive, up-to-date with the current practice guidelines, and gave good insight into the practical application of the technology. Those cases, among others, will help me change some of my own practices in the clinic.

Geriatric Medicine

Some of the vascular medicine presentations highlighted very different categories of disease that we usually tend to ignore, and this was especially relevant to geriatric medicine. T.S. Dharmarajan, MD, MACP, AGSF, outlined a number of factors we have to consider from the geriatric patient’s perspective, which is important because we see a lot of them. Aditya Sharma, MBBS, discussed a program that was very helpful in changing some of the things we do in our clinical practice in managing the geriatric population.

BRYAN W. KLUCK, DO

Throughout its history, C3 has been notorious for extensive, unparalleled collegiality. The event has a high percentage of international attendees, a high percentage of midlevel providers, and a high percentage of the people who are trainees of cardiac fellows, vascular fellows and radiology fellows from all over the world. Importantly, the event is not a faculty teaching to an audience of listeners. It’s not even the newer concept of “teach back,” which is a little better than plain old lectures. It really is an opportunity to have dialogue, both in conference and also between sessions. Attendees keep telling faculty members what they really do in practice, and everybody walks away enriched from it. Everyone walks away with a tip or two as how to do things better for their patient the next day or week or month. The C3 modus operandi has been to cultivate that and perpetuate that in a way that no other conference really does. I think that’s what makes this conference so fantastic. What makes it unique is that you rub elbows with your colleagues, your down-in-the-trenches people.

Endovenous Disease Sessions

One of the standout sessions again was the one on the treatment of endovenous disease, an emerging area. It’s something that’s new for virtually all practitioners, whether they be vascular surgeons, vascular medicine specialists or cardiologists. It’s an area that has been underserved, underrepresented and underappreciated, but the discussion that went on at the endovenous session was really extraordinary. It’s such a new area that even the people that are giving the talks are listening to the people in the audience, who say, “this is how I handle this particular problem. This is my approach to this particular nuance of endovenous imaging and endovenous procedures.”

Origin of Stenting

Bryan W. Kluck

During the Legends session, Marvin Woodall, BBA, who as CEO of Cordis was there at the start of coronary stenting, gave a very authoritative, very personal, and very on-the-scene representation of how coronary interventions evolved from balloon angioplasty to the stent era. He gave a good history of it because he was essentially the architect of it, helping lead the team that developed the first stent and then later the first drug-coated stent. I was thrilled to sit and listen to and be part of that talk.

Complex Cases

Each day, there were evening sessions held outside the lecture halls in the industry area, where excellent cases were presented. These were simply very complicated cases. And it turned out that that venue was particularly good for case presentation. Regardless of background, everyone had an equal chance to ask questions. Sometimes provocative, controversial statements were made. That’s the first time I’ve seen that at C3 or anywhere. When the session started, there were 12 or 13 chairs and a couple of people that were presenting the case behind the podium. And by the end of the session, there were probably 100 to 150 people gathered around, most of whom were standing because there were only 12 chairs. It was remarkable.

One particular case made me rethink my approach. A patient came in for a lab, and at first it appeared it wasn’t going to be very complicated. By the time the case was over, everyone realized that hemodynamic support should have been used. The case reinforced that even if you have a case that looks daunting, hemodynamic support up-front should be emphasized and reemphasized.

GAUTAM KUMAR, MBBS, MRCP, FASE, FACC, FSCAI

Gautam Kumar

These sessions provide ideas for different techniques from what you may be using at your institution. This is a major advantage of attending.

PCI and Hemodynamic Support

One of the presentations that I really enjoyed was the session on the last day of the meeting on high-risk PCI with hemodynamic support. It may have been a case of saving the best for last. There were a number of different speakers with perspectives on hemodynamic support for PCI, discussed in many different angles. Much was learned about alternate access sites. I especially liked the tips about using the axillary artery as an access site, and how to percutaneously grow stents successfully.

Disclosure: Kluck reports serving on an advisory board for Boston Scientific. Balar and Kumar report no relevant financial disclosures.

From June 28 to July 1, interventional cardiologists, interventional radiologists, vascular surgeons and clinicians from other disciplines attended the 12th annual Complex Cardiovascular Catheter Therapeutics (C3) Advanced Endovascular and Coronary Intervention Global Summit in Orlando, Florida. Discussing sessions of interest with Cardiology Today’s Intervention are Nilesh Balar, MD, MBA, chairman, department of surgery at St. Michael’s Medical Center, Newark, New Jersey; Bryan W. Kluck, DO, co-course director for the event and interventional cardiologist at Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania; and Gautam Kumar, MBBS, MRCP, FASE, FACC, FSCAI, associate professor of medicine at Emory University and director of the echocardiography laboratory at Atlanta VA Medical Center.

NILESH BALAR, MD, MBA

Once again, this year was spectacular in terms of the number of legends that were there. The depth and breadth of the topics covered was outstanding. Also important is the global perspective that I get from being there, especially from the Chinese faculty, who bring a lot to the table in terms of the sheer number of cases they do and the clinical material they have. It was important for me to see management of some scenarios which we don’t get to see that often. The total number of cases that they do is probably 10 times more than we have in the United States. So that was a big plus for us.

Venous Sessions

Photo: C3 Conference 2016; reprinted with permission.

The venous sessions were a new component this year. Particularly interesting was a discussion of the treatment of deep venous diseases and presentations from some very fine faculty. There were a large number of cases with in-depth discussion of management for the venous disease, as well as of use of IVUS. Difficult clinical scenarios for managing the venous obstructive disease were addressed.

Nilesh Balar

PAD Cases

Regarding peripheral artery disease, the highlight was live cases with our European colleagues, in which they performed pedal artery reconstruction. There were two such cases and they were totally outstanding. They were comprehensive, up-to-date with the current practice guidelines, and gave good insight into the practical application of the technology. Those cases, among others, will help me change some of my own practices in the clinic.

Geriatric Medicine

Some of the vascular medicine presentations highlighted very different categories of disease that we usually tend to ignore, and this was especially relevant to geriatric medicine. T.S. Dharmarajan, MD, MACP, AGSF, outlined a number of factors we have to consider from the geriatric patient’s perspective, which is important because we see a lot of them. Aditya Sharma, MBBS, discussed a program that was very helpful in changing some of the things we do in our clinical practice in managing the geriatric population.

BRYAN W. KLUCK, DO

Throughout its history, C3 has been notorious for extensive, unparalleled collegiality. The event has a high percentage of international attendees, a high percentage of midlevel providers, and a high percentage of the people who are trainees of cardiac fellows, vascular fellows and radiology fellows from all over the world. Importantly, the event is not a faculty teaching to an audience of listeners. It’s not even the newer concept of “teach back,” which is a little better than plain old lectures. It really is an opportunity to have dialogue, both in conference and also between sessions. Attendees keep telling faculty members what they really do in practice, and everybody walks away enriched from it. Everyone walks away with a tip or two as how to do things better for their patient the next day or week or month. The C3 modus operandi has been to cultivate that and perpetuate that in a way that no other conference really does. I think that’s what makes this conference so fantastic. What makes it unique is that you rub elbows with your colleagues, your down-in-the-trenches people.

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Endovenous Disease Sessions

One of the standout sessions again was the one on the treatment of endovenous disease, an emerging area. It’s something that’s new for virtually all practitioners, whether they be vascular surgeons, vascular medicine specialists or cardiologists. It’s an area that has been underserved, underrepresented and underappreciated, but the discussion that went on at the endovenous session was really extraordinary. It’s such a new area that even the people that are giving the talks are listening to the people in the audience, who say, “this is how I handle this particular problem. This is my approach to this particular nuance of endovenous imaging and endovenous procedures.”

Origin of Stenting

Bryan W. Kluck

During the Legends session, Marvin Woodall, BBA, who as CEO of Cordis was there at the start of coronary stenting, gave a very authoritative, very personal, and very on-the-scene representation of how coronary interventions evolved from balloon angioplasty to the stent era. He gave a good history of it because he was essentially the architect of it, helping lead the team that developed the first stent and then later the first drug-coated stent. I was thrilled to sit and listen to and be part of that talk.

Complex Cases

Each day, there were evening sessions held outside the lecture halls in the industry area, where excellent cases were presented. These were simply very complicated cases. And it turned out that that venue was particularly good for case presentation. Regardless of background, everyone had an equal chance to ask questions. Sometimes provocative, controversial statements were made. That’s the first time I’ve seen that at C3 or anywhere. When the session started, there were 12 or 13 chairs and a couple of people that were presenting the case behind the podium. And by the end of the session, there were probably 100 to 150 people gathered around, most of whom were standing because there were only 12 chairs. It was remarkable.

One particular case made me rethink my approach. A patient came in for a lab, and at first it appeared it wasn’t going to be very complicated. By the time the case was over, everyone realized that hemodynamic support should have been used. The case reinforced that even if you have a case that looks daunting, hemodynamic support up-front should be emphasized and reemphasized.

GAUTAM KUMAR, MBBS, MRCP, FASE, FACC, FSCAI

Gautam Kumar

These sessions provide ideas for different techniques from what you may be using at your institution. This is a major advantage of attending.

PCI and Hemodynamic Support

One of the presentations that I really enjoyed was the session on the last day of the meeting on high-risk PCI with hemodynamic support. It may have been a case of saving the best for last. There were a number of different speakers with perspectives on hemodynamic support for PCI, discussed in many different angles. Much was learned about alternate access sites. I especially liked the tips about using the axillary artery as an access site, and how to percutaneously grow stents successfully.

Disclosure: Kluck reports serving on an advisory board for Boston Scientific. Balar and Kumar report no relevant financial disclosures.