Proceedings of TRICO 2024 from the desk of Tejas Patel

Dear Esteemed Colleagues and Friends,

It brings me immense pleasure to present the comprehensive account of TRICO 2024, the Eighteenth International Transcatheter Intervention Course, held on the 3rd and 4th of February this year. Our journey in preparing for this monumental event commenced in September, with meticulous planning involving the formulation of the agenda, collaboration with distinguished international and national guest faculties, and the curation of challenging cases for live demonstrations. This edition of TRICO placed a special emphasis on advancing our knowledge in imaging, physiology, and showcasing cutting-edge techniques and technologies for coronary calcium management, chronic total occlusions (CTO), and bifurcation lesions. The event also featured enriching didactics by renowned international guest faculties, along with a thought-provoking panel discussion.

I am delighted to acknowledge the invaluable contributions of Dr. Shigeru Saito of Japan and Dr. Samir Pancholy from the USA, who graciously accepted the roles of Course Directors alongside myself and Sanjay. The course unfolded as an intensive program, encompassing 11 hours of live demonstrations, 8 didactic sessions led by our esteemed international guest faculty, and a dynamic panel discussion. Notable experts such as Takashi Akasaka, Rajiv Gulati, Malcolm Bell, Tak W. Kwan, Md. Shafiqur Rahman Patwary, and Md. Shahbuddin, among others, lent their expertise as International Guest Faculties. Additionally, Khaled Ziada, Avtandil Babunashvili, and Mirjamol Zufarov graciously consented to participate, adding further depth to the international representation. A stellar lineup of 18 National Guest Faculties also confirmed their participation, contributing to the diverse and enriching academic atmosphere.

The event showcased live demonstrations on eighteen carefully selected patients, all admitted on the 2nd morning at Apex Heart Institute. As a testament to our commitment to quality, I personally visited the Nirma University Auditorium to ensure optimal image and sound quality for the live transmission of these crucial procedures. On the evening of February 2nd, a warm gathering at my home was hosted, extending a heartfelt welcome to our International Guests. Although Dr. Saito and Dr. Akasaka arrived late and couldn’t join, the evening proved to be a delightful opportunity for camaraderie.

On the morning of February 3rd, precisely at 8:45 a.m., I delivered the welcome address from Apex Heart Institute to a captivated audience in the jam-packed Nirma University Auditorium. The day commenced with a challenging live case of a heavily calcified LMCA bifurcation stenosis, skillfully executed by myself and Sanjay, with on-site commentary provided by Dr. Akasaka and Dr. Gulati. The use of Intravascular Lithotripsy (IVL) and Optical Coherence Tomography (OCT) guidance proved pivotal in the successful management of this case, leading to intense discussions among the panel, on-site commentators, and us.

Subsequent live cases included an Ostial LAD CTO, masterfully demonstrated by Dr. Saito and Rajni, and an intriguing case of heavily calcified LAD ostial and RCA stenosis in a patient with mirror image dextrocardia, performed by myself and Sanjay. This case showcased the coronary cannulation technique and the effective use of IVL for complex calcium management under OCT guidance, concluding with stenting and an excellent outcome confirmed by OCT evaluation. Dr. Akasaka’s insightful comments on OCT imaging added further depth to the session. The fourth case, led by Tak Kwan with Aman Patel, involved a complex LCX-OM bifurcation, where the DK Crush technique was elegantly demonstrated, resulting in an excellent outcome confirmed by IVUS imaging. This marked the conclusion of the first live demonstration session.

The second live demonstration session, post-lunch, commenced with a challenging case of a critical In-Stent Restenosis (ISR) in a tortuous RCA, performed by Dr. Samir Pancholy with Dr. Aman Patel. Samir’s utilization of OCT imaging sparked a thought-provoking discussion on the utility of OCT in interpreting the pathophysiology of stent failure. Engaging conversations between Dr. Khaled Ziada, Samir Pancholy, and the panel at Nirma Auditorium further enriched the session. The day concluded with a complex LAD diagonal bifurcation case by Dr. Shigeru Saito, demonstrating his adept skills in managing it under IVUS guidance, utilizing a guide extension catheter and rotational atherectomy. Following this, the panel discussion I moderated for two hours with the international guest faculties delved into 12 intricate and complicated cases. The topics ranged from the utilization of imaging in complex coronary situations to addressing cath lab nightmares during Percutaneous Coronary Intervention (PCI) and detailing various approaches to treating or managing coronary aneurysms. The discussions were insightful and provided a wealth of knowledge to all participants, marking the end of day 1.

The evening unfolded with a Gala Dinner attended by most participants, creating an informal setting for fruitful interactions with national and international guest faculties. The quality of the discussions was matched by the excellence of the food, providing a pleasant break before preparing for the second day.

On the 4th of February, the second day of the course, participants gathered in the auditorium at 9:00 a.m. sharp. The day’s proceedings began with a challenging case of a diffusely diseased, heavily calcified, and tortuous RCA, executed by myself and Sanjay, with on-site commentary by Malcolm Bell and Mirjamol Zufarov. Wiring proved challenging, necessitating the use of a guide extension catheter to navigate the balloon across the lesion. Despite encountering difficulties with the IVL catheter even after balloon dilatation, we successfully employed IVL, with OCT imaging providing valuable insights. A discussion on the management of calcific nodules ensued between the team, on-site commentators, and the panel, ultimately resulting in the endoluminal reconstruction of the RCA with an excellent outcome confirmed by OCT imaging.

The second case featured a long-segment CTO of the mid-RCA, masterfully performed by Dr. Saito with Rajni. This challenging case showcased Dr. Saito’s expertise in elegantly demonstrating wiring through intra-arterial collaterals in CTO. The audience was captivated throughout, and the end result was nothing short of perfection. The third case, again involving a diffusely diseased and tortuous RCA, was performed by myself and Aman. This case highlighted endoluminal reconstruction using rotational atherectomy and OCT guidance, resulting in an excellent outcome that garnered widespread appreciation. The fourth case, a diffusely diseased small-caliber tortuous LAD, was managed by myself and Sanjay. Despite facing struggles at every stage, we achieved an excellent result, with Avtandil Babunashvili providing useful comments as the on-site commentator. The live demonstration session concluded, and participants dispersed for a well-deserved short lunch break.

Post-lunch, the auditorium remained engaged as we seamlessly transitioned into several back-to-back didactic sessions delivered by esteemed academicians in the field. Speakers included Samir Pancholy, Takashi Akasaka, Malcolm Bell, Rajiv Gulati, Khalid Ziada, Aman Patel, and Girish Godbole, each delivering insightful talks. Two additional talks by Aman Patel and Girish Godbole from India further enriched the academic content. Despite the exhaustive 11 hours of live demonstrations, the auditorium remained full, attesting to the engaging and enriching nature of the talks. The delivery and content of each presentation were met with appreciation and enthusiasm.

In conclusion, TRICO 2024 stands as a power-packed, hectic, and meaningful journey over two days, made possible by the collective efforts of all involved. My sincere thanks and gratitude extend to Dr. Saito, the international guest faculties, and the national guest faculties for their pivotal roles in creating yet another successful chapter in the TRICO legacy. I eagerly anticipate the pleasure of your company for TRICO 2025, and the dates for the next edition will be announced soon.

Warm regards,

Tejas Patel,
Course Director,
TRICO 2024.