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Aedma SK, Naik A, Kanmanthareddy A. Coronary Bifurcation Stenting: Review of Current Techniques and Evidence. Curr Cardiol Rev 2023; 19:e060422203185. [PMID: 35388761 PMCID: PMC10201883 DOI: 10.2174/1573403x18666220406113517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Coronary bifurcation stenting constitutes 20% of all PCI performed. Given the extensive prevalence of bifurcation lesions, various techniques have sought to optimally stent the bifurcation to improve revascularization while also decreasing rates of stent thrombosis and lesion recurrence. Advanced techniques, such as planned two-stent approaches, have been shown to have improved outcomes but also require fluoroscopy and procedure time, posing an economic argument as well as a patient-outcome one. OBJECTIVE Because of the many strategies posited in the literature, it becomes essential to objectively evaluate evidence from randomized controlled trials and meta-analyses to help determine the optimal stenting strategy. METHODS We reviewed the clinical evidence on the efficacy of coronary bifurcation stenting. RESULTS In this paper, we review the most recent randomized controlled trials and meta-analyses on the efficacy of various stenting techniques and advances in stenting technologies published to gauge the current state of understanding and chart where the field is heading. CONCLUSION Bifurcation stenting is a maturing problem in the field of interventional cardiology that is adapting to the needs of the patients and advances in technology.
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Affiliation(s)
- Surya Kiran Aedma
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, 61801, USA
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, Illinois, 61820, USA
| | - Arun Kanmanthareddy
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, 68198, USA
- CHI Health Heart Institute, Omaha, Nebraska, 68124, USA
- Division of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska, 68124, USA
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Movahed MR. Coronary artery bifurcation lesion classifications, interventional techniques and clinical outcome. Expert Rev Cardiovasc Ther 2014; 6:261-74. [DOI: 10.1586/14779072.6.2.261] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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SCHOB ALAN, BHATT MEHUL, ALFONSO CARLOS, DE MARCHENA EDUARDO. Cryoplasty for the Treatment of Coronary Bifurcation Stenoses Following Main Vessel Stenting. J Interv Cardiol 2013; 26:239-44. [DOI: 10.1111/joic.12032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- ALAN SCHOB
- Miami VA Medical Center and the University of Miami Miller School of Medicine; Miami, Florida
| | - MEHUL BHATT
- Miami VA Medical Center and the University of Miami Miller School of Medicine; Miami, Florida
| | - CARLOS ALFONSO
- Miami VA Medical Center and the University of Miami Miller School of Medicine; Miami, Florida
| | - EDUARDO DE MARCHENA
- Miami VA Medical Center and the University of Miami Miller School of Medicine; Miami, Florida
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Yakushiji T, Maehara A, Mintz GS, Saito S, Araki H, Oviedo C, Choi SY, Tahk SJ, Leon MB, Stone GW, Moses JW, Ochiai M. An intravascular ultrasound comparison of left anterior descending artery/first diagonal branch versus distal left main coronary artery bifurcation lesions. EUROINTERVENTION 2013; 8:1040-6. [PMID: 23339810 DOI: 10.4244/eijv8i9a160] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We report the intravascular ultrasound (IVUS) analysis of plaque distribution in left anterior descending (LAD) artery/first diagonal (D1) and distal left main coronary artery (LMCA) bifurcation lesion location. METHODS AND RESULTS We reviewed 58 angiograms of LAD/D1 bifurcation lesions with pre-intervention IVUS of both the LAD and D1 and compared these data to a corresponding cohort (n=81) of LMCA bifurcations, dividing each bifurcation into three segments: MV (main vessel), MB (main branch distal to the carina), and SB (side branch). In the LAD/D1 cohort, D1 (SB) had less calcium and a smaller plaque burden compared to the other two segments. Continuous plaque from the LAD proximal to the carina (MV) into the LAD distal to the carina (MB) was seen in 90%, from the MV into the SB in 72%, and from the MV into both the MB and SB in 62%. In the LMCA cohort, ostial left circumflex (LCX) (SB) had less calcium and a smaller plaque burden compared to the distal LMCA (MV) and ostial LAD (MB). Continuous plaque from MV to MB was seen in 96%, from MV to the SB in 78%, and from MV to both branches in 74%. CONCLUSIONS The IVUS analysis of the LAD/D1 and LMCA bifurcations revealed that most lesions had diffuse plaques extending from the MV into the MB with the SB having the least amount of calcium and the smallest plaque burden, regardless of location.
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Affiliation(s)
- Tadayuki Yakushiji
- The Cardiovascular Research Foundation and Columbia University Medical Center, 111 East 59th Street, New York, NY 10022, USA
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Bartorelli AL, Trabattoni D, Kaplan AV. Challenges and innovations in coronary bifurcation stenting: the Tryton™ side-branch stent. Interv Cardiol 2010. [DOI: 10.2217/ica.10.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kyono H, Guagliumi G, Sirbu V, Rosenthal N, Tahara S, Musumeci G, Trivisonno A, Bezerra H, Costa M. Optical coherence tomography (OCT) strut-level analysis of drug-eluting stents (DES) in human coronary bifurcations. EUROINTERVENTION 2010. [DOI: 10.4244/eijv6i1a11] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Movahed MR, Kern K, Thai H, Ebrahimi R, Friedman M, Slepian M. Coronary artery bifurcation lesions: a review and update on classification and interventional techniques. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2008; 9:263-8. [DOI: 10.1016/j.carrev.2008.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 05/19/2008] [Indexed: 01/10/2023]
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Abdel Hakim DE, Garot P, Champagne S, Maklady F, El Hawary A, Dubois-Randé JL, Lesault PF, Teiger E. Impact of bifurcation lesions on clinical outcome and prognosis of primary angioplasty in acute myocardial infarction. EUROINTERVENTION 2008; 4:93-8. [DOI: 10.4244/eijv4i1a16] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Louvard Y, Thomas M, Dzavik V, Hildick-Smith D, Galassi AR, Pan M, Burzotta F, Zelizko M, Dudek D, Ludman P, Sheiban I, Lassen JF, Darremont O, Kastrati A, Ludwig J, Iakovou I, Brunel P, Lansky A, Meerkin D, Legrand V, Medina A, Lefèvre T. Classification of coronary artery bifurcation lesions and treatments: Time for a consensus! Catheter Cardiovasc Interv 2008; 71:175-83. [DOI: 10.1002/ccd.21314] [Citation(s) in RCA: 231] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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11
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Moyer CD, Berger PB, White CJ. Drug-Eluting Coronary Stents. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Pugliese F, Cademartiri F, van Mieghem C, Meijboom WB, Malagutti P, Mollet NRA, Martinoli C, de Feyter PJ, Krestin GP. Multidetector CT for visualization of coronary stents. Radiographics 2006; 26:887-904. [PMID: 16702461 DOI: 10.1148/rg.263055182] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Whereas the clinical diagnosis of in-stent thrombosis is straightforward, that of in-stent restenosis remains a problem, because although many patients experience chest pain after coronary stent placement, that symptom is secondary to ischemia in only a few. The use of a noninvasive technique to identify such patients for early invasive intervention versus more conservative management is thus highly desirable. Multidetector computed tomography (CT) performed with 16-section scanners recently emerged as such a technique and has overtaken modalities such as electron-beam CT and magnetic resonance imaging as an alternative to conventional angiography for the assessment of in-stent restenosis. The improved hardware design of the current 64-section CT scanners allows even better delineation of stent struts and lumen. The more reliable criterion of direct lumen visualization thus may be substituted for the presence of distal runoff, which lacks specificity for a determination of in-stent patency because of the possibility of collateral pathways. However, the capability to accurately visualize the in-stent lumen depends partly on knowledge of the causes of artifacts and how they can be compensated for with postprocessing and proper image display settings. In addition, an understanding of the major stent placement techniques used in the treatment of lesions at arterial bifurcations is helpful.
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Affiliation(s)
- Francesca Pugliese
- Department of Radiology, Erasmus MC, Dr Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands.
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Díaz de la Llera LS, Ballesteros SM, Guisado A, Aguilera A, Campos A, Sánchez Á, Villa M, Retegui G. Tratamiento de las lesiones bifurcadas mediante técnica de crush T stenting: resultados inmediatos y a medio plazo. Rev Esp Cardiol 2006. [DOI: 10.1157/13087898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Levy EI, Ecker RD, Hanel RA, Sauvageau E, Wehman JC, Guterman LR, Hopkins LN. Acute M2 bifurcation stenting for cerebral infarction: lessons learned from the heart: technical case report. Neurosurgery 2006; 58:E588; discussion E588. [PMID: 16528156 DOI: 10.1227/01.neu.0000197522.11613.0c] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Acute ischemic stroke is the third leading cause of death in the United States. For patients with NIHSS scores >10 and evaluated within 6 hours, intra-arterial thrombolysis is the treatment of choice. The Merci retriever (Concentric Medical Inc., Mountain View, CA) and IV TPA are currently the only FDA-approved treatments for acute ischemic stroke. For patients who do not meet the criteria for TPA administration and/or in whom the Merci device fails, options are limited. Intracranial stenting for acute ischemic stroke after failed thrombolysis is now possible because of improved delivery systems and appropriately sized stents. CLINICAL PRESENTATION A 26-year-old woman presented with an NIHSS score of 11 (right-sided hemiparesis and mixed aphasia) 4 hours from the time of symptom onset. CT perfusion demonstrated increased time to peak in the entire left hemisphere; conventional angiography demonstrated a left M1 occlusion. INTERVENTION After crossing the occlusion with a microcatheter, reteplase (2 units) was administered into the clot. Mechanical thrombolysis was then attempted, without restoration of flow. Two 3 x 12-mm coronary stents were placed from the M1 into the superior and inferior divisions, respectively, with complete restoration of flow (TIMI 3). Within 72 hours, the patient had an NIHSS score of 1, with a small infarction in the external capsule. CONCLUSION Novel stroke interventions need to be developed for patients with acute ischemic stroke in whom traditional interventions fail. We present (to our knowledge) the first case of successful revascularization of an acute M1 occlusion accomplished with placement of two coronary stents.
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Affiliation(s)
- Elad I Levy
- Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York 14209, USA
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Brunel P, Lefevre T, Darremont O, Louvard Y. Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: Results of the French multicenter “TULIPE” study. Catheter Cardiovasc Interv 2006; 68:67-73. [PMID: 16763988 DOI: 10.1002/ccd.20800] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In previous prospective studies, a strategy of (a) stenting of the main branch, (b) provisional T-stenting of the side branch, and (c) final kissing balloon inflation, was associated with high success and low target lesion revascularization (TLR) rates on the long-term. OBJECTIVES To examine the performance of this strategy in a multicenter study. METHODS Consecutive patients were treated at 14 French medical centers for de novo coronary bifurcation lesions with the same technique used. Immediate results and clinically-driven TLR at 7 months were examined. RESULTS The mean reference diameters of the main and side branches were 3.2 +/- 0.6 mm and 2.4 +/- 0.5 mm, respectively. The side branch was stented in 34% of patients. A <30% residual stenosis in the main branch was achieved in 99%, <50% in the side branch in 90%, and both in 89% of procedures. The in-hospital major adverse cardiovascular event were a Q-wave and 5 non-Qwaves MI (0.54% and 2.7%). At 7 months of follow-up, 3 patients (1.76%) had died, 1 suffered a non-Q-wave MI (0.59%), and 28 (15.88%) underwent TLR. By multivariate analysis, a lower left ventricular ejection fraction (OR: 0.934), moderate calcifications (OR: 7.86), and non-use of the "jailed" wire technique (OR: 4.26) were associated with reinterventions during follow-up. CONCLUSIONS A strategy of provisional T-stenting with a tubular stent and final kissing balloon angioplasty for the treatment of coronary bifurcation lesions was safe and associated with a low TLR rate at 7 months. This strategy should be applicable to the new era of drug eluting stents.
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Affiliation(s)
- Philippe Brunel
- Unité de Soins et de Cardiologie Interventionnelle, Nouvelles Cliniques Nantaises, Nantes, France.
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Costa RA, Mintz GS, Carlier SG, Lansky AJ, Moussa I, Fujii K, Takebayashi H, Yasuda T, Costa JR, Tsuchiya Y, Jensen LO, Cristea E, Mehran R, Dangas GD, Iyer S, Collins M, Kreps EM, Colombo A, Stone GW, Leon MB, Moses JW. Bifurcation Coronary Lesions Treated With the “Crush” Technique. J Am Coll Cardiol 2005; 46:599-605. [PMID: 16098422 DOI: 10.1016/j.jacc.2005.05.034] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Revised: 02/28/2005] [Accepted: 03/10/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We report intravascular ultrasound (IVUS) findings after crush-stenting of bifurcation lesions. BACKGROUND Preliminary results with the crush-stent technique are encouraging; however, isolated reports suggest that restenosis at the side branch (SB) ostium continues to be a problem. METHODS Forty patients with bifurcation lesions underwent crush-stenting with the sirolimus-eluting stent. Postintervention IVUS was performed in both branches in 25 lesions and only the main vessel (MV) in 15 lesions; IVUS analysis included five distinct locations: MV proximal stent, crush area, distal stent, SB ostium, and SB distal stent. RESULTS Overall, the MV minimum stent area was larger than the SB (6.7 +/- 1.7 mm2 vs. 4.4 +/- 1.4 mm2, p < 0.0001, respectively). When only the MV was considered, the minimum stent area was found in the crush area (rather than the proximal or MV distal stent) in 56%. When both the MV and the SB were considered, the minimum stent area was found at the SB ostium in 68%. The MV minimum stent area measured <4 mm2 in 8% of lesions and <5 mm2 in 20%. For the SB, a minimum stent area <4 mm2 was found in 44%, and a minimum stent area <5 mm2 in 76%, typically at the ostium. "Incomplete crushing"--incomplete apposition of SB or MV stent struts against the MV wall proximal to the carina--was seen in >60% of non-left main lesions. CONCLUSIONS In the majority of bifurcation lesions treated with the crush technique, the smallest minimum stent area appeared at the SB ostium. This may contribute to a higher restenosis rate at this location.
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Affiliation(s)
- Ricardo A Costa
- Cardiovascular Research Foundation and Columbia University Medical Center, New York, New York 10022, USA
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Lefèvre T, Ormiston J, Guagliumi G, Schultheiss HP, Quilliet L, Reimers B, Brunel P, Wijns W, Buettner HJ, Hartmann F, Veldhof S, Miquel K, Su X, van der Giessen WJ. The FRONTIER Stent Registry. J Am Coll Cardiol 2005; 46:592-8. [PMID: 16098421 DOI: 10.1016/j.jacc.2005.05.033] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 03/08/2005] [Accepted: 03/22/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate the safety and performance of the Multi-Link Frontier coronary bifurcation stent system (Guidant Corp., Santa Clara, California), a novel dedicated device designed for permanent side branch (SB) access, stent delivery by simultaneous kissing balloon inflation, and optimal main branch (MB) and SB ostium scaffolding. BACKGROUND The treatment of coronary bifurcation lesions remains challenging, and various approaches using stents have been proposed. METHODS The primary end point was the 180-day incidence of major adverse cardiac events (MACE) per intent-to-treat analysis. Secondary end points included device success, 30-day MACE, angiographic restenosis, and target lesion revascularization (TLR) rates at 180 days. RESULTS After a learning phase of two cases per center, 105 patients were prospectively included in 11 centers. The left anterior descending coronary artery/diagonal bifurcation was the target in 80% of cases. The Frontier stent was successfully implanted in 96 patients (91%), and procedural success was obtained in 93%. Two patients suffered in-hospital myocardial infarction (MI) secondary to SB occlusion, and one patient underwent elective coronary artery bypass grafting. At 30 days and 6 months, the MACE rates were 2.9% and 17.1% (no death, no subacute stent thrombosis, Q-wave MI 1.0% and 1.9%, non-Q-wave MI 1.0% and 1.9%, TLR 1.0% and 13.3%). The MB in-stent restenosis was 25.3%, in-segment 29.9%. The SB restenosis was 29.1%. The overall restenosis rate for any branch was 44.8%. CONCLUSIONS The results of this Frontier registry demonstrate the safety and performance of this dedicated stent system for the treatment of bifurcation lesions. The device can be successfully implanted in more than 90% of all cases, with a high procedural success rate and low 30-day and 6-month MACE rates.
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Garot P, Lefèvre T, Savage M, Louvard Y, Bamlet WR, Willerson JT, Morice MC, Holmes DR. Nine-Month Outcome of Patients Treated by Percutaneous Coronary Interventions for Bifurcation Lesions in the Recent Era. J Am Coll Cardiol 2005; 46:606-12. [PMID: 16098423 DOI: 10.1016/j.jacc.2005.01.065] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 01/11/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this research was to determine the influence of bifurcation lesions on the outcome of patients undergoing percutaneous coronary intervention (PCI) in the recent era. BACKGROUND The treatment of bifurcation lesions by PCI has been associated with an increased complication rate. Whether recent improvements of interventional practice have translated into improved outcomes in this patient subgroup is unknown. METHODS The 11,482 patients enrolled in the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) were stratified according to the presence (n = 1,412) or absence (n = 10,068) of at least one bifurcation lesion treated by PCI. Baseline characteristics and outcome of patients undergoing PCI for bifurcation lesions were compared to those of patients treated for nonbifurcation lesions. RESULTS Patients treated for bifurcation lesions were less likely to have prior myocardial infarction (MI), prior coronary artery bypass graft surgery, and had a higher proportion of current stable angina (p < 0.01 for all comparisons). Bifurcation lesions involved more frequently the left anterior descending coronary artery and were more complex (angulated, eccentric, ostial, and tortuous) than nonbifurcation lesions. Percutaneous coronary intervention of bifurcation lesions was characterized by less frequent stent implantation (71% vs. 80%); PCI of bifurcation lesions was associated with an increased rate of combined end point death/MI/target vessel revascularization (TVR) at nine months (18% vs. 15%, p = 0.002) because of increased rates of TVR (17% vs. 14%, p < 0.001), whereas death (1%) and MI (1%) were not different between groups. CONCLUSIONS Percutaneous coronary intervention of bifurcation lesions is associated with higher TVR at follow-up. However, the risk of death, MI, death/MI was similar in patients treated for bifurcation or nonbifurcation lesions.
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Sharma SK. Simultaneous kissing drug-eluting stent technique for percutaneous treatment of bifurcation lesions in large-size vessels. Catheter Cardiovasc Interv 2005; 65:10-6. [PMID: 15810018 DOI: 10.1002/ccd.20363] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Treatment of bifurcation lesions is associated with high procedural complications and restenosis rate due to plaque shift, suboptimal angiographic results, difficulty in crossing the stent struts, and incomplete coverage of the side-branch ostium. The simultaneous kissing stent (SKS) technique involves two stents, one in main vessel (MV) and one in the side branch (SB) with overlapping stents in the MV proximally, extending proximally the carina of bifurcation. We analyzed our first 200 consecutive patients (202 lesions) who underwent SKS technique for true bifurcation lesions using sirolimus eluting stents, with a minimum follow-up of 6 months. Procedural success was 100% for MV and 99% for SB using SKS technique, with clinical success rate of 97%. In-hospital and 30-day major adverse cardiac events were 3% and 5%, respectively, with a procedure time of 36 +/- 14 min. At mean follow-up of 9 +/- 2 months, the incidence of target lesion revascularization was 4% in the entire group. Therefore, SKS technique using sirolimus-eluting stents may become an effective treatment strategy for large-size bifurcation lesions. However, in order to establish its superiority, SKS technique needs to be compared in a randomized manner with conventional stent techniques.
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Affiliation(s)
- Samin K Sharma
- Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai Hospital, 1 Gustave Levy Place, New York, NY 10029, USA.
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Sharma SK, Choudhury A, Lee J, Kim MC, Fisher E, Steinheimer AM, Kini AS. Simultaneous kissing stents (SKS) technique for treating bifurcation lesions in medium-to-large size coronary arteries. Am J Cardiol 2004; 94:913-7. [PMID: 15464676 DOI: 10.1016/j.amjcard.2004.06.027] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Revised: 06/15/2004] [Accepted: 06/15/2004] [Indexed: 11/15/2022]
Abstract
The treatment of bifurcation lesions (BLs) is associated with high procedural complication and restenosis rates. Two techniques of BL interventions were compared: the simultaneous kissing stents (SKS) technique, involving 2 stents, 1 in the main vessel and 1 in the side branch (n = 100), and the conventional stent strategy (CSS) technique, involving a stent in the main vessel and provisional stenting for the side branch (n = 100). In-hospital and 30-day major adverse cardiac events were greater in the CSS group, with significantly less procedure time with the SKS technique. The incidence of target lesion revascularization was 5% in the SKS group and 18% in the CSS group (p = 0.007). Therefore, the SKS technique seems to be rapid, safe, and effective for the treatment of medium- to large-size BLs, with a trend toward fewer acute complications and promising mid-term results.
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Yue N, Roberts KB, Son H, Khosravi S, Pfau SE, Nath R. Optimization of dose distributions for bifurcated coronary vessels treated with catheter-based photon and beta emitters using the simulated annealing algorithm. Med Phys 2004; 31:2610-22. [PMID: 15487744 DOI: 10.1118/1.1783533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The dose distributions in the bifurcated vessels treated with a catheter-based delivery system are complicated by the geometry of bifurcation consisting of a main and a branch vessel at different angles, and it is difficult to generate satisfactory dose distributions. We hypothesize that increasing the number of dwell positions can result in better dose distributions. An optimization method based on the simulated annealing was developed to demonstrate the validity of this idea. In this method, the source in the branch treatment was allowed to take up to five dwell positions. A cost function was constructed to deliver the prescription dose to the planning targets with penalties for both overdosing and underdosing. By using the optimization algorithm, it was found that for 90 degrees to 60 degrees bifurcated vessels an optimized single dwell position treatment scheme can be as effective as the schemes that include up to five dwell positions. As the bifurcation angle becomes smaller than 60 degrees, the dose distributions generated with the single dwell position scheme become less satisfactory than the more complicated treatment schemes with multiple dwell positions. By using a three-dwell-position treatment scheme for the 192Ir source, the overdosing can be kept under 166% even at a bifurcation angle of 20 degrees.
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Affiliation(s)
- Ning Yue
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8040, USA.
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Colombo A, Stankovic G, Orlic D, Corvaja N, Liistro F, Airoldi F, Chieffo A, Spanos V, Montorfano M, Di Mario C. Modified T-stenting technique with crushing for bifurcation lesions: immediate results and 30-day outcome. Catheter Cardiovasc Interv 2004; 60:145-51. [PMID: 14517916 DOI: 10.1002/ccd.10622] [Citation(s) in RCA: 216] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We report a new stenting technique employed in 20 consecutive patients to treat true bifurcation lesions using the Cypher stent (Cordis, Warren, NJ). Both stents are advanced at the site of the bifurcation. The proximal marker of the side-branch stent must be situated in the main branch at a distance of 4-5 mm proximal to the carina of the bifurcation and the main branch stent must cover the bifurcation as well as the protruding segment of the side-branch stent. The side-branch stent is deployed first and balloon and wire are removed. The stent deployed in the main branch completely covers and crushes the protruding segment of the side branch stent against the vessel wall of the main branch. Following main- and side-branch predilatation, stents were successfully deployed in all lesions. Final kissing balloon inflation was performed in seven patients. Two patients had in-hospital myocardial infarction and one patient underwent in-hospital re-PTCA due to a dissection distal to a stent. No other major adverse cardiac events were observed in-hospital and during 1-month clinical follow-up. Treatment of bifurcation lesions using crushing stent technique is feasible with acceptable rate of procedural complications. Angiographic follow-up is necessary to prove the advantage of this specific technique to give complete coverage of the ostium of the side branch with a drug-eluting stent.
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Klein LW. The bifurcation lesion: more evidence that a new lesion classification system should be widely adopted. Catheter Cardiovasc Interv 2002; 55:434-5. [PMID: 11948887 DOI: 10.1002/ccd.10147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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