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He Y, Shen B, Song M, Nienaber CA, Zheng Y, Lu X, Xiao Q, Yang X, Bi S, Jin J. Buddy Balloon versus Buddy Wire Technique Regarding Accuracy of Stent Placement during Percutaneous Coronary Intervention. Int Heart J 2022; 63:654-660. [PMID: 35831149 DOI: 10.1536/ihj.21-841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We aimed to evaluate whether the buddy balloon technique (BBT) is superior to the buddy wire technique (BWT) with regard to the accuracy of stent placement during percutaneous coronary intervention (PCI).We enrolled patients who had been identified with significant stent movement before the stent was dilated at five hospitals and were randomly converted to either the BBT or BWT technique. The primary endpoints were the incidence of technical success and major adverse cardiovascular events (cardiac death, myocardial infarction, target lesion revascularization, and in-stent restenosis) at 2 years of follow-up. The secondary endpoints were the contrast volume used for the procedure and the total procedural time.From August 2018 to July 2019, 66 patients were enrolled, with 33 patients in each group. All patients were successfully followed up to 2 years. At the primary endpoints, compared with patients treated using BWT, those in the BBT group showed significantly better technical success (93.94% versus 39.39%, respectively; P < 0.0001). There was no significant difference in the incidence of major cardiovascular adverse events (6.06% versus 12.12%, respectively; P = 0.392). At the secondary endpoints, the contrast volume used for the procedure was lower with BBT (85.97 ± 22.45 versus 115.00 ± 21.45 mL, respectively; P < 0.0001); similarly, the total procedural time was shorter with BBT (65.94 ± 12.14 versus 74.33 ± 15.36 minutes, respectively; P < 0.0001).BBT could better restrict stent movement and facilitate precise stent deployment, with significant superiority over BWT. In addition, BBT can reduce the procedural time and contrast dose.
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Affiliation(s)
- Yun He
- Department of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital
| | - Bin Shen
- Department of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital
| | - MingBao Song
- Department of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital
| | - Christoph A Nienaber
- Department of Cardiology, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College
| | - Yi Zheng
- Department of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital
| | - XueMei Lu
- Department of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital
| | - Qing Xiao
- Department of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital
| | - XiaoLing Yang
- Department of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital
| | - Shuo Bi
- Department of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital
| | - Jun Jin
- Institute of Cardiovascular Diseases of PLA, Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University)
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Zhou Y, Chen S, Huang L, Hildick-Smith D, Ferenc M, Jabbour RJ, Azzalini L, Colombo A, Chieffo A, Zhao X. Definite stent thrombosis after drug-eluting stent implantation in coronary bifurcation lesions: A meta-analysis of 3,107 patients from 14 randomized trials. Catheter Cardiovasc Interv 2017; 92:680-691. [PMID: 29214736 DOI: 10.1002/ccd.27443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/06/2017] [Accepted: 11/11/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Yu Zhou
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
| | - Shengda Chen
- State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University; China
- IBiTech, bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT Department; Ghent University; De Pintelaan Ghent Belgium
| | - Lan Huang
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
| | - David Hildick-Smith
- Sussex Cardiac Centre; Brighton and Sussex University Hospitals; Brighton United Kingdom
| | - Miroslaw Ferenc
- The Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen, Suedring 15, Bad Krozingen; Germany
| | | | | | | | - Alaide Chieffo
- Cardiology Department; San Raffaele Hospital; Milan Italy
| | - Xiaohui Zhao
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
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Zhang P, Chen D, Tian D, Zhang Q, Wang M, Li Q, Luo X. Simultaneous Kissing Stenting: A Valuable Technique for Reconstructing the Stenotic Initial Segment of the Right Subclavian Artery. INTERVENTIONAL NEUROLOGY 2017; 6:65-72. [PMID: 28611836 DOI: 10.1159/000455288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022]
Abstract
Atherosclerotic stenosis or occlusion often involves the subclavian artery. For lesions that are close to the orifice of the right subclavian artery, stenting of the right subclavian artery itself blocks the pathway from the innominate artery to the right carotid artery and causes problems in patients with multiple angiostenosis, especially involving the right carotid system. In this study, we report 2 cases using simultaneous kissing stenting (SKS) of the right subclavian artery and the right carotid artery to relieve right subclavian stenosis and maintain right carotid system patency. Standard stenting methods were used to perform SKS. Two self-expanding stents were implanted simultaneously into the initial segment of the right subclavian artery and the right carotid artery, forming a "Y" shape, with the overlap of the proximal segments in the innominate artery ≥5 mm. After SKS, the stenosed right subclavian artery was dilated, and the patency of the right carotid system was maintained. The symptoms of patients were relieved and the stents were intact at several months of follow-up. In conclusion, SKS of the right subclavian artery and the right carotid artery might be a safe and effective procedure when the stenotic or occlusive lesion in the initial segment of the right subclavian artery is close to the orifice, and lesions (or potential ones) exist in the right carotid system.
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Affiliation(s)
- Ping Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Daiqi Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Daishi Tian
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Qiang Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Minghuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Qian Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Xiang Luo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Lotfi A, Simmons A, Barber T. Evaluation of Different Meshing Techniques for the Case of a Stented Artery. J Biomech Eng 2016; 138:4032502. [PMID: 26784359 DOI: 10.1115/1.4032502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Indexed: 02/01/2023]
Abstract
The formation and progression of in-stent restenosis (ISR) in bifurcated vessels may vary depending on the technique used for stenting. This study evaluates the effect of a variety of mesh styles on the accuracy and reliability of computational fluid dynamics (CFD) models in predicting these regions, using an idealized stented nonbifurcated model. The wall shear stress (WSS) and the near-stent recirculating vortices are used as determinants. The meshes comprise unstructured tetrahedral and polyhedral elements. The effects of local refinement, as well as higher-order elements such as prismatic inflation layers and internal hexahedral core, have also been examined. The uncertainty associated with individual mesh style was assessed through verification of calculations using the grid convergence index (GCI) method. The results obtained show that the only condition which allows the reliable comparison of uncertainty estimation between different meshing styles is that the monotonic convergence of grid solutions is in the asymptotic range. Comparisons show the superiority of a flow-adaptive polyhedral mesh over the commonly used adaptive and nonadaptive tetrahedral meshes in terms of resolving the near-stent flow features, GCI value, and prediction of WSS. More accurate estimation of hemodynamic factors was obtained using higher-order elements, such as hexahedral or prismatic grids. Incorporating these higher-order elements, however, was shown to introduce some degrees of numerical diffusion at the transitional area between the two meshes, not necessarily translating into high GCI value. Our data also confirmed the key role of local refinement in improving the performance and accuracy of nonadaptive mesh in predicting flow parameters in models of stented artery. The results of this study can provide a guideline for modeling biofluid domain in complex bifurcated arteries stented in regards to various stenting techniques.
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Sgueglia GA, D'Errico F, Gaspardone A. One-shot 86-mm slender transradial bifurcation stenting. Int J Cardiol 2016; 203:1100-2. [PMID: 26642372 DOI: 10.1016/j.ijcard.2015.11.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 11/30/2022]
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6
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Kherada NI, Sartori S, Tomey MI, Mennuni MG, Meelu OA, Roy S, Mohanty BD, Baber U, Pyo R, Kovacic JC, Sweeny J, Moreno P, Krishnan P, Dangas GD, Mehran R, Sharma SK, Kini AS. Dedicated two-stent technique in complex bifurcation percutaneous coronary intervention with use of everolimus-eluting stents: the EES-bifurcation study. Int J Cardiol 2014; 174:13-7. [PMID: 24731975 DOI: 10.1016/j.ijcard.2014.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/09/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the outcomes of initial one-stent (1S) versus dedicated two-stent (2S) strategies in complex bifurcation percutaneous coronary intervention (PCI) using everolimus-eluting stents (EES). BACKGROUND PCI of true bifurcation lesions is technically challenging and historically associated with reduced procedural success and increased restenosis. Prior studies comparing initial one-stent (1S) versus dedicated two-stent (2S) strategies using first-generation drug-eluting stents have shown no reduction in ischemic events and more complications with a 2S strategy. METHODS We performed a retrospective study of 319 consecutive patients undergoing PCI at a single referral center with EES for true bifurcation lesions, defined by involvement of both the main vessel (MV) and side branch (SB). Baseline, procedural characteristics, quantitative coronary angiography and clinical outcomes in-hospital and at one year were compared for patients undergoing 1S (n=175) and 2S (n=144) strategies. RESULTS Baseline characteristics were well-matched. 2S strategy was associated with greater SB acute gain (0.65±0.41 mm vs. 1.11±0.47 mm, p<0.0001). In-hospital serious adverse events were similar (9% with 2S vs. 8% with 1S, p=0.58). At one year, patients treated by 2S strategy had non-significantly lower rates of target vessel revascularization (5.8% vs. 7.4%, p=0.31), myocardial infarction (7.8% vs. 12.2%, p=0.31) and major adverse cardiovascular events (16.6% vs. 21.8%, p=0.21). CONCLUSION In this study of patients undergoing PCI for true coronary bifurcation lesions using EES, 2S strategy was associated with superior SB angiographic outcomes without excess complications or ischemic events at one year.
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Affiliation(s)
- Nisharahmed I Kherada
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Matthew I Tomey
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marco G Mennuni
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Omar A Meelu
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Swathi Roy
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bibhu D Mohanty
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Robert Pyo
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jason C Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Pedro Moreno
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Prakash Krishnan
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
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7
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Dash D. Recent perspective on coronary artery bifurcation interventions. HEART ASIA 2014; 6:18-25. [PMID: 27326157 PMCID: PMC4832703 DOI: 10.1136/heartasia-2013-010451] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/17/2014] [Indexed: 02/03/2023]
Abstract
Coronary bifurcation lesions are frequent in routine practice, accounting for 15-20% of all lesions undergoing percutaneous coronary intervention (PCI). PCI of this subset of lesions is technically challenging and historically has been associated with lower procedural success rates and worse clinical outcomes compared with non-bifurcation lesions. The introduction of drug-eluting stents has dramatically improved the outcomes. The provisional technique of implanting one stent in the main branch remains the default approach in most bifurcation lesions. Selection of the most effective technique for an individual bifurcation is important. The use of two-stent techniques as an intention to treat is an acceptable approach in some bifurcation lesions. However, a large amount of metal is generally left unapposed in the lumen with complex two-stent techniques, which is particularly concerning for the risk of stent thrombosis. New technology and dedicated bifurcation stents may overcome some of the limitations of two-stent techniques and revolutionise the management of bifurcation PCI in the future.
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Džavík V, Kaul U, Guagliumi G, Chevalier B, Smits PC, Stuteville M, Li D, Sudhir K, Grube E. Two-year outcomes after deployment of XIENCE V everolimus-eluting stents in patients undergoing percutaneous coronary intervention of bifurcation lesions: a report from the SPIRIT V single arm study. Catheter Cardiovasc Interv 2013; 82:E163-72. [PMID: 23225766 DOI: 10.1002/ccd.24775] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 11/20/2012] [Accepted: 12/02/2012] [Indexed: 11/10/2022]
Abstract
The aim of this analysis was to analyze outcomes of patients undergoing Xience V EES treatment of bifurcation lesions, a subset in which treatment is particularly challenging. The SPIRIT V Study provided an evaluation of the Xience V everolimus eluting stent (EES) performance in complex patient and lesion population. The SPIRIT V Single Arm Study enrolled 2700 patients with de novo coronary artery lesions suitable to be optimally treated with a maximum of four planned Xience V EES. Lesion evaluation was by visual assessment. The outcomes of the 492 patients undergoing Xience V EES stenting of ≥1 bifurcation lesion were compared to those with no bifurcation lesion treated. Compared to those without bifurcation treatment, patients with bifurcation treatment were more likely to have multi-vessel disease (49% vs 40%), left main treatment (3.1% vs 0.9%), more lesions treated (1.5 vs 1.3), calcification (36.4% vs 27.5%), and ostial (17.1% vs 8.2%) and angulated lesions (29.3% vs 21.1%), all P < 0.001. The 30-day composite rate of death, myocardial infarction (MI), target vessel revascularization (TVR) was 4.3% in patients with bifurcation PCI and 2.2% in those with non-bifurcation PCI (P = 0.017). At 2 years, this composite event rate was 11.3% and 10.0% in these two groups, respectively (P = 0.403). Rates of cardiac death, MI, target lesion revascularization (TLR), TVR, and ARC defined definite or probable stent thrombosis (0.4% vs 0.9%, P = 0.402) were not significantly different between the two groups. Despite greater patient and lesion complexity, treatment of patients with bifurcation lesions using the Xience V EES in the SPIRIT V prospective Single Arm Study was safe and effective, with low overall event rates that were similar to those without bifurcation lesion treatment. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
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9
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CHEEMA ASIMN, JOLLY SANJITS, BURSTEIN JASONM, SHARIEFF WASEEM, MOHAMMAD ATIF, YEOH EUNICE, MANCINI GJOHN, CANTOR WARRENJ, KUTRYK MICHAELJ, STRAUSS BRADLEYH, CHISHOLM ROBERTJ. Angiographic and Clinical Outcomes after Implantation of Drug Eluting Stents in Bifurcation Lesions with Crush or Kissing Stent Technique. J Interv Cardiol 2013; 26:145-52. [DOI: 10.1111/j.1540-8183.2013.12022.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- ASIM N. CHEEMA
- Terrence Donnelly Heart Center, Division of Cardiology, St. Michael's Hospital; Toronto, Ontario; Canada
| | - SANJIT S. JOLLY
- Terrence Donnelly Heart Center, Division of Cardiology, St. Michael's Hospital; Toronto, Ontario; Canada
| | - JASON M. BURSTEIN
- Terrence Donnelly Heart Center, Division of Cardiology, St. Michael's Hospital; Toronto, Ontario; Canada
| | | | - ATIF MOHAMMAD
- Terrence Donnelly Heart Center, Division of Cardiology, St. Michael's Hospital; Toronto, Ontario; Canada
| | - EUNICE YEOH
- Cardiovascular Imaging Research Core Laboratory, Vancouver General Hospital; Vancouver, British Columbia; Canada
| | - G.B. JOHN MANCINI
- Cardiovascular Imaging Research Core Laboratory, Vancouver General Hospital; Vancouver, British Columbia; Canada
| | - WARREN J. CANTOR
- Terrence Donnelly Heart Center, Division of Cardiology, St. Michael's Hospital; Toronto, Ontario; Canada
| | - MICHAEL J.B. KUTRYK
- Terrence Donnelly Heart Center, Division of Cardiology, St. Michael's Hospital; Toronto, Ontario; Canada
| | - BRADLEY H. STRAUSS
- Terrence Donnelly Heart Center, Division of Cardiology, St. Michael's Hospital; Toronto, Ontario; Canada
| | - ROBERT J. CHISHOLM
- Terrence Donnelly Heart Center, Division of Cardiology, St. Michael's Hospital; Toronto, Ontario; Canada
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Dash D. Stenting of left main coronary artery stenosis: A to Z. HEART ASIA 2013; 5:18-27. [PMID: 27326065 DOI: 10.1136/heartasia-2012-010218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 12/26/2012] [Accepted: 12/28/2012] [Indexed: 11/03/2022]
Abstract
For several decades, coronary artery bypass grafting (CABG) has been considered as the gold standard treatment of unprotected left main coronary artery (LMCA) disease. The marked improvement in technique and technology makes percutaneous coronary interventions (PCIs) feasible for patients with unprotected LMCA stenosis. The recent introduction of drug-eluting stents (DESs), together with advances in periprocedural and postprocedural adjunctive pharmacotherapies, has improved outcomes of PCIs of these lesions. Recent studies comparing efficacy and safety of PCIs using drug-eluting stents and CABG revealed comparable results in terms of safety and a lower need for repeat revascularisation for CABG. Patient selection for both the techniques directly impacts clinical outcome. Despite improvement in stent technology and operator experience, management can be challenging especially in LMCA bifurcation lesions and, therefore, an integrated approach combining advanced devices, tailored techniques, adjunctive support of physiological evaluation, and adjunctive pharmacological agents should be reinforced to improve clinical outcome.
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Affiliation(s)
- Debabrata Dash
- Department of Cardiology , Fortis Raheja Hospital, Cumballa Hill Hospital , Mumbai, Maharastra , India
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Basalus MWZ, Tandjung K, Sen H, van Apeldoorn AA, Grijpma DW, von Birgelen C. Recent insights from scanning electron microscopic assessment of durable polymer-coated drug-eluting stents. Interv Cardiol 2012. [DOI: 10.2217/ica.12.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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12
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Spencer JA, Hermiller JB. Evaluation and treatment of coronary bifurcation disease: current strategies and new technologies. Interv Cardiol 2012. [DOI: 10.2217/ica.12.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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García Del Blanco B, Martí G, Bellera N, Otaegui I, Serra V, Ferreira I, Domingo E, Angel J, Candell J, García-Dorado D. Clinical and procedural evaluation of the Nile Croco® dedicated stent for bifurcations: a single centre experience with the first 151 consecutive non-selected patients. EUROINTERVENTION 2011; 7:216-24. [DOI: 10.4244/eijv7i2a36] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Zago AC, Saadi EK, Zago AJ. Endovascular approach to treat ascending aortic pseudoaneurysm in a patient with previous CABG and very high surgical risk. Catheter Cardiovasc Interv 2011; 78:551-7. [DOI: 10.1002/ccd.23005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 01/20/2011] [Indexed: 11/08/2022]
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Mahmoudi M, Waksman R. Bifurcation stenting: the current state of play. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 13:51-7. [PMID: 21273147 DOI: 10.1016/j.carrev.2010.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/09/2010] [Indexed: 10/18/2022]
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16
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Latib A, Moussa I, Sheiban I, Colombo A. When are two stents needed? Which technique is the best? How to perform? EUROINTERVENTION 2010; 6 Suppl J:J81-7. [DOI: 10.4244/eijv6supja13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Girasis C, Onuma Y, Wong CK, Kukreja N, van Domburg R, Serruys P. Long-term outcome after the V stenting technique in de novo bifurcation lesions using drug-eluting stents. EUROINTERVENTION 2010; 5:197-205. [PMID: 20449930 DOI: 10.4244/eijv5i2a31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To report long-term outcome data on the V technique using drug-eluting stents. METHODS AND RESULTS From April 2002 to December 2006, 31 consecutive patients were successfully treated with V stenting of a de novo bifurcation lesion. The technique involves the deployment of two stents in the two branches of a bifurcation, the proximal edges of the stents just touching one another. Patients exclusively received either sirolimus- (10), paclitaxel- (20) or biolimus-eluting (one) stents. On average, 1.5 +/- 0.8 stents with a total length of 26.6 +/- 17.2 mm and 1.1 +/- 0.4 stents with a total length of 18.3 +/- 7.6 mm were deployed in the distal main vessel and side branch respectively. Mean duration of follow-up was 853 +/- 553 days. Within 30 days, three patients died; two other patients had definite stent thrombosis involving the V stents, both requiring re-PCI. Beyond 30 days and within one year, there was one death and three cases of target vessel revascularisation, including one target lesion revascularisation. There were a further three deaths (one cardiac) beyond one year. Eleven patients (35.5%) had angiographic follow-up, exhibiting a binary restenosis rate of 9.1% at 203 +/- 33 days. CONCLUSIONS In this real-world cohort, late clinical events stand in accord with studies on competitive techniques, but early outcome was less encouraging, probably due to the baseline risks.
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Stinis CT, Hu SPC, Price MJ, Teirstein PS. Three-year outcome of drug-eluting stent implantation for coronary artery bifurcation lesions. Catheter Cardiovasc Interv 2010; 75:309-14. [PMID: 19924774 DOI: 10.1002/ccd.22302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To compare the very long-term clinical outcomes of bifurcation lesions using the crush and the simultaneous kissing stent (SKS) techniques. BACKGROUND A variety of two-stent techniques have been used to treat coronary artery bifurcation lesions in the drug-eluting stent era, but the long-term clinical outcome of these approaches is not known. METHODS A total of 74 consecutive patients underwent bifurcation stenting using either the crush or SKS techniques. Mean patient age was 66.91 + or - 11.3 years; 26% were diabetic, and the left anterior descending/diagonal bifurcation was the most frequently treated lesion (68%). RESULTS In-hospital outcomes were not significantly different between groups. Over a median follow-up of 3.3 years, 1 patient in the SKS group and 3 patients in the crush group died (P = ns). Probable stent thrombosis leading to death according to the Academic Research Consortium definition occurred in 1 patient in the crush group. Mortality in the remaining 3 patients was noncardiac. Target lesion revascularization (TLR) occurred in 14 patients (40%) in the SKS group and 5 patients (12.8%) in the crush group (P = 0.015). Survival free from major adverse cardiac events (MACE) was significantly less in the SKS group and predominantly driven by TLR (60 vs. 88%, P = 0.001). CONCLUSIONS In conclusion, over a median of 3.3 years of follow-up, TLR and MACE are significantly lower in bifurcation lesions treated with the crush technique when compared with the SKS technique. Definite or probable stent thrombosis is rare with either technique.
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Affiliation(s)
- Curtiss T Stinis
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA 92037, USA.
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Niccoli G, Ferrante G, Porto I, Burzotta F, Leone AM, Mongiardo R, Mazzari MA, Trani C, Rebuzzi AG, Crea F. Coronary bifurcation lesions: To stent one branch or both? A meta-analysis of patients treated with drug eluting stents. Int J Cardiol 2010; 139:80-91. [DOI: 10.1016/j.ijcard.2008.10.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Revised: 09/02/2008] [Accepted: 10/12/2008] [Indexed: 11/29/2022]
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Brar S, Gray W, Dangas G, Leon M, Aharonian V, Brar S, Moses J. Bifurcation stenting with drug-eluting stents: a systematic review and meta-analysis of randomised trials. EUROINTERVENTION 2009; 5:475-84. [DOI: 10.4244/eijv5i4a76] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Stankovic G, Darremont O, Ferenc M, Hildick-Smith D, Louvard Y, Albiero R, Pan M, Lassen JF, Lefèvre T. Percutaneous coronary intervention for bifurcation lesions: 2008 consensus document from the fourth meeting of the European Bifurcation Club. EUROINTERVENTION 2009; 5:39-49. [PMID: 19577982 DOI: 10.4244/eijv5i1a8] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Goran Stankovic
- Institute for Cardiovascular Diseases, Clinical Center of Serbia, Belgrade, Serbia.
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Latib A, Colombo A. Bifurcation disease: what do we know, what should we do? JACC Cardiovasc Interv 2009; 1:218-26. [PMID: 19463303 DOI: 10.1016/j.jcin.2007.12.008] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 12/10/2007] [Indexed: 01/17/2023]
Abstract
The percutaneous treatment of coronary bifurcations has moved past an important milestone in that the 1- versus 2-stent debate appears to have been resolved. The provisional approach of implanting one stent on the main branch should be the default approach in most bifurcations lesions. Selection of the most appropriate strategy for an individual bifurcation is important. Some bifurcations require 1 stent, whereas others require the stenting of both branches. Irrespective of whether a 1- or 2-stent strategy is chosen, the results after bifurcation percutaneous coronary intervention (PCI) have dramatically improved. Dedicated bifurcation stents are an exciting new technology that may further simplify the management of bifurcation PCI and change some of these concepts.
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Affiliation(s)
- Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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Suzuki N, Angiolillo DJ, Tannenbaum MA, Driesman MH, Smith C, Bikkina M, Meckel CR, Morales CE, Xenopoulos NP, Coletta JE, Bezerra HG, Bass TA, Costa MA. Strategies for drug-eluting stent treatment of bifurcation coronary artery disease in the United States: Insights from the e-Cypher S.T.L.L.R.Trial. Catheter Cardiovasc Interv 2009; 73:890-7. [DOI: 10.1002/ccd.21796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Prasad SB, Whitbourn R, Malaiapan Y, Ahmar W, MacIsaac A, Meredith IT. Primary percutaneous coronary intervention for acute myocardial infarction caused by unprotected left main stem thrombosis. Catheter Cardiovasc Interv 2009; 73:301-7. [DOI: 10.1002/ccd.21886] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Rigattieri S, Silvestri P, Minucci A, Di Russo C, Ferraiuolo G, Giardina B, Capoluongo E, Loschiavo P. Drug-eluting stents in a patient with favism: is the aspirin administration safe? J Cardiovasc Med (Hagerstown) 2009; 9:1159-62. [PMID: 18852594 DOI: 10.2459/jcm.0b013e32831103c3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe the case of a 64-year-old patient with glucose-6-phosphate dehydrogenase deficiency who was referred to our hospital because of an acute inferior myocardial infarction.Given the possible risk of acute haemolytic anaemia, aspirin was not given in the acute phase, and the patient was successfully treated by balloon angioplasty of the right coronary artery.After functional and genetic testing showing the presence of the Mediterranean mutation, known to be a class II variant, the patient received oral daily aspirin (100 mg) under strict monitoring in order to promptly detect any sign of haemolysis. After 4 days, a complex percutaneous coronary intervention with an implantation of two drug-eluting stents was successfully performed on the left coronary artery. After 3 months, the patient is free from adverse events.Glucose-6-phosphate dehydrogenase deficiency is commonly considered a contraindication to aspirin intake; however, this case shows that aspirin at low, antiplatelet dosage is well tolerated and should not be denied to patients with ischaemic heart disease and complex coronary anatomy.
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Varbella F, Gagnor A, Tomassini F, Infantino V, Conte MR. Immediate and long-term results of treatment of complex lesions of the left anterior descending coronary artery involving a large diagonal branch with drug-eluting stents. J Cardiovasc Med (Hagerstown) 2008; 9:1088-94. [DOI: 10.2459/jcm.0b013e328304ab09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Waksman R, Bonello L. The 5 Ts of Bifurcation Intervention: Type, Technique, Two Stents, T-Stenting, Trials. JACC Cardiovasc Interv 2008; 1:366-8. [DOI: 10.1016/j.jcin.2008.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 06/19/2008] [Indexed: 10/21/2022]
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Abstract
Percutaneous coronary intervention (PCI) for bifurcation lesions is technically limited by the risk of side branch occlusion. In comparison with nonbifurcation interventions, bifurcation interventions have a lower rate of procedural success, higher procedural costs and a higher rate of clinical and angiographic restenosis. The recent introduction of drug-eluting stents (DES) has resulted in reduced incidence of main vessel restenosis compared with historical controls. However, side-branch ostial residual stenosis and long-term restenosis still remain problematic. In the era of DES, techniques employing two stents have emerged that allow stenting of the large side branch in addition to the main artery. Stenting of the main vessel with provisional side branch stenting seems to be the prevailing approach. This paper reviews outcome data with different treatment modalities for this complex lesion with particular emphasis on the use of DES as well as potential new therapeutic approaches.
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Affiliation(s)
- Rishi Sukhija
- Division of Cardiology, Department of Medicine, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jawahar L. Mehta
- Division of Cardiology, Department of Medicine, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Department of Medicine, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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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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Takahashi H, Letourneur D, Grainger DW. Delivery of large biopharmaceuticals from cardiovascular stents: a review. Biomacromolecules 2007; 8:3281-93. [PMID: 17929968 PMCID: PMC2606669 DOI: 10.1021/bm700540p] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This review focuses on new and emerging large-molecule bioactive agents delivered from stent surfaces in drug-eluting stents (DESs) to inhibit vascular restenosis in the context of interventional cardiology. New therapeutic agents representing proteins, nucleic acids (small interfering RNAs and large DNA plasmids), viral delivery vectors, and even engineered cell therapies require specific delivery designs distinct from traditional smaller-molecule approaches on DESs. While small molecules are currently the clinical standard for coronary stenting, extension of the DESs to other lesion types, peripheral vasculature, and nonvasculature therapies will seek to deliver an increasingly sophisticated armada of drug types. This review describes many of the larger-molecule and biopharmaceutical approaches reported recently for stent-based delivery with the challenges associated with formulating and delivering these drug classes compared to the current small-molecule drugs. It also includes perspectives on possible future applications that may improve safety and efficacy and facilitate diversification of the DESs to other clinical applications.
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Affiliation(s)
- Hironobu Takahashi
- Department of Pharmaceutics and Pharmaceutical Chemistry, 30 South 2000 East, University of Utah, Salt Lake City, UT 84112-5280, USA
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Cheema A, Hong T. Buddy wire technique for stent placement at non-aorto ostial coronary lesions. Int J Cardiol 2007; 118:e75-80. [PMID: 17400315 DOI: 10.1016/j.ijcard.2007.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Accepted: 01/02/2007] [Indexed: 11/28/2022]
Abstract
Percutaneous coronary intervention (PCI) of coronary non-aorto ostial lesions offers technical challenges not encountered with other lesion sub types. Stenting of these lesions improves acute angiographic result and lowers the rate of restenosis. However, precise stent placement at non-aorto ostial lesions is technically difficult with risk of incomplete lesion coverage or jailing of the main branch. In this report, we describe a buddy wire technique to facilitate precise stent placement at non-aorto ostial lesions.
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Assali AR, Assa HV, Ben-Dor I, Teplitsky I, Solodky A, Brosh D, Fuchs S, Kornowski R. Drug-eluting stents in bifurcation lesions: to stent one branch or both? Catheter Cardiovasc Interv 2007; 68:891-6. [PMID: 17086532 DOI: 10.1002/ccd.20870] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The objective of this study was to compare two techniques to treat bifurcation lesions: a single drug-eluting stent (DES) implanted in the main branch combined with balloon dilatation for the side branch vs. stenting of both branches (double stent). BACKGROUND Percutaneous coronary intervention in coronary bifurcation lesions remains challenging. Although DES reduce restenosis in lesions, the double stent procedure has not shown clear advantages over a single stent with balloon dilation. METHODS Fifty-three symptomatic patients with true bifurcation lesions were treated using either the double stent technique (n = 25) or one stent in the parent vessel plus balloon angioplasty of the side branch (n = 28). Procedural results and major adverse cardiac event rates (MACE: cardiac death, myocardial infarction, target vessel revascularization (TVR)) were compared. RESULTS Angiographic procedural success (residual stenosis <30% in both branches) was 75% in the single stent group and 100% in the double stent group (P = 0.01). All differences were due to residual stenosis of the side branch. Clinical follow-up (6-18 months) was available for all patients; 90.5% of patients had a coronary angiography or nuclear stress test. Three patients (11%) in the single stent group and two (8%) in the double stent group had ischemia-driven TVR (P = NS). Asymptomatic angiographic restenosis (>50% diameter stenosis) in the ostium of the side branch was seen in two patients in the double-stent group. At 6 months, MACE-free was comparable between groups (89.3% vs. 88%, P = 0.7). CONCLUSIONS When treating bifurcation lesions with sirolimus-eluting stents, restenosis following a single stent procedure is comparable to stenting both parent and side branch vessels. Thus, stenting the main-branch lesion, coupled with balloon angioplasty in the side branch, produces a high success rate and good clinical outcomes at 6 months.
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Affiliation(s)
- Abid R Assali
- Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
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Kaplan AV. Double barrel stenting of the left main: proceed with caution. Catheter Cardiovasc Interv 2007; 69:216-7. [PMID: 17253605 DOI: 10.1002/ccd.20989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Schlundt C, Kreft JG, Fuchs F, Achenbach S, Daniel WG, Ludwig J. Three-dimensional on-line reconstruction of coronary bifurcated lesions to optimize side-branch stenting. Catheter Cardiovasc Interv 2007; 68:249-53. [PMID: 16830353 DOI: 10.1002/ccd.20653] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Christian Schlundt
- Department of Internal Medicine 2, University Hospital Erlangen, Germany.
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Kim YH, Park DW, Suh IW, Jang JS, Hwang ES, Jeong YH, Lee SW, Lee SW, Lee CW, Hong MK, Kim JJ, Park SW, Park SJ. Long-term outcome of simultaneous kissing stenting technique with sirolimus-eluting stent for large bifurcation coronary lesions. Catheter Cardiovasc Interv 2007; 70:840-6. [PMID: 17621657 DOI: 10.1002/ccd.21254] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study was conducted to evaluate the outcomes of simultaneous kissing stenting with sirolimus-eluting stent (SES). BACKGROUND Percutaneous intervention for bifurcation coronary lesions is still challenging. METHODS This study was designed to evaluate the long-term outcomes of 36 consecutive patients with large bifurcation coronary lesions who underwent simultaneous kissing stenting with SES. RESULTS Lesion location was unprotected left main in 29 patients (81%) and anterior descending artery in 7 (19%). The patients received a combination of aspirin and clopidogrel for 6 months and cilostazol for 1 month. Mean proximal reference diameter was 4.05 +/- 0.68 mm. Compared with the side branch (SB), the main vessel (MV) involved longer lesions (25.8 +/- 17.0 mm vs. 10.2 +/- 10.8 mm, P < 0.001) and smaller preprocedural minimal lumen diameters (1.02 +/- 0.53 mm vs. 1.46 +/- 0.78 mm, P = 0.006) and was treated with larger stents (3.1 +/- 0.3 mm vs. 3.0 +/- 0.3 mm, P = 0.006). Angiographic success rate was 100%. Over the follow-up of 26.7 +/- 8.6 months, no deaths, myocardial infarctions or stent thromboses occurred. Target lesion revascularization was performed in five patients (14%). Overall angiographic restenosis occurred in 5/30 patients (17%), consisting of 4 (13%) at MV and 3 (10%) at SB. At follow-up angiography, a membranous diaphragm at the carina was identified in 14 patients (47%), but only one of whom was associated with angiographic restenosis. CONCLUSION Simultaneous kissing stenting with SES appears a feasible stenting technique in large bifurcation coronary lesions. However, a new angiographic structure of carinal membrane developed in a half of patients at follow-up and its influence needs to be further investigated.
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Affiliation(s)
- Young-Hak Kim
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Morton AC, Siotia A, Arnold ND, Korgul P, Bowles J, Heppenstall J, Gunn J. Simultaneous kissing stent technique to treat left main stem bifurcation disease. Catheter Cardiovasc Interv 2007; 69:209-15. [PMID: 17195202 DOI: 10.1002/ccd.20944] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND While several endovascular techniques have been developed for treating arterial bifurcation lesions, there is, as yet, no single, widely accepted technique for treating left main stem (LMS) bifurcation lesions with stents. The simultaneous kissing stent (SCS) technique seems particularly suited for such lesions. The authors describe a consecutive cohort of patients with LMS bifurcation stenosis treated with this technique and present mechanistic insights from a porcine model. METHODS Thirty consecutive patients with LMS bifurcation stenosis +/- multivessel disease were treated with SCS technique using paclitaxel-eluting stents. The technique involves simultaneous implantation of two stents (LMS-LAD and LMS-Cx) so that the proximal end of both stents lie at the same level in the body of LMS. Symptom status was recorded and follow-up angiography was performed. In addition, four pigs underwent SCS implantation of the LMS and were studied by direct examination, histology, and scanning electron microscopy. RESULTS The patients' mean age was 63, 26 were elective and 19 were male. Paclitaxel-eluting stents (Taxus, Boston Scientific) were used. There was one in-hospital death in a highly unstable patient. At 6-month follow-up angiography, two patients required target lesion revascularization. At 13 +/- 3 month follow-up, the remaining patients remain well, with no other major adverse cardiac events. The animals all survived with patent stents. SEM demonstrated full re-endothelialization and histology showed a thin but complete neointima covering the stent struts. CONCLUSION The SCS technique for treating LMS bifurcation disease with paclitaxel-eluting stents is safe and feasible. Medium term clinical and angiographic results are good. An endothelium and a thin neointima cover the metal struts.
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Affiliation(s)
- Allison C Morton
- Division of Clinical Sciences (North), Cardiovascular Research Unit, University of Sheffield, Sheffield, United Kingdom
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Murasato Y, Horiuchi M, Otsuji Y. Three-dimensional modeling of double-stent techniques at the left main coronary artery bifurcation using micro-focus X-ray computed tomography. Catheter Cardiovasc Interv 2007; 70:211-20. [PMID: 17421017 DOI: 10.1002/ccd.21133] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Various double-stent techniques using drug-eluting stents have been proposed to treat the left main coronary artery (LMCA) bifurcation. However, use of these techniques is frequently associated with focal restenosis at the ostium of the left circumflex coronary artery (LCX). OBJECTIVES To examine the results of double-stent techniques, using a silicon model of the LMCA bifurcation and three-dimensional (3D) reconstruction images created with micro-focus X-ray computed tomography (MFCT). METHODS Crush, kissing, and modified T stentings were performed with bare metal stents in a LMCA bifurcation model. The stents were then inspected using MFCT at a minimal resolution of 0.06 mm. RESULTS Gaps in stent apposition to the vessel were observed at the site of stent overlap in the distal LMCA with all stenting techniques. In crush stenting, when the left anterior descending artery stent overlapped the LCX stent, the latter was crushed on the myocardial side of the vessel, and a gap was observed on the nonmyocardial side, at the LCX ostium. When the overlap was reversed, the LCX stent was crushed on the nonmyocardial side and a gap was observed on the myocardial side. In the case of kissing stents, stent overlap created a gap beneath the overlapped portion of the stents. In modified T-stenting, correct positioning of the LCX stent was difficult and MFCT imaging revealed a nonmyocardial gap. CONCLUSIONS Close apposition of the stent to the vessel at the ostium of the LCX is difficult to achieve at the LMCA bifurcation, regardless of which double-stent technique is employed, due to the site's wide bifurcation angle and complex 3D structure. The distribution of plaque and the bifurcation angle should be considered before double-stent deployment, to avoid leaving a gap over significant plaques.
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Affiliation(s)
- Yoshinobu Murasato
- Division of Cardiovascular Medicine, Chikuho Social Insurance Hospital, Nogata, and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Barlis P, Tanigawa J, Kaplan S, di Mario C. Complex Coronary Interventions: Unprotected Left Main and Bifurcation Lesions. J Interv Cardiol 2006; 19:510-24. [PMID: 17107366 DOI: 10.1111/j.1540-8183.2006.00203.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Percutaneous coronary intervention has moved forward with great speed since the advent of stents and now more recently the introduction of drug-eluting technologies. This has seen the modern interventional cardiologist tackle more and more complex coronary lesions, of which unprotected left main (ULM) and bifurcations still remain challenging and controversial. ULM coronary artery stenosis traditionally remains a surgical indication although there have been recent reports and studies demonstrating the feasibility of a percutaneous strategy in select patient groups. Furthermore, drug-eluting stents have shown great benefit in reducing the problem of restenosis and have also become the mainstay treatment modality for bifurcation lesions with a choice between one- or two-stent strategies determined by the extent of disease burden in the main vessel and side branch and the response of the side branch ostium following treatment of the main vessel. This article will provide a contemporary review of percutaneous intervention for these two lesion subsets and describe the relative merits of each of the different strategies in current use with a glimpse into what the future may hold.
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Affiliation(s)
- Peter Barlis
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom
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Vaina S, Serruys PW. Progressive stent technologies: new approaches for the treatment of cardiovascular diseases. Expert Opin Drug Deliv 2006; 3:783-97. [PMID: 17076600 DOI: 10.1517/17425247.3.6.783] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The CYPHER (Cordis, Johnson & Johnson) sirolimus-eluting stent and the TAXU (Boston Scientific) paclitaxel-eluting stent have been extensively evaluated and have been proven to be significant novel tools for the treatment of coronary artery disease. Several sirolimus derivatives have already emerged, receiving CE Mark approval. However, in the future, it is likely that drugs presently under investigation will address additional mechanisms associated with neointimal formation, either as single agents or in combination with antiproliferative compounds. Concurrently, alterations on stent platform design (helicoidal, open-closed cell), coatings (biodegradable, bioabsorbable, nanoporous) and polymers are being explored.
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Affiliation(s)
- Sophia Vaina
- Thoraxcentre, Ba 583, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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EL-JACK SEIFEDDINS, DIXON SIMONR, GRINES CINDYL, O'NEILL WILLIAMW. Bifurcation Stenting: Unnecessary Challenge or a Last Frontier in Intervention. J Interv Cardiol 2006. [DOI: 10.1111/j.1540-8183.2006.00168.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Dzavik V, Kharbanda R, Ivanov J, Ing DJ, Bui S, Mackie K, Ramsamujh R, Barolet A, Schwartz L, Seidelin PH. Predictors of long-term outcome after crush stenting of coronary bifurcation lesions: importance of the bifurcation angle. Am Heart J 2006; 152:762-9. [PMID: 16996856 DOI: 10.1016/j.ahj.2006.04.033] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 04/26/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We hypothesized that the bifurcation angle (BA) may affect the outcome of crush stenting (CS) of bifurcation lesions and thus set out to determine the effect of the BA on outcome of patients undergoing coronary bifurcation CS. METHODS Of 538 bifurcation PCI cases performed between November 2003 and March 2005, 133 were performed using CS (n = 56), balloon CS (n = 71), or reverse CS (n = 6). Patients were divided into low-angle and high-angle groups using the median BA as the cut point. RESULTS The median BA was 50 degrees. High-angle patients were more likely to be women (33% vs 15%, P = .02), with a prior percutaneous coronary intervention (26% vs 12%. P = .05) and coronary artery bypass grafting (15% vs 5%, P = .05). Procedural success was 98.5% in the low-angle and 95.4% in the high-angle group (P = nonsignificant). Two high-angle patients had acute stent thrombosis, and 1 died in hospital. Four additional high-angle patients (6.1%) and 1 low-angle patient (1.5%) died (P = nonsignificant) during follow-up. Major adverse cardiac events (MACE) occurred more frequently in the high-angle group (22.7% vs 6.2%, P = .007). Bifurcation angle > or = 50 degrees (P = .004), no final kissing balloon inflation (P = .012), and creatinine clearance < 40 mL/min (P = .031) independently predicted MACE. CONCLUSIONS Bifurcation angle > or = 50 degrees is an independent predictor of MACE after bifurcation CS, in addition to no final kissing balloon inflation and severe renal dysfunction. A high BA confers a setting of increased turbulent flow that is further exacerbated by suboptimal treatment of the crushed side-branch stent. Further study to improve outcome in this subset of patients is warranted.
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Affiliation(s)
- Vladimir Dzavik
- Interventional Cardiology Program, Division of Cardiology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Sharma SK, Chen V. Coronary interventional devices: balloon, atherectomy, thrombectomy and distal protection devices. Cardiol Clin 2006; 24:201-15, vi. [PMID: 16781938 DOI: 10.1016/j.ccl.2006.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With increased operator experience and improved device technology, there has been a constant growth in the number of complex lesions (ie, thrombotic lesions, diffuse lesions,calcified lesions, nondilatable rigid lesions, ostial lesions, bifurcations, and chronic total occlusions) attempted by interventionalists with the use of drug-eluting stents. Although coronary stent implantation remains the mainstay and ultimate step for the treatment of most coronary lesions, adjunctive devices may be essential for lesion preparation in some cases (5%-10%) to allow stent deployment and expansion and prevent distal embolization. Thrombectomy and distal protection devices have shown to be effective in the interventions of saphenous vein graft lesions, although their use remains unproven in acute myocardial infarctions.
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Affiliation(s)
- Samin K Sharma
- Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai Hospital, One Gustave Levy Place, New York, NY 10029, USA.
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Abstract
Treatment of coronary bifurcation lesions represents a challenging area in interventional cardiology, but recent advances in percutaneous coronary interventions have led to a dramatic increase in the number of patients successfully treated percutaneously. When compared with nonbifurcation interventions, bifurcation interventions have a lower rate of procedural success, higher procedural costs, longer hospitalization, and a higher rate of clinical and angiographic restenosis. The recent introduction of drug-eluting stents has resulted in a lower event rate and reduction of main vessel restenosis compared with historical controls. Side branch ostial residual stenosis and long-term restenosis remain a problem, however. Although stenting the main vessel with provisional side branch stenting seems to be the prevailing approach, in the era of drug-eluting stents, various two stent techniques have emerged to allow stenting of the large side branch also.
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Affiliation(s)
- Samin K Sharma
- Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai Hospital, One Gustave Levy Place, New York, NY 10029, USA.
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Colombo A. Contemporary Treatment of Coronary Bifurcations with Drug-Eluting Stent: Part II. J Interv Cardiol 2006; 19:51-3. [PMID: 16483340 DOI: 10.1111/j.1540-8183.2006.00104.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Antonio Colombo
- EMO Centro Cuore Columbus, San Raffaele Hospital, Milan, Italy.
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Collins N, Dzavik V. A modified balloon crush approach improves side branch access and side branch stent apposition during crush stenting of coronary bifurcation lesions. Catheter Cardiovasc Interv 2006; 68:365-71. [PMID: 16892432 DOI: 10.1002/ccd.20791] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Despite the advent of drug eluting stents and newer interventional techniques designed to treat the main vessel and side branch in bifurcation stenoses, optimal treatment of the side branch remains problematic. We aimed to assess the feasibility of a modified balloon crush technique for percutaneous treatment of coronary bifurcation stenoses. BACKGROUND Use of the crush technique in bifurcation stenoses remains limited by access to the side branch after main vessel stent deployment, as well as limitations of side branch stent deployment. The modified balloon crush technique aims to improve side branch access and stent apposition. METHODS The modified balloon crush is similar to the previously described balloon crush technique. Following side branch stent deployment, a balloon positioned in the main vessel is deployed to crush the proximal side branch stent. A guide wire is then placed into the side branch with a subsequent high-pressure balloon inflation at the side branch ostium. This opens the stent struts at the ostium of the side branch, facilitating future passage of the guide wire following main vessel stent deployment, prior to kissing balloon inflation. RESULTS We performed this modification of the crush technique safely in 10 patients. We were successful in obtaining side branch access in nine of ten patients following initial main vessel stent deployment. In the only failure, there was a 90 degrees angle between the main vessel and side branch. CONCLUSIONS The modified balloon crush technique can be safely performed, while optimizing side branch access and side branch stent apposition.
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Affiliation(s)
- Nicholas Collins
- Interventional Cardiology Program, Division of Cardiology, University Health Network, Toronto, Ontario, Canada
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