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Zuin M, Chiastra C, Morbiducci U, Gallo D, Bilato C, Rigatelli G. Carina: A major determinant in the pathophysiology and treatment of coronary bifurcation lesions. Catheter Cardiovasc Interv 2024. [PMID: 39354881 DOI: 10.1002/ccd.31254] [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] [Received: 03/10/2024] [Revised: 08/22/2024] [Accepted: 09/23/2024] [Indexed: 10/03/2024]
Abstract
Over the last decade, several in vivo and computational investigations have significantly advanced our understanding of the pathophysiology of coronary bifurcations, contributing to the enhancement of their percutaneous revascularization. The carina of the coronary bifurcations plays a substantial role in generating their main hemodynamic features, including distinctive flow patterns with secondary flows and specific shear stress patterns. These factors play a pivotal role in determining the susceptibility, development, and progression of atherosclerosis. The underlying pathophysiological mechanisms of atherosclerosis in coronary bifurcations are complex and multifactorial. Understanding these mechanisms is fundamental to comprehending lesions at the bifurcation level and informing future treatment strategies. This review aims to present the currently available data regarding the pathophysiological and prognostic role of the carina in coronary bifurcations, offering an interpretation of these findings from the perspective of interventional cardiologists, providing valuable insights for their clinical practice.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Claudio Chiastra
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Gianluca Rigatelli
- Interventional Cardiology Unit, Department of Cardiology, Madre Teresa Hospital, Padova, Italy
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Xu Y, Li Y, Shen H, Zhang B, Zhao Q, Cheng Y, Zhao Z, Guo Q, Yang J, Zhou Y. Clinical effectiveness and radial artery remodeling assessment via very-high-frequency ultrasound/ultra biomicroscopy after applying slender 7Fr sheath for transradial approach in left main bifurcation disease. Curr Med Res Opin 2020; 36:1643-1652. [PMID: 32847430 DOI: 10.1080/03007995.2020.1815684] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the clinical effect and radial remodeling of transradial slender 7 Fr sheath for left main bifurcation disease (LM bifurcation). METHODS From January 2018 to September 2019, 236 patients with LM bifurcation undergoing transradial percutaneous coronary intervention (PCI) from two heart centers were divided into slender 7 Fr sheath group (n = 127) and 6 Fr sheath group (n = 109). Quantitative coronary angiography (QCA) and very high-frequency ultrasound/ultra biomicroscopy (VHFUBM) were used to assess the clinical effect and radial remodeling of transradial sheath. RESULTS Slender 7 Fr sheath group had a higher preoperative distal bifurcation angle (67.271 ± 22.886) than 6 Fr group (55.831 ± 20.245) (p < .05). Post-PCI QCA results showed significant differences in minimum lumen diameter at proximal left anterior descending artery (LAD) and left circumflex artery (LCX) between two groups (p < .05). There were no significant differences in target vessel myocardial infarction, target vessel revascularization, death and major adverse cardiocerebrovascular events (MACCE) at 30-day and 1-year follow-up between two groups (p>.05). No significant differences were observed in radial artery diameter (RAD), intimal-medial thickness (IMT) and radial artery injury at 24-h and 90-day follow-up between two groups. CONCLUSION With larger main and side branch diameter, larger angle of bifurcation and higher SYNTAX score, transradial slender 7 Fr sheath obtained similar clinical effects as 6 Fr sheath without increasing the occurrence of adverse events. Similar follow-up RAD, IMT and radial artery injury were observed. Therefore, slender 7 Fr sheath has safety and feasibility in applying to transradial LM-Bifurcation PCI.
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Affiliation(s)
- Yingkai Xu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yingkai Li
- Departments of Cardiology and Clinical Laboratory, Cangzhou Teaching Hospital of Tianjin Medical University, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Hua Shen
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Beibei Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Qi Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yujing Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Ziwei Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Qianyun Guo
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Jiaqi Yang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
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Collet C, Grundeken MJ, Asano T, Onuma Y, Wijns W, Serruys PW. State of the art: coronary angiography. EUROINTERVENTION 2018; 13:634-643. [PMID: 28844026 DOI: 10.4244/eij-d-17-00465] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the early days of coronary angiography, the precise quantification of luminal narrowing was challenging. The introduction of balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA]) by Andreas Grüntzig in 1977 was perhaps the greatest incentive to the development of quantitative coronary angiography (QCA). QCA has played a crucial role in evaluating interventional techniques and assessing the results of new technologies. With the advent of drug-eluting stents (DES), QCA metrics such as late lumen loss and diameter stenosis (restenosis) proved to be instrumental in assessing new technologies. Refinements in QCA with the advent of dedicated bifurcation analysis and three-dimensional (3D) QCA have broadened the application of QCA. Beyond angiographic metrics, new developments in the field of QCA have introduced the functional component in the assessment of coronary lesions. Angiography-derived fractional flow reserve (FFR) may be a good tool for diagnosing ischaemia-producing lesions in patients with non-complex coronary artery disease. Furthermore, the incremental functional information can be used to expand the traditional late lumen loss (LLL) and restenosis concepts.
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Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Ormiston JA, Kassab G, Finet G, Chatzizisis YS, Foin N, Mickley TJ, Chiastra C, Murasato Y, Hikichi Y, Wentzel JJ, Darremont O, Iwasaki K, Lefèvre T, Louvard Y, Beier S, Hojeibane H, Netravali A, Wooton J, Cowan B, Webster MW, Medrano-Gracia P, Stankovic G. Bench testing and coronary artery bifurcations: a consensus document from the European Bifurcation Club. EUROINTERVENTION 2018; 13:e1794-e1803. [PMID: 29131803 DOI: 10.4244/eij-d-17-00270] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This is a consensus document from the European Bifurcation Club concerning bench testing in coronary artery bifurcations. It is intended to provide guidelines for bench assessment of stents and other strategies in coronary bifurcation treatment where the United States Food and Drug Administration (FDA) or International Organization for Standardization (ISO) guidelines are limited or absent. These recommendations provide guidelines rather than a step-by-step manual. We provide data on the anatomy of bifurcations and elastic response of coronary arteries to aid model construction. We discuss testing apparatus, bench testing endpoints and bifurcation nomenclature.
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Barlis P, Poon EKW, Thondapu V, Grundeken MJ, Tu S, Hayat U, Ooi A, Moore S, Tenekecioglu E, Wykrzykowska JJ, Serruys PW. Reversal of flow between serial bifurcation lesions: insights from computational fluid dynamic analysis in a population-based phantom model. EUROINTERVENTION 2016; 11:e1-3. [PMID: 26390509 DOI: 10.4244/eijv11i5a111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Peter Barlis
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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De Paolis M, Felix C, van Ditzhuijzen N, Fam JM, Karanasos A, de Boer S, van Mieghem NM, Daemen J, Costa F, Bergoli LC, Ligthart JMR, Regar E, de Jaegere PP, Zijlstra F, van Geuns RJ, Diletti R. Everolimus-eluting bioresorbable vascular scaffolds implanted in coronary bifurcation lesions: Impact of polymeric wide struts on side-branch impairment. Int J Cardiol 2016; 221:656-64. [PMID: 27423087 DOI: 10.1016/j.ijcard.2016.06.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Limited data are available on bioresorbable vascular scaffolds (BVS) performance in bifurcations lesions and on the impact of BVS wider struts on side-branch impairment. METHODS Patients with at least one coronary bifurcation lesion involving a side-branch ≥2mm in diameter and treated with at least one BVS were examined. Procedural and angiographic data were collected and a dedicated methodology for off-line quantitative coronary angiography (QCA) in bifurcation was applied (eleven-segment model), to assess side-branch impairment occurring any time during the procedure. Two- and three-dimensional QCA were used. Optical coherence tomography (OCT) analysis was performed in a subgroup of patients and long-term clinical outcomes reported. RESULTS A total of 102 patients with 107 lesions, were evaluated. Device- and procedural-successes were 99.1% and 94.3%, respectively. Side-branch impairment occurring any time during the procedure was reported in 13 bifurcations (12.1%) and at the end of the procedure in 6.5%. Side-branch minimal lumen diameter (Pre: 1.45±0.41mm vs Final: 1.48±0.42mm, p=0.587) %diameter-stenosis (Pre: 26.93±16.89% vs Final: 27.80±15.57%, p=0.904) and minimal lumen area (Pre: 1.97±0.89mm(2) vs Final: 2.17±1.09mm(2), p=0.334), were not significantly affected by BVS implantation. Mean malapposed struts at the bifurcation polygon-of-confluence were 0.63±1.11. CONCLUSIONS The results of the present investigation suggest feasibility and relative safety of BVS implantation in coronary bifurcations. BVS wide struts have a low impact on side-branch impairment when considering bifurcations with side-branch diameter≥2mm.
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Affiliation(s)
- Marcella De Paolis
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Cordula Felix
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Nienke van Ditzhuijzen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jiang Ming Fam
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Antonis Karanasos
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Sanneke de Boer
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Francesco Costa
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Luis Carlos Bergoli
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jurgen M R Ligthart
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Peter P de Jaegere
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Robert Jan van Geuns
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
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Berland J, Lefèvre T, Brenot P, Fajadet J, Motreff P, Guerin P, Dupouy P, Schandrin C. DANUBIO - a new drug-eluting balloon for the treatment of side branches in bifurcation lesions: six-month angiographic follow-up results of the DEBSIDE trial. EUROINTERVENTION 2015; 11:868-76. [DOI: 10.4244/eijv11i8a177] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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ZHANG DONG, DOU KEFEI. Coronary Bifurcation Intervention: What Role Do Bifurcation Angles Play? J Interv Cardiol 2015; 28:236-48. [DOI: 10.1111/joic.12203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- DONG ZHANG
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute; Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 China
| | - KEFEI DOU
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute; Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 China
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Grundeken MJ, Ishibashi Y, Ramcharitar S, Tuinenburg JC, Reiber JH, Tu S, Aben JP, Girasis C, Wykrzykowska JJ, Onuma Y, Serruys PW. The need for dedicated bifurcation quantitative coronary angiography (QCA) software algorithms to evaluate bifurcation lesions. EUROINTERVENTION 2015; 11 Suppl V:V44-9. [DOI: 10.4244/eijv11sva10] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Muramatsu T, Grundeken MJ, Ishibashi Y, Nakatani S, Girasis C, Campos CM, Morel MA, Jonker H, de Winter RJ, Wykrzykowska JJ, García-García HM, Leon MB, Serruys PW, Onuma Y. Comparison between two- and three-dimensional quantitative coronary angiography bifurcation analyses for the assessment of bifurcation lesions: A subanalysis of the TRYTON pivotal IDE coronary bifurcation trial. Catheter Cardiovasc Interv 2015; 86:E140-9. [DOI: 10.1002/ccd.25925] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Takashi Muramatsu
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- Department of Cardiology; Fujita Health University Hospital; Toyoake Japan
| | - Maik J. Grundeken
- Amsterdam Heart center; Academic Medical Center; Amsterdam The Netherlands
| | - Yuki Ishibashi
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Chrysafios Girasis
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- First Cardiology Department; Onassis Cardiac Surgery Center; Athens Greece
| | - Carlos M. Campos
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- Department of Interventional Cardiology; Heart Institute (InCor), University of São Paulo Medical School; São Paulo Brazil
| | | | - Hans Jonker
- Cardialysis; B.V.; Rotterdam The Netherlands
| | | | | | - Hector M. García-García
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis; B.V.; Rotterdam The Netherlands
| | - Martin B. Leon
- Cardiovascular Research Foundation/Columbia University Medical Center; New York Presbyterian Hospital; New York New York
| | - Patrick W. Serruys
- International Centre for Circulatory Health; NHLI; Imperial College London; London United Kingdom
| | - Yoshinobu Onuma
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
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Kousera CA, Nijjer S, Torii R, Petraco R, Sen S, Foin N, Hughes AD, Francis DPP, Xu XY, Davies JE. Patient-specific coronary stenoses can be modeled using a combination of OCT and flow velocities to accurately predict hyperemic pressure gradients. IEEE Trans Biomed Eng 2015; 61:1902-13. [PMID: 24845301 DOI: 10.1109/tbme.2014.2310954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Computational fluid dynamics (CFD) is increasingly being developed for the diagnostics of arterial diseases. Imaging methods such as computed tomography (CT) and angiography are commonly used. However, these have limited spatial resolution and are subject to movement artifact. This study developed a new approach to generate CFD models by combining high-fidelity, patient-specific coronary anatomy models derived from optical coherence tomography (OCT) imaging with patient-specific pressure and velocity phasic data. Additionally, we used a new technique which does not require the catheter to be used to determine the centerline of the vessel. The CFD data were then compared with invasively measured pressure and velocity. Angiography imaging data of 21 vessels collected from 19 patients were fused with OCT visualizations of the same vessels using an algorithm that produces reconstructions inheriting the in-plane (10 μm) and longitudinal (0.2 mm) resolution of OCT. Proximal pressure and distal velocity waveforms ensemble averaged from invasively measured data were used as inlet and outlet boundary conditions, respectively, in CFD simulations. The resulting distal pressure waveform was compared against the measured waveform to test the model. The results followed the shape of the measured waveforms closely (cross-correlation coefficient = 0.898 ± 0.005, ), indicating realistic modeling of flow resistance, the mean of differences between measured and simulated results was -3. 5 mmHg, standard deviation of differences (SDD) = 8.2 mmHg over the cycle and -9.8 mmHg, SDD = 16.4 mmHg at peak flow. Models incorporating phasic velocity in patient-specific models of coronary anatomy derived from high-resolution OCT images show a good correlation with the measured pressure waveforms in all cases, indicating that the model results may be an accurate representation of the measured flow conditions.
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Inter–Core Lab Variability in Analyzing Quantitative Coronary Angiography for Bifurcation Lesions. JACC Cardiovasc Interv 2015; 8:305-314. [DOI: 10.1016/j.jcin.2014.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/04/2014] [Accepted: 12/17/2014] [Indexed: 11/17/2022]
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Ishibashi Y, Grundeken MJ, Nakatani S, Iqbal J, Morel MA, Généreux P, Girasis C, Wentzel JJ, Garcia-Garcia HM, Onuma Y, Serruys PW. In vitro validation and comparison of different software packages or algorithms for coronary bifurcation analysis using calibrated phantoms: Implications for clinical practice and research of bifurcation stenting. Catheter Cardiovasc Interv 2014; 85:554-63. [DOI: 10.1002/ccd.25618] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/21/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Yuki Ishibashi
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
| | - Maik J. Grundeken
- The Heart Center; Academic Medical Center; Amsterdam The Netherlands
| | | | - Javaid Iqbal
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Philippe Généreux
- New York - Presbyterian Hospital and Columbia University Medical Center, New York; New York - Cardiovascular Research Foundation; New York
| | - Chrysafios Girasis
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- The Onassis Cardiac Surgery Center; Kallithea Greek
| | | | | | - Yoshinobu Onuma
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis B.V; Rotterdam The Netherlands
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHL 1; Imperial College London; London United Kingdom
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Magro M, Girasis C, Bartorelli AL, Tarantini G, Russo F, Trabattoni D, D'Amico G, Galli M, Gómez Juame A, de Sousa Almeida M, Simsek C, Foley D, Sonck J, Lesiak M, Kayaert P, Serruys PW, van Geuns RJ. Acute procedural and six-month clinical outcome in patients treated with a dedicated bifurcation stent for left main stem disease: the TRYTON LM multicentre registry. EUROINTERVENTION 2013; 8:1259-69. [PMID: 23538155 DOI: 10.4244/eijv8i11a194] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Tryton side branch (SB) reverse culotte stenting has been employed for the treatment of left main (LM) stem bifurcations in patients at high risk for bypass surgery. The aim of this study was to assess acute angiographic results and six-month clinical outcome after implantation of the Tryton stent in the LM. METHODS AND RESULTS We studied 52 consecutive patients with LM disease treated in nine European centres. Angiographic and clinical data analysis was performed centrally. Fifty-one of 52 patients (age 68±11 yrs, 75% male, 42% unstable angina, SYNTAX score 20±8) were successfully treated with the Tryton stent. Medina class was 1,1,1 in 33 (63%), 1,0,1 in 7 (13%), 1,1,0 in 3 (6%), 0,1,1 in 8 (4%) and 0,0,1 in 1 (2%). The Tryton stent on a stepped balloon (diameter 3.5-2.5 mm) was used in 41/51 (80%) of cases. The mean main vessel stent diameter was 3.4±0.4 mm with an everolimus-eluting stent employed in 30/51 (59%) of cases. Final kissing balloon dilatation was performed in 48/51 (94%). Acute gain was 1.52±0.86 mm in the LM and 0.92±0.47 mm in the SB. The angiographic success rate was 100%; the procedural success rate reached 94%. Periprocedural MI occurred in three patients. At six-month follow-up, the TLR rate was 12%, MI 10% and cardiac death 2%. The hierarchical MACE rate at six months was 22%. No cases of definite stent thrombosis occurred. CONCLUSIONS The use of the Tryton stent for treatment of LM bifurcation disease in combination with a conventional drug-eluting stent is feasible and achieves an optimal angiographic result. Safety of the procedure and six-month outcome are acceptable in this high-risk lesion PCI. Further safety and efficacy studies with long-term outcome assessment of this strategy are warranted.
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Affiliation(s)
- Michael Magro
- Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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Girasis C, Schuurbiers JC, Muramatsu T, Aben JP, Onuma Y, Soekhradj S, Morel MA, van Geuns RJ, Wentzel JJ, Serruys PW. Advanced three-dimensional quantitative coronary angiographic assessment of bifurcation lesions: methodology and phantom validation. EUROINTERVENTION 2013; 8:1451-60. [DOI: 10.4244/eijv8i12a219] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Ji C, Hou ZG, Xie XL. An image-based guidewire navigation method for robot-assisted intravascular interventions. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:6680-5. [PMID: 22255871 DOI: 10.1109/iembs.2011.6091647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper aims at using a newly developed robotic system to automatically deliver guidewires or catheters to the target site on percutaneous coronary interventions (PCIs) or electrophysiology interventions. An autonomous delivery strategy using electromagnetic tracking technology is introduced and phantom experiments are performed to validate this strategy. In order to advance the guidewire into the planned branch, the strategy classifies this branch selection problem into three cases according to the width of the vessels and employs an image-based algorithm for the first and second cases. Another image-based algorithm specifically designed for the third case is also presented.
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Affiliation(s)
- Cheng Ji
- Key Laboratory of Complex Systems and Intelligence Science,Institute of Automation, Chinese Academy of Sciences, Beijing, China.
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Girasis C, Schuurbiers JC, Onuma Y, Aben JP, Weijers B, Morel MA, Wentzel JJ, Serruys PW. Advances in two-dimensional quantitative coronary angiographic assessment of bifurcation lesions: improved small lumen diameter detection and automatic reference vessel diameter derivation. EUROINTERVENTION 2012; 7:1326-35. [DOI: 10.4244/eijv7i11a208] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Girasis C, Onuma Y, Schuurbiers JC, Morel MA, van Es GA, van Geuns RJ, Wentzel JJ, Serruys PW. Validity and variability in visual assessment of stenosis severity in phantom bifurcation lesions: A survey in experts during the fifth meeting of the european bifurcation club. Catheter Cardiovasc Interv 2011; 79:361-8. [DOI: 10.1002/ccd.23213] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 04/12/2011] [Indexed: 02/05/2023]
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