1
|
Cozzi O, Maurina M, Cacia M, Bernardini V, Gohar A, Cao D, Mangieri A, Condello F, Leone PP, Sticchi A, Rossi ML, Gasparini G, Stefanini GG, Condorelli G, Reimers B, Colombo A, Regazzoli D. Clinical and procedural outcomes of percutaneous coronary intervention for de novo lesions involving the ostial left circumflex coronary artery. Catheter Cardiovasc Interv 2023; 102:1048-1056. [PMID: 37933728 DOI: 10.1002/ccd.30903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/02/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Percutaneous treatment for ostial left circumflex artery (LCx) lesions is known to be associated with suboptimal results. AIMS The present study aims to assess the procedural and long-term clinical outcomes of percutaneous coronary intervention (PCI) for de novo ostial LCx lesions overall and according to the coronary revascularization strategy. METHODS Consecutive patients undergoing PCI with second generation drug eluting stents or drug coated balloons for de novo ostial LCx lesions in three high-volume Italian centers between 2012 and 2021 were retrospectively evaluated. The primary endpoint was target-vessel revascularization (TVR) at 2 years. Secondary endpoints included major adverse cardiovascular and cerebrovascular events (MACCE), target lesion revascularization, myocardial infarction, stroke, all-cause death, and repeat revascularization. RESULTS A total of 366 patients were included in the analysis with a median follow-up of 901 (IQR: 450-1728) days. 79.5% of the patients were male, 33.6% were diabetic, 49.7% had a previous PCI, and 23.1% a prior surgical revascularization. Very ostial LCx stenting was performed in 34.1%, crossover from left main to LCx in 17.3%, and a two-stent strategy in 48.6% of cases, respectively. In the overall population, the incidence of TVR at 2 years was 19.0% while MACCE rate was 25.7%. No major differences in clinical outcomes were found according to the stenting strategy. Use of intracoronary imaging was associated with fewer MACCE (HR: 0.47, 95% CI: 0.25-1.13, p = 0.01), while the diameter of the stent implanted in the ostial LCx was associated with less TVR (HR: 0.43, 95% CI: 0.25-0.75, p = 0.002). CONCLUSIONS Percutaneous revascularization of the ostial LCx is associated with a high rate of TVR, regardless of the stenting strategy. Intracoronary imaging and proper stent sizing may reduce the failure rates.
Collapse
Affiliation(s)
- Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Matteo Maurina
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Michele Cacia
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Aisha Gohar
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Davide Cao
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Cardiology, Humanitas Gavazzeni, Bergamo, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Francesco Condello
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Alessandro Sticchi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | | | - Gabriele Gasparini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| |
Collapse
|
5
|
Shiraishi J, Kataoka E, Ozawa T, Shiraga A, Ikemura N, Matsubara Y, Nishimura T, Ito D, Kojima A, Kimura M, Kishita E, Nakagawa Y, Hyogo M, Sawada T. Angiographic and Clinical Outcomes After Stent-less Coronary Intervention Using Rotational Atherectomy and Drug-Coated Balloon in Patients with De Novo Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:647-653. [PMID: 31494063 DOI: 10.1016/j.carrev.2019.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/04/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We investigated angiographic and clinical outcomes in patients with de novo lesions undergoing rotational atherectomy (RA) followed by drug-coated balloon (DCB) dilation (RA/DCB). BACKGROUND Implantation of drug-eluting stent (DES) has been a mainstay of the interventional treatment of coronary artery disease (CAD); however, there still remain several DES-unsuitable clinical/lesion conditions. Nowadays DCB for de novo lesions has attracted more attention, and RA, which tends not to cause major dissection but to debulk intima, might be one of suitable pre-treatments before DCB. METHODS AND RESULTS Thirty patients (34 lesions) undergoing RA/DCB for de novo lesions were enrolled. Clinical/lesion background included severe calcification, calcified nodule, inlet/outlet of aneurysm, ostial lesion, severe thrombocytopenia, bleeding tendency, and/or sequelae of Kawasaki disease. The largest burr size used was 1.83 ± 0.23 mm, and the mean DCB diameter was 2.71 ± 0.47 mm. Angiographic success was obtained in 94% of the lesions. No acute closure but 1 no reflow occurred. Repeat angiography (mean, 6.6 months after procedure) was performed for 19 lesions. Frequency of binary restenosis was 21.1%, and late lumen loss was 0.34 ± 0.30 mm. During a mean follow-up period of 13.1 months, 6 deaths (2 sudden deaths, 1 cardiac death, 3 non-cardiac deaths), 2 strokes, and 2 target lesion revascularizations were observed. CONCLUSIONS Stent-less PCI using RA/DCB might be an alternative revascularization therapy for CAD patients complicated with DES-unsuitable conditions.
Collapse
Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan.
| | - Eisuke Kataoka
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Takaaki Ozawa
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Akiko Shiraga
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Nariko Ikemura
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Yuki Matsubara
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Tetsuro Nishimura
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Daisuke Ito
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Akiteru Kojima
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Masayoshi Kimura
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Eigo Kishita
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Yusuke Nakagawa
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Masayuki Hyogo
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Takahisa Sawada
- Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan
| |
Collapse
|
7
|
Takagi K, Naganuma T, Chieffo A, Fujino Y, Latib A, Tahara S, Ishiguro H, Montorfano M, Carlino M, Kawamoto H, Kurita N, Hozawa K, Nakamura S, Nakamura S, Colombo A. Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.003359. [DOI: 10.1161/circinterventions.116.003359] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 09/26/2016] [Indexed: 11/16/2022]
Abstract
Background—
There are only little data available on the comparison of clinical outcomes between a 1-stent strategy (1-SS) and a 2-stent strategy (2-SS) for percutaneous coronary intervention in unprotected distal left main disease.
Methods and Results—
Between April 2005 and August 2011, we recruited 937 consecutive unprotected distal left main patients treated with drug-eluting stents (1-SS, 608 patients; 2-SS, 329 patients). Major adverse cardiovascular events were defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR) during the median follow-up period of 1592 days. Furthermore, the individual components of major adverse cardiovascular events, cardiac death, and stent thrombosis were evaluated. More complex lesions were seen with 2-SS than with 1-SS. Cardiac death occurred more frequently with 1-SS than with 2-SS (propensity score–adjusted hazard ratio, 0.52; 95% confidence interval, 0.29–0.64;
P
=0.03), whereas TLR occurred more frequently with 2-SS than with 1-SS (propensity score–adjusted hazard ratio, 1.59; 95% confidence interval, 1.15–2.20;
P
=0.005). TLR was mainly driven by revascularizations after restenosis at the ostial left circumflex artery (propensity score–adjusted hazard ratio, 1.94; 95% confidence interval, 1.33–2.82;
P
=0.001). However, there were no differences in major adverse cardiovascular events, all-cause death, stent thrombosis, and myocardial infarction. Of the 139 pairs that were propensity score matched, only TLRs were significantly higher in the 2-SS group (hazard ratio, 1.59; 95% confidence interval, 1.00–2.53;
P
=0.05).
Conclusions—
The difference between 1-SS and 2-SS in percutaneous coronary intervention for unprotected distal left main disease may be summarized by the high incidence of TLR, mainly because of restenosis at the ostial left circumflex artery in the 2-SS group.
Collapse
Affiliation(s)
- Kensuke Takagi
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Toru Naganuma
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Alaide Chieffo
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Yusuke Fujino
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Azeem Latib
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Satoko Tahara
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Hisaaki Ishiguro
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Matteo Montorfano
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Mauro Carlino
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Hiroyoshi Kawamoto
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Naoyuki Kurita
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Koji Hozawa
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Shotaro Nakamura
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Sunao Nakamura
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| | - Antonio Colombo
- From the Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan (K.T., T.N., Y.F., S.T., H.I., H.K., N.K., K.H., Shotaro Nakamura, Sunao Nakamura); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A. Chieffo, A.L., M.M., M.C., A. Colombo); and Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A. Colombo)
| |
Collapse
|
8
|
Wang H, Liu J, Zheng X, Rong X, Zheng X, Peng H, Silber-Li Z, Li M, Liu L. Three-dimensional virtual surgery models for percutaneous coronary intervention (PCI) optimization strategies. Sci Rep 2015; 5:10945. [PMID: 26042609 PMCID: PMC4455241 DOI: 10.1038/srep10945] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/11/2015] [Indexed: 12/03/2022] Open
Abstract
Percutaneous coronary intervention (PCI), especially coronary stent implantation, has been shown to be an effective treatment for coronary artery disease. However, in-stent restenosis is one of the longstanding unsolvable problems following PCI. Although stents implanted inside narrowed vessels recover normal flux of blood flows, they instantaneously change the wall shear stress (WSS) distribution on the vessel surface. Improper stent implantation positions bring high possibilities of restenosis as it enlarges the low WSS regions and subsequently stimulates more epithelial cell outgrowth on vessel walls. To optimize the stent position for lowering the risk of restenosis, we successfully established a digital three-dimensional (3-D) model based on a real clinical coronary artery and analysed the optimal stenting strategies by computational simulation. Via microfabrication and 3-D printing technology, the digital model was also converted into in vitro microfluidic models with 3-D micro channels. Simultaneously, physicians placed real stents inside them; i.e., they performed “virtual surgeries”. The hydrodynamic experimental results showed that the microfluidic models highly inosculated the simulations. Therefore, our study not only demonstrated that the half-cross stenting strategy could maximally reduce restenosis risks but also indicated that 3-D printing combined with clinical image reconstruction is a promising method for future angiocardiopathy research.
Collapse
Affiliation(s)
- Hujun Wang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China.,Key Laboratory of Soft Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
| | - Jinghua Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing 100029, China
| | - Xu Zheng
- State key laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing 100190, China
| | - Xiaohui Rong
- Key Laboratory of Soft Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
| | - Xuwei Zheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing 100029, China
| | - Hongyu Peng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing 100029, China
| | - Zhanghua Silber-Li
- State key laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing 100190, China
| | - Mujun Li
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026, China
| | - Liyu Liu
- Key Laboratory of Soft Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
| |
Collapse
|