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Cornelissen A, Guo L, Sakamoto A, Jinnouchi H, Sato Y, Kuntz S, Kawakami R, Mori M, Fernandez R, Fuller D, Gadhoke N, Kolodgie FD, Surve D, Romero ME, Virmani R, Finn AV. Histopathologic and physiologic effect of bifurcation stenting: current status and future prospects. Expert Rev Med Devices 2020; 17:189-200. [PMID: 32101062 DOI: 10.1080/17434440.2020.1733410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Coronary bifurcation lesions are involved in up to 20% of all percutaneous coronary interventions (PCI). However, bifurcation lesion intervention is associated with a high complication rate, and optimal treatment of coronary bifurcation is an ongoing debate.Areas covered: Both different stenting techniques and a variety of devices have been suggested for bifurcation treatment, including the use of conventional coronary stents, bioresorbable vascular scaffolds (BVS), drug-eluting balloons (DEB), and stents dedicated to bifurcations. This review will summarize different therapeutic approaches with their advantages and shortcomings, with special emphasis on histopathologic and physiologic effects of each treatment strategy.Expert opinion: Histopathology and clinical data have shown that a more simple treatment strategy is beneficial in bifurcation lesions, achieving superior results. Bifurcation interventions through balloon angioplasty or placement of stents can importantly alter the bifurcation's geometry and accordingly modify local flow conditions. Computational fluid dynamics (CFD) studies have shown that the outcome of bifurcation interventions is governed by local hemodynamic shear conditions. Minimizing detrimental flow conditions as much as possible should be the ultimate strategy to achieve long-term success of bifurcation interventions.
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Affiliation(s)
- Anne Cornelissen
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA.,Department of Cardiology, Angiology, and Critical Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Liang Guo
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Atsushi Sakamoto
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Hiroyuki Jinnouchi
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Yu Sato
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Salome Kuntz
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Rika Kawakami
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Masayuki Mori
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Raquel Fernandez
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Daniela Fuller
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Neel Gadhoke
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Frank D Kolodgie
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Dipti Surve
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Maria E Romero
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA
| | - Aloke V Finn
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, MD, USA.,School of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Grundeken MJ, de Winter RJ, Wykrzykowska JJ. Safety and efficacy of the Tryton Side Branch Stent™ for the treatment of coronary bifurcation lesions: an update. Expert Rev Med Devices 2017; 14:545-555. [DOI: 10.1080/17434440.2017.1338135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maik J. Grundeken
- Department of Cardiology, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J. de Winter
- Department of Cardiology, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
| | - Joanna J. Wykrzykowska
- Department of Cardiology, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
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