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Reddy PKV, Daibes J, Skaf M, Ochoa R, Fujisaki T, Lin P, Patel A, Kwan T. The Use of Bumper Wire Technique and Intravascular Ultrasound for Precise Aorto-Ostial Stenting. Front Cardiovasc Med 2022; 9:929472. [PMID: 35911530 PMCID: PMC9329583 DOI: 10.3389/fcvm.2022.929472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAorto-ostial interventions are challenging due to the limitations of contemporary equipment, imprecise ostial demarcation, and problematic ostial lesion characteristics. Suboptimal stent placement is common and portends worse clinical outcomes. Procedural and long-term outcomes of the bumper wire technique with intravascular ultrasound (IVUS) assessment have not been investigated.MethodsA single-center retrospective study was conducted. Patients who underwent ostial lesion percutaneous coronary intervention (PCI) with the bumper wire technique between January 2019 and September 2020 were identified. The primary endpoint was to determine the geographic miss rate defined by inadequate ostial coverage or excess stent protrusion of > 2 mm by IVUS or angiography. The secondary endpoint was target lesion failure (TLF) at 6 months after PCI, defined as the composite of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularization.ResultsIn total, 45 patients were identified. The average age was 71.7 years old, and 85.4% were men. Indication for PCI was acute coronary syndrome in about a third of patients. Twenty-six patients had left main ostial lesions and 19 patients had right coronary artery ostial lesions. Geographic miss was detected in two patients (4.4%): one patient (2.2%) had excess proximal stent protrusion and one patient (2.2%) had an ostial miss. Six patients were lost to follow-up. TLF, stroke, or major bleeding were not observed in any of the patients.ConclusionThe bumper wire technique is safe and efficient with low rates of geographic miss or adverse clinical outcomes. This is the first study to confirm precise aorto-ostial stent implantation with the bumper wire technique using IVUS confirmation.
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Affiliation(s)
- Pavan K. V. Reddy
- Division of Cardiovascular Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York, NY, United States
| | - Joseph Daibes
- Division of Cardiovascular Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York, NY, United States
| | - Michel Skaf
- Department of Medicine, Icahn School of Medicine, Mount Sinai Morningside and West, New York, NY, United States
| | - Roberto Ochoa
- Department of Medicine, Icahn School of Medicine, Mount Sinai Morningside and West, New York, NY, United States
| | - Tomohiro Fujisaki
- Department of Medicine, Icahn School of Medicine, Mount Sinai Morningside and West, New York, NY, United States
| | - Patricia Lin
- Chinatown Cardiology, New York, NY, United States
| | - Apurva Patel
- Division of Cardiovascular Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York, NY, United States
- Chinatown Cardiology, New York, NY, United States
| | - Tak Kwan
- Division of Cardiovascular Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York, NY, United States
- Chinatown Cardiology, New York, NY, United States
- *Correspondence: Tak Kwan,
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Claessen B, Henriques JP, Dangas GD. Specialized Balloons in Percutaneous Coronary Intervention. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Operator Experience and Outcomes After Left Main Percutaneous Coronary Intervention. Curr Cardiol Rep 2018; 20:29. [PMID: 29572751 DOI: 10.1007/s11886-018-0972-0] [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: 10/17/2022]
Abstract
PURPOSE OF REVIEW This review was performed with the goal of summarizing the role of operator experience in the treatment of severe left main stenosis by percutaneous intervention techniques. RECENT FINDINGS The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial demonstrated that percutaneous coronary intervention and coronary artery bypass grafting had similar clinical outcomes for severe left main disease. However, PCI of the left main coronary stenosis is considered to be a high-risk intervention because of the large area of myocardium at jeopardy that can quickly cause hemodynamic compromise. Operator experience and familiarity with the use of hemodynamic support devices, plaque modification techniques, and intravascular imaging tools is associated with better clinical outcomes. In patients with severe left main stenosis undergoing percutaneous coronary intervention by high-volume operators, the clinical outcomes are superior.
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Belardi JA, Albertal M. Aorto-Ostial Lesions: Battling an Old Foe. Catheter Cardiovasc Interv 2016; 88:1075-1076. [PMID: 27976543 DOI: 10.1002/ccd.26865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 11/06/2022]
Abstract
Aorto-ostial lesions (AOLs) entail several diagnostic and treatment challenges. The Flash Ostial System enables flaring of the overhanging stent, optimizing stent deployment in AOLs. Careful planning is essential to achieve optimal stent implantation and avoid early and late complications during the treatment of AOLs.
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Affiliation(s)
- Jorge A Belardi
- Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariano Albertal
- Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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