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Hennessey B, Pareek N, Macaya F, Yeoh J, Shlofmitz E, Gonzalo N, Hill J, Escaned J. Contemporary percutaneous management of coronary calcification: current status and future directions. Open Heart 2023; 10:e002182. [PMID: 36796870 PMCID: PMC9936324 DOI: 10.1136/openhrt-2022-002182] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
Severe coronary artery calcification is one of the greatest challenges in attaining success in percutaneous coronary intervention, limiting acute and long-term results. In many cases, plaque preparation is a critical prerequisite for delivery of devices across calcific stenoses and also to achieve adequate luminal dimensions. Recent advances in intracoronary imaging and adjunctive technologies now allow the operator to select the most appropriate strategy in each individual case. In this review, we will revisit the distinct advantages of a complete assessment of coronary artery calcification with imaging and application of appropriate and contemporary plaque modification technologies in achieving durable results in this complex lesion subset.
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Affiliation(s)
- Breda Hennessey
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
| | - Nilesh Pareek
- King's College Hospital NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine & Sciences, BHF Centre of Excellence, King's College London, London, UK
| | - Fernando Macaya
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
- King's College Hospital NHS Foundation Trust, London, UK
| | - Julian Yeoh
- King's College Hospital NHS Foundation Trust, London, UK
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nieves Gonzalo
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
| | - Jonathan Hill
- King's College Hospital NHS Foundation Trust, London, UK
- Royal Brompton Hospital, London, UK
| | - Javier Escaned
- Hospital Clinico San Carlos Instituto Cardiovascular, Madrid, Comunidad de Madrid, Spain
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Mohamed MO, Lamellas P, Roguin A, Oemrawsingh RM, Ijsselmuiden AJJ, Routledge H, van Leeuwen F, Debrus R, Roffi M, Mamas MA. Clinical Outcomes of Percutaneous Coronary Intervention for Bifurcation Lesions According to Medina Classification. J Am Heart Assoc 2022; 11:e025459. [PMID: 36000428 PMCID: PMC9496427 DOI: 10.1161/jaha.122.025459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Coronary bifurcation lesions (CBLs) are frequently encountered in clinical practice and are associated with worse outcomes after percutaneous coronary intervention. However, there are limited data around the prognostic impact of different CBL distributions. Methods and Results All CBL percutaneous coronary intervention procedures from the prospective e‐Ultimaster (Prospective, Single‐Arm, Multi Centre Observations Ultimaster Des Registry) multicenter international registry were analyzed according to CBL distribution as defined by the Medina classification. Cox proportional hazards models were used to compare the hazard ratio (HR) of the primary outcome, 1‐year target lesion failure (composite of cardiac death, target vessel–related myocardial infarction, and clinically driven target lesion revascularization), and its individual components between Medina subtypes using Medina 1.0.0 as the reference category. A total of 4003 CBL procedures were included. The most prevalent Medina subtypes were 1.1.1 (35.5%) and 1.1.0 (26.8%), whereas the least prevalent was 0.0.1 (3.5%). Overall, there were no significant differences in patient and procedural characteristics among Medina subtypes. Only Medina 1.1.1 and 0.0.1 subtypes were associated with increased target lesion failure (HR, 2.6 [95% CI, 1.3–5.5] and HR, 4.0 [95% CI, 1.6–9.0], respectively) at 1 year, compared with Medina 1.0.0, prompted by clinically driven target lesion revascularization (HR, 3.1 [95% CI, 1.1–8.6] and HR, 4.6 [95% CI, 1.3–16.0], respectively) as well as cardiac death in Medina 0.0.1 (HR, 4.7 [95% CI, 1.0–21.6]). No differences in secondary outcomes were observed between Medina subtypes. Conclusions In a large multicenter registry analysis of coronary bifurcation percutaneous coronary intervention procedures, we demonstrate prognostic differences in 1‐year outcomes between different CBL distributions, with Medina 1.1.1 and 0.0.1 subtypes associated with an increased risk of target lesion failure.
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Affiliation(s)
- Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences Keele University Newcastle United Kingdom.,Institute of Health Informatics University College London London United Kingdom
| | - Pablo Lamellas
- Department of Interventional Cardiology and Endovascular Therapeutics Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina
| | - Ariel Roguin
- Department of Cardiology Hillel Yaffe Medical Center Hadera Israel
| | | | | | | | | | - Roxane Debrus
- Medical and Clinical Division Terumo Europe NV Leuven Belgium
| | - Marco Roffi
- Division of Cardiology University Hospitals Geneva Switzerland
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences Keele University Newcastle United Kingdom
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Harding SA, Webber B, Fairley S, Ormiston JA. Real-time intravascular ultrasound guidance: A novel technique for accurate placement of ostial stents. Catheter Cardiovasc Interv 2021; 99:699-705. [PMID: 34132465 DOI: 10.1002/ccd.29830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/19/2021] [Accepted: 06/06/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To describe a novel technique for ostial stent placement using real-time IVUS guidance. BACKGROUND Accurate placement of coronary stents at ostial locations is challenging with the true ostium frequently being missed increasing the risk of adverse events. We have developed a novel technique for ostial stent placement and report our benchtop testing and initial clinical experience. METHODS Benchtop testing was performed to validate the appearance of the stent and delivery system on IVUS. Benchtop testing of real-time IVUS guided ostial stent positioning was carried out in a left main bifurcation phantom. Real-time IVUS guidance of stent placement in aorto-ostial, ostial left anterior descending (LAD), or ostial circumflex lesions was assessed in a prospective registry. RESULTS Bench model IVUS demonstrated clear differences between the appearances of the stent and other components of the delivery system. Positioning of 10 consecutive stents into the ostial LAD using real-time IVUS guidance was assessed in a left main bifurcation model. Median distance from proximal stent edge to LAD ostium was 0.39 mm (interquartile range 0.31 to 0.73). Real-time IVUS guidance of ostial stent placement was performed in 50 patients (51 lesions). Angiographic success was 100%. IVUS post-stenting demonstrated median distance from the proximal stent edge to the ostium was 0.2 mm (interquartile range 0.1 to 0.5 mm). There was one periprocedural myocardial infarction but no other major adverse cardiac events at 30-days. CONCLUSIONS We have developed a novel technique using real-time IVUS guidance allowing accurate ostial stent placement.
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Affiliation(s)
- Scott A Harding
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Bruce Webber
- Department of Interventional Cardiology, Intracare, Auckland, New Zealand
| | - Sarah Fairley
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - John A Ormiston
- Department of Interventional Cardiology, Intracare, Auckland, New Zealand
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Bogana Shanmugam V, Psaltis PJ, Tay L, Malaiapan Y, Ahmar W. Procedural and Clinical Outcomes in Management of Bifurcational Lesions in ST Elevation Myocardial Infarction. Heart Lung Circ 2019; 29:272-279. [PMID: 30850216 DOI: 10.1016/j.hlc.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/24/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bifurcation percutaneous coronary intervention (PCI) remains a challenging frontier in interventional cardiology, especially in the setting of ST-elevation myocardial infarction (STEMI). We examined the procedural and clinical outcomes of this patient subset. METHODS We conducted a retrospective case-control study. Between February 2006 and March 2011, 129 patients with STEMI underwent bifurcation PCI at our institution. One hundred and twenty-nine (129) control STEMI patients with non-bifurcation PCI were selected from the institutional database, matched for age, gender, culprit vessel, and lesion location. Patients with cardiac arrest, cardiogenic shock, or who required mechanical ventilation were excluded. Twelve (12)-month follow-up data were collected by telephone calls and examination of the medical records. RESULTS The average age of patients presenting with STEMI was 61.6 ± 13.1 in the bifurcation group and 61.5 + 31.1 in the non-bifurcation group. There was no difference in lesion type, use of thrombus aspiration catheters, or glycoprotein inhibitors (GPI) among them. Also, the use of drug eluting stent (DES), total cumulative length of stent used, and diameter of the post-dilation balloon were similar. Final kissing balloon post-dilation was performed in 40.3% of bifurcation PCI cases. The incidence of procedural failure (TIMI 0 flow) was 1.5% vs. 0%; p = 0.478. At 12-months follow-up, the bifurcation PCI group had higher incidence of target lesion revascularisation (TLR) (10.9% vs. 3.9%, p = 0.050), mortality (10.1% vs. 2.3%, p = 0.020), and stent thrombosis (9.3% vs. 1.6%; p = 0.013); comprising one acute, nine subacute, and two late vs. two subacute stent thromboses. CONCLUSIONS During acute STEMI, bifurcation PCI has excellent acute procedural outcomes, but significantly increased incidence of TLR, stent thrombosis and mortality at 12 months.
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Affiliation(s)
| | - Peter J Psaltis
- Monash Heart, Monash Medical Centre, Melbourne, Vic, Australia
| | - Leslie Tay
- Monash Heart, Monash Medical Centre, Melbourne, Vic, Australia
| | | | - Wally Ahmar
- Monash Heart, Monash Medical Centre, Melbourne, Vic, Australia
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5
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Reed GW, Rossi JE, Masri A, Griffin BP, Ellis SG, Kapadia SR, Desai MY. Angiographic predictors of adverse outcomes after percutaneous coronary intervention in patients with radiation associated coronary artery disease. Catheter Cardiovasc Interv 2019; 94:E104-E110. [PMID: 30690850 DOI: 10.1002/ccd.28107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/04/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine procedural predictors of long-term outcomes for patients with radiation associated coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI). BACKGROUND Patients who develop CAD after external beam radiation therapy (XRT) for cancer are at high-risk for adverse events following PCI. It is unknown if specific angiographic features can predict outcomes in this population. METHODS This is an observational study of 157 patients with malignancy who received XRT prior to PCI. Rates of major adverse cardiovascular and cerebrovascular events (MACCEs; all-cause mortality, myocardial infarction, repeat revascularization, or stroke) were compared across patient characteristics over time with the Cox proportional hazards and Kaplan-Meier's analyses. RESULTS During follow-up of 5.4 ± 4.5 years, 91 (58%) patients had MACCE. On Kaplan-Meier's analysis of angiographic characteristics, MACCE was more frequent in patients with at least moderate target vessel calcification (P = 0.023), ostial stenosis (P = 0.049), target vessel diameter ≥ 3.0 mm (P = 0.018), a SYNTAX score ≥ the median of 11 (P = 0.014), or bare metal stenting (BMS)/balloon angioplasty (BA) compared to drug-eluting stenting (DES) (P = 0.006). Cardiac death was more frequent in patients with SYNTAX score ≥ 11 (P = 0.028) or BMS (P = 0.043). After multivariable adjustment for both angiographic and clinical characteristics, independent predictors of MACCE were BMS placement (P = 0.013), chronic kidney disease ≥ stage 3 (P = 0.019), New York Heart Association (NYHA) heart failure class ≥3 (P = 0.034), and SYNTAX score ≥ 11 (P = 0.041). CONCLUSIONS In patients previously exposed to XRT treated with PCI, independent angiographic predictors of MACCE include SYNTAX score ≥ 11 and BMS placement, suggestive that DES should be preferred in this population.
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Affiliation(s)
- Grant W Reed
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jeffrey E Rossi
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ahmad Masri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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Du Y, Zhao YX, Liu W, Zhang JW, Yan ZX, Zhou YJ. Stenting for Aorto-Ostial In-Stent Restenosis via Side Strut of an Excessively Protruding Stent Guided by Intracoronary Imaging. Chin Med J (Engl) 2018; 131:2767-2768. [PMID: 30425210 PMCID: PMC6247583 DOI: 10.4103/0366-6999.245261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yu Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Ying-Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Wei Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Jian-Wei Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Zhen-Xian Yan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
| | - Yu-Jie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China
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Shaheen M, Mokarrab M, Youssef A, Aref M, Abushouk AI, Elmaraezy A, Almasswary A. Physiological evaluation of the provisional side-branch intervention strategy for bifurcation lesions using instantaneous wave-free ratio. Indian Heart J 2018; 70 Suppl 3:S254-S258. [PMID: 30595269 PMCID: PMC6309120 DOI: 10.1016/j.ihj.2018.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 01/10/2023] Open
Abstract
Background The provisional side-branch intervention strategy remains the gold standard approach for repair of coronary bifurcation lesions. We performed this study to evaluate the clinical and functional outcomes of using the instantaneous wave-free ratio (iFR) for physiological assessment in provisional side-branch repair of bifurcation lesions. Methods Fifty patients with coronary bifurcation lesions were equally divided into two groups: (I) an iFR-guided side-branch intervention group and (II) a conventional group, in which the operator selected a different interventional method. After the procedure, we performed a six-month follow-up for postoperative ejection fraction (EF) and clinical cardiac outcomes. Results Our results showed that the iFR measurement procedure was technically feasible in bifurcation lesions, with no procedural-related complications. Moreover, measuring iFR significantly predicted the side-branch percent stenosis after stenting of the main branch (r = −0.81, p < 0.0001). Compared to the conventional group, the iFR-guided group showed a significantly shorter procedural time (MD = −14.6 min, 95% CI [−27.7, −1.4]) and hospital stay duration (MD = −0.92 days, 95% CI [−1.6, −0.28]). However, no significant differences were recorded between the iFR-guided and conventional groups in terms of postoperative EF (p = 0.9), six-month heart failure class (p = 0.89), or post-interventional angina (p = 0.066). Conclusion Using iFR for physiological assessment during the provisional side-branch intervention strategy can reduce the procedural time and length of hospital stay in patients with bifurcation lesions. Larger trials should compare the clinical outcomes of iFR to other physiological assessment methods such as the fractional flow reserve (FFR) in patients with coronary bifurcation lesions. ClinicalTrials.gov number: NCT02785510
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Affiliation(s)
- Mohamed Shaheen
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Moustafa Mokarrab
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali Youssef
- Department of Cardiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mansour Aref
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Ahmed Elmaraezy
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt
| | - Adel Almasswary
- Department of Cardiology, Aseer Central Hospital, Abha, Saudi Arabia
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Abstract
Coronary artery disease of the septal perforator branches can lead to clinical ischemia and conduction abnormalities. Performing interventional procedures in these vessels is frequently impossible because they are small, which makes it difficult to approach them and to select appropriate equipment. Larger septal perforator branches have been treated percutaneously in a few patients; however, the clinical effectiveness and long-term outcomes are not known. We present our experience in managing obstructive septal perforator branch stenosis in 4 patients.
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Vaquerizo B, Fernández-Nofreiras E, Oategui I, Suarez de Lezo J, Rumoroso JR, Martín P, Routledge H, Tizón-Marcos H. Second-Generation Drug-Eluting Balloon for Ostial Side Branch Lesions (001-Bifurcations): Mid-Term Clinical and Angiographic Results. J Interv Cardiol 2017; 29:285-92. [PMID: 27245124 DOI: 10.1111/joic.12292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In the drug-eluting stent era, the best strategy to treat Medina 001 lesion remains unestablished. This is the first prospective registry assessing the efficacy and safety of the second-generation drug-coated balloon in patients with side-branch ostial lesion. METHODS Forty-nine patients with de novo Medina 001 lesion and associated myocardial ischemia were treated with second-generation drug-coated balloon-Dior balloon catheter (Eurocor GmbH, Bonn Germany), and prospectively included in this study. After mandatory pre-dilatation, a paclitaxel-eluting balloon was inflated for a minimum of 45 seconds. Left main bifurcation, severely calcified lesions and cardiogenic shock, were the only exclusion criteria. RESULTS The inclusion period was 2.7 years. Mean age was 62 ± 12 years old, 41% diabetic, 65% presented with acute coronary syndrome. The most common vessel treated was the first diagonal (50%). Pre-dilatation with a cutting balloon was used in 59%. Angiographic success was 86% (in 14% a bare metal stent was implanted because of acute recoil [n = 5] or coronary dissection more than type B [n = 2]). At a mean of 12.2 ± 2.2 months, major cardiac adverse events rate was 14.3% (1 myocardial infarction, 0 cardiac deaths, 7 target lesion revascularization). There was no thrombosis or occlusion. At a mean of 7.2 ± 1.1 months, binary restenosis was 22.5% (n = 7) with a late loss of 0.32 ± 0.73 mm. CONCLUSION Medina 001 lesion is an infrequent type of coronary lesion. Drug-coated balloon-Dior is a safe and technically easy therapeutic option, associated with acceptable mid-term clinical outcomes. (J Interven Cardiol 2016;29:285-292).
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Affiliation(s)
- Beatriz Vaquerizo
- Interventional Cardiology Unit, Hospital del Mar, Barcelona, Spain.,Interventional Cardiology Unit, Hospital Sant Pau, Barcelona, Spain
| | | | - Inmanol Oategui
- Interventional Cardiology Unit, Hospital Vall Hebron, Barcelona, Spain
| | | | | | - Pedro Martín
- Interventional Cardiology Unit, H. Dr. Negrín, Gran Canaria, Spain
| | - Helen Routledge
- Department of Cardiology, Worcestershire Royal Hospital, Worcester, UK
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Yamamoto K, Sakakura K, Adachi Y, Taniguchi Y, Wada H, Momomura SI, Fujita H. Comparison of mid-term clinical outcomes between "complete full-metal jacket strategy" versus "incomplete full-metal jacket strategy" for diffuse right coronary artery stenosis with drug-eluting stents. J Cardiol 2016; 69:823-829. [PMID: 27816320 DOI: 10.1016/j.jjcc.2016.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/18/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal strategy for diffuse right coronary artery (RCA) stenosis remains unclear. OBJECTIVE The objective of this study was to compare the mid-term outcomes of "complete full-metal jacket (c-FMJ) stenting strategy" with "incomplete full-metal jacket (i-FMJ) stenting strategy" for the diffuse long RCA lesion using drug-eluting stents (DES). METHODS Between July 2007 and October 2015, 121 patients underwent percutaneous coronary intervention (PCI) for diffuse RCA lesions using DES. Fifty-three patients underwent c-FMJ PCI, whereas 68 patients underwent i-FMJ. Thirty patients received angiographical follow-up in the c-FMJ group, while 34 patients received angiographical follow-up in the i-FMJ group. The primary endpoint was major adverse cardiac events (MACE): cardiac death, stent thrombosis (ST), target lesion revascularization (TLR), and target vessel revascularization (TVR). RESULTS The incidence of MACE was significantly lower in the c-FMJ group (13.3%) as compared to the i-FMJ group (41.2%) (p=0.013). There was no cardiac death in either group. The incidence of ST was comparable between the i-FMJ group (2.9%) and c-FMJ group (3.3%) (p=1.00), while TLR was significantly less in the c-FMJ group (6.7%) compared to the i-FMJ group (32.4%) (p=0.011). CONCLUSIONS The mid-term MACE was significantly less in the c-FMJ group than in the i-FMJ group, indicating that c-FMJ stenting was a favorable strategy for the diffuse long RCA lesion.
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Affiliation(s)
- Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yusuke Adachi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Chen X, Zhang D, Yin D, Li J, Zhao Z, Wang H, Yang Y, Xu B, Dou K. Can “true bifurcation lesion” actually be regarded as an independent risk factor of acute side branch occlusion after main vessel stenting?: A retrospective analysis of 1,200 consecutive bifurcation lesions in a single center. Catheter Cardiovasc Interv 2016; 87 Suppl 1:554-63. [DOI: 10.1002/ccd.26403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/21/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Xuhua Chen
- The State Key Laboratory of Cardiovascular Disease Department of Cardiology; Cardiovascular Institute Fuwai Hospital and the National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Dong Zhang
- The State Key Laboratory of Cardiovascular Disease Department of Cardiology; Cardiovascular Institute Fuwai Hospital and the National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Dong Yin
- The State Key Laboratory of Cardiovascular Disease Department of Cardiology; Cardiovascular Institute Fuwai Hospital and the National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Jia Li
- The State Key Laboratory of Cardiovascular Disease Department of Cardiology; Cardiovascular Institute Fuwai Hospital and the National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Zhiyong Zhao
- The State Key Laboratory of Cardiovascular Disease Department of Cardiology; Cardiovascular Institute Fuwai Hospital and the National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Hao Wang
- The State Key Laboratory of Cardiovascular Disease Department of Cardiology; Cardiovascular Institute Fuwai Hospital and the National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Yuejin Yang
- The State Key Laboratory of Cardiovascular Disease Department of Cardiology; Cardiovascular Institute Fuwai Hospital and the National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Bo Xu
- The State Key Laboratory of Cardiovascular Disease Department of Cardiology; Cardiovascular Institute Fuwai Hospital and the National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
| | - Kefei Dou
- The State Key Laboratory of Cardiovascular Disease Department of Cardiology; Cardiovascular Institute Fuwai Hospital and the National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing 100037 China
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12
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Percutaneous transluminal angioplasty for radial-cephalic fistulae with stenosis at the arteriovenous junction. Am J Med Sci 2012; 343:435-9. [PMID: 22052413 DOI: 10.1097/maj.0b013e318231153c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the predictive factors for initial success and long-term patency of percutaneous transluminal angioplasty for radial-cephalic (RC) fistulae with stenosis at the arteriovenous junction (AVJ). Stenosis at the AVJ of RC fistulae involves both the feeding artery and drainage vein and is similar to a bifurcation lesion, which carries a worse outcome. The optimal intervention method for this type of lesion is currently unknown. METHODS Ninety-one percutaneous transluminal angioplasty procedures for stenosis at the AVJ of RC fistulae were reviewed retrospectively. Parameters including age, sex, location of the RC fistula (right or left arm), approach site (radial artery or cephalic vein) and involvement of proximal radial artery (PRA) dilatation were analyzed for initial procedure success and long-term patency rates. RESULTS The total initial success rate was 94.5%. The existence of total occlusion was recognized as the only factor significantly associated with a high procedural failure rate (39% versus 0%, P < 0.001). For long-term patency rate, the only significant factor was the involvement of PRA dilatation (P = 0.026 by Cox-Mantel and 0.03 by generalized Wilcoxon methods). The 6-month, 1-year and 18-month patency rates were 64%, 45.3% and 20.9%, respectively, for all procedures, and 70.7% versus 57.8%, 56.1% versus 35.6% and 36.6% versus 6.7% for procedures with and without PRA dilatation, respectively. CONCLUSIONS In treating stenosis at the AVJ of RC fistulae, while initial procedural failure occurred mainly in occluded lesions, involvement of PRA dilatation was the only significant predictive factor associated with long-term patency.
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Stayman AN, Nogueira RG, Gupta R. A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis. Stroke 2011; 42:2212-6. [DOI: 10.1161/strokeaha.110.611459] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Aaron N. Stayman
- From the Department of Neurology (A.N.S.), Vanderbilt University School of Medicine, Nashville, TN; Departments of Neurology (R.G.N., R.G.), Neurosurgery and Radiology, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA
| | - Raul G. Nogueira
- From the Department of Neurology (A.N.S.), Vanderbilt University School of Medicine, Nashville, TN; Departments of Neurology (R.G.N., R.G.), Neurosurgery and Radiology, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA
| | - Rishi Gupta
- From the Department of Neurology (A.N.S.), Vanderbilt University School of Medicine, Nashville, TN; Departments of Neurology (R.G.N., R.G.), Neurosurgery and Radiology, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA
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Erglis A, Narbute I, Juhnevica D, Kumsars I, Jegere S. Lessons for the treatment of bifurcation lesions: from nowadays to the future. Interv Cardiol 2011. [DOI: 10.2217/ica.10.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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15
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Halapas A, Hauptmann KE. Sideguard®dedicated stent system for the treatment of coronary bifurcation artery lesions. Interv Cardiol 2011. [DOI: 10.2217/ica.10.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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16
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Gutiérrez-Chico JL, Villanueva-Benito I, Villanueva-Montoto L, Vázquez-Fernández S, Kleinecke C, Gielen S, Íñiguez-Romo A. Szabo technique versus conventional angiographic placement in bifurcations 010-001 of Medina and in aorto-ostial stenting: angiographic and procedural results. EUROINTERVENTION 2010; 5:801-8. [DOI: 10.4244/eijv5i7a134] [Citation(s) in RCA: 36] [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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17
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Outcomes after percutaneous coronary intervention of ostial lesions in the era of drug-eluting stents. Catheter Cardiovasc Interv 2009; 73:763-8. [DOI: 10.1002/ccd.21941] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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18
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Kakino S, Ogasawara K, Kubo Y, Kashimura H, Konno H, Sugawara A, Kobayashi M, Sasaki M, Ogawa A. Clinical and angiographic long-term outcomes of vertebral artery–subclavian artery transposition to treat symptomatic stenosis of vertebral artery origin. J Neurosurg 2009; 110:943-7. [DOI: 10.3171/2008.10.jns08687] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Although angioplasty and stent placement for vertebral artery (VA)–origin stenosis have been performed using endovascular techniques, a high likelihood of restenosis has been observed in the long term. Therefore, the authors assessed the long-term clinical and angiographic outcomes in patients after VA–subclavian artery (SA) transposition.
Methods
Thirty-six patients (31 men, 5 women; mean age 64.3 years, range 46–76 years) underwent clinical evaluation (modified Rankin Scale [mRS]) and cervical angiographic evaluation preoperatively and within 1 month of and 6 months after VA-SA transposition undertaken to treat symptomatic stenosis of VA origin.
Results
Postoperative neurological deficits due to intraoperative brain ischemia did not occur, and MR imaging demonstrated no new postoperative ischemic lesions in any of the patients. One patient died of acute myocardial infarction 2 months after surgery and another developed a left thalamic hemorrhage (mRS score of 5) at 42 months postsurgery. None of the remaining 34 patients experienced further ischemic events, and the mRS score in all of these patients remained unchanged during a mean follow-up period of 54 months. The degree of VA-origin stenosis (preoperative mean 84%) was reduced to ≤ 30% after surgery (mean 2%). Long-term follow-up angiography in 29 patients (81%) revealed the absence of restenosis, defined as > 50% luminal narrowing, in all of them.
Conclusions
The clinical and angiographic long-term outcomes demonstrated here suggest that VA-SA transposition will be useful in patients with symptomatic stenosis of VA origin.
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Affiliation(s)
| | | | | | | | | | | | | | - Makoto Sasaki
- 2Radiology, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
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Abdel Hakim DE, Garot P, Champagne S, Maklady F, El Hawary A, Dubois-Randé JL, Lesault PF, Teiger E. Impact of bifurcation lesions on clinical outcome and prognosis of primary angioplasty in acute myocardial infarction. EUROINTERVENTION 2008; 4:93-8. [DOI: 10.4244/eijv4i1a16] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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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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21
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Ozaki K, Oda H, Suzuki T, Ohno Y, Tsuchida K, Takahashi K, Miida T. A case of intracoronary protruded thrombus caused after bailout stenting for side branch occlusion. J Cardiol 2008; 51:70-3. [DOI: 10.1016/j.jjcc.2007.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Revised: 10/31/2007] [Accepted: 11/07/2007] [Indexed: 11/16/2022]
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22
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Dahm JB, Dörr M, Scholz E, Ruppert J, Hummel A, Staudt A, Felix SB. Cutting-balloon angioplasty effectively facilitates the interventional procedure and leads to a low rate of recurrent stenosis in ostial bifurcation coronary lesions: A subgroup analysis of the NICECUT multicenter registry. Int J Cardiol 2007; 124:345-50. [PMID: 17434613 DOI: 10.1016/j.ijcard.2007.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 01/08/2007] [Accepted: 02/17/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Displacement of plaque is a major concern during coronary intervention of ostial bifurcation lesions. For this reason, angioplasty involves complex stenting procedures, which may trigger development of restenosis in a previously non-diseased parent vessel. OBJECTIVES To examine, whether plaque displacement may be prevented by scoring atherosclerotic plaque with a cutting-balloon (CB) stand-alone procedure. METHODS Data of patients with Duke E and B type ostial bifurcation lesions (>/=70% stenosis involving a diagonal and/or marginal branch >2 mm deriving from a non-diseased parent vessel), who were treated with CB as stand-alone procedure within the prospective NICECUT multicenter trial were analyzed. Primary endpoint was the rate of binary stenosis and target lesion revascularization (TLR). Secondary endpoints were procedural success and major adverse cardiac events (MACE) at 6-months follow-up. RESULTS 63 out of 65 lesions (56 patients) were successfully amenable to treatment with CB (96.4% procedural success). 76.9% of patients were successfully treated with CB as a stand-alone procedure, while provisional stenting was necessary in 23.1%. At follow-up, binary stenosis was found in 23.2%, among the total population. Total rate of TLR and MACE were 7.7% and 3.6%, respectively, compared to 4.0% and 2.0% in patients for whom CB stand-alone procedure was feasible, while it was 20.0% and 6.7% for stented lesions. CONCLUSIONS CB angioplasty as a stand-alone procedure may facilitate interventional treatment of ostial bifurcation lesions and may help to avoid complex stenting procedures. It is associated with a low rate of binary stenosis and TLR.
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Affiliation(s)
- Johannes B Dahm
- Department of Cardiology-Angiology, Heart and Vascular Center Neu-Bethlehem, Göttingen, Germany.
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23
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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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Dahm JB, Ruppert J, Hartmann S, Vogelgesang D, Hummel A, Felix SB. Directional atherectomy facilitates the interventional procedure and leads to a low rate of recurrent stenosis in left anterior descending and left circumflex artery ostium stenoses: subgroup analysis of the FLEXI-CUT study. Heart 2006; 92:1285-9. [PMID: 16449510 PMCID: PMC1861141 DOI: 10.1136/hrt.2005.081752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine by retrospective analysis of data from the FLEXI-CUT monocentre registry whether atherectomy can effectively simplify complex stent implantation in ostial bifurcation lesions by reducing the procedure to stenting of the left anterior descending (LAD) or left circumflex (LCX) artery ostium alone. PATIENTS AND METHODS All patients who had been enrolled in the prospective FLEXI-CUT study (directional atherectomy with adjunctive balloon angioplasty) were retrospectively analysed on the basis of significant LAD or LCX ostial stenosis (>or= 70% stenosis) deriving from an undiseased left main stem. The primary combined end point was the rate of target lesion revascularisation (TLR) and binary restenosis; secondary end points were procedural success and major adverse cardiac events (MACE) at the six-month follow up. RESULTS Of 30 patients enrolled with significant LAD or LCX ostium stenosis, 29 were effectively treated with directional atherectomy (96.7% procedural success). All patients underwent single-vessel stenting procedures of solely the LAD or LCX ostium. At follow up, binary stenosis was 25% (6 of 24), TLR (angiographic plus clinical) 10.3% (3 of 29) and total MACE 6.9% (2 of 29). CONCLUSIONS Directional atherectomy with single-vessel stenting procedures facilitates the interventional treatment of LAD and LCX ostium stenosis, and leads to remarkably low TLR and binary stenosis at follow up.
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Affiliation(s)
- J B Dahm
- Department of Cardiology, Ernst Moritz Arndt University Greifswald, Friedrich-Loeffler-Strasse 23b, D-17487 Greifswald, Germany.
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Abstract
The introduction and widespread use of coronary stents have been the most important advancement in the percutaneous treatment of coronary artery disease since the introduction of balloon angioplasty. Coronary artery stents reduce the rate of angiographic and clinical restenosis compared to balloon angioplasty. This angiographic restenosis was further reduced with the introduction of drug-eluting stents and hence further reduction in the frequency of major adverse cardiac events. Herein we present a comprehensive and up-to-date review about the use of drug-eluting stents in the treatment of coronary artery disease.
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Ikeno F, Kim YH, Luna J, Condado JA, Colombo A, Grube E, Fitzgerald PJ, Park SJ, Yeung AC. Acute and long-term outcomes of the novel side access (SLK-View™) stent for bifurcation coronary lesions: A multicenter nonrandomized feasibility study. Catheter Cardiovasc Interv 2006; 67:198-206. [PMID: 16404749 DOI: 10.1002/ccd.20556] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate technical feasibility and procedural safety of SLK-View stent for treating bifurcation lesions. BACKGROUND Percutaneous treatment of coronary bifurcation lesions represents a technical challenge. Several stenting techniques and dedicated devices have proven unsuccessful, with high rates of side branch occlusion at index procedure and follow-up. METHODS Eighty one patients with 84 de novo coronary artery lesions involving a major side branch underwent SLK-View (Advanced Stent Technologies, Inc., Pleasanton, CA) stent implantation with subsequent kissing balloon post dilatation. SLK-View stent is a new scaffolding device incorporating a side aperture that allows access to the side-branch of a bifurcation after deployment of the stent in main vessel. All patients underwent angiographic follow-up at 6 months. Procedural, in-hospital, and 6-month follow-up outcomes were examined. RESULTS The lesions were located in left main (n = 11), left anterior descending (n = 50), left circumflex (n = 8), right coronary artery (n = 7), and 1 ramus intermedius. The most frequent lesions (44.1%) were true bifurcations. Successful stent delivery to bifurcation was accomplished in 82/84 of the cases (97.6%). Technical success was obtained in 99 and 94% of main vessel and side branches, respectively. Stenting in side-branch was performed in 21 lesions (25%). Side-branches were accessed effectively in 100% of bifurcations postprocedurally. Binary restenosis rate at 6-month follow-up was 28.3% and 37.7% for main vessel and side-branch, respectively. TLR rate at 6-month follow-up was 21% and CABG rate of 6%. CONCLUSION In this consecutive multicenter series of patients with coronary bifurcation lesions, this novel side-branch access stent proved feasible, with a high procedural success rate, while maintaining side-branch access.
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Affiliation(s)
- Fumiaki Ikeno
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
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28
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Connelly KA, Boyle A, Wilson A, Macisaac A, Fox P, Whitbourn R. Coronary artery stent thrombosis associated with exercise testing. Heart Lung Circ 2005; 12:66-9. [PMID: 16352109 DOI: 10.1046/j.1444-2892.2003.00165.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chest pain following coronary artery stenting is common, yet finding the cause can be difficult. Exercise testing has long been used in the assessment of chest pain, but its usefulness in patients who have recently undergone coronary artery stenting is in doubt. A case of exercise testing appearing to precipitate acute stent thrombosis in a patient several weeks post-coronary artery stenting is reported and compared to a similar case in the literature. The role of exercise testing in the assessment of chest pain early after coronary artery stenting is then reviewed.
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Affiliation(s)
- Kim A Connelly
- Department of Cardiology, St Vincent's Hospital, Melbourne, Victoria, Australia
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Huang HL, Hsieh IC, Chang SH, Chang HJ, Chen CC, Hung KC, Wen MS, Wu D. Acute and long-term outcomes of intracoronary stenting in aorto-ostial, left anterior descending artery-ostial and nonostial stenoses. Int J Cardiol 2005; 101:391-7. [PMID: 15907406 DOI: 10.1016/j.ijcard.2004.03.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Revised: 02/03/2004] [Accepted: 03/05/2004] [Indexed: 10/26/2022]
Abstract
Percutaneous transluminal coronary angioplasty in ostial lesions is technically difficult and is associated with a lower procedural success rate, higher complication rate and restenosis rate as compared to nonostial lesions. The safety, feasibility, immediate and 6-month angiographic, and long-term clinical outcomes of stenting in aorto-ostial, left anterior descending artery (LAD)-ostial and nonostial stenoses, were retrospectively compared in 19 patients with 20 aorto-ostial lesions (group A), 97 with 97 LAD-ostial lesions (group B) and 1778 with 2242 nonostial lesions (group C). The major adverse cardiac events during hospitalization were similar among the three groups (p = 0.816). Twelve patients with 12 lesions in group A, 75 with 75 lesions in group B and 1384 with 1749 lesions in group C underwent a 6-month follow-up coronary angiography. There were no differences in acute gain (2.04 +/- 0.46 vs. 2.34 +/- 0.50 vs. 2.39 +/- 0.54 mm, respectively, p = 0.057) and net gain (0.89 +/- 1.02 vs. 1.26 +/- 1.08 vs. 1.34 +/- 0.76 mm, respectively, p = 0.105) among the three groups. Group B had a larger late loss than group A and C (1.15 +/- 1.01 vs. 1.22 +/- 0.76 vs. 1.04 +/- 0.65 mm, respectively, p = 0.048) and group A had a larger loss index than group B and C (0.59 +/- 0.50 vs. 0.52 +/- 0.31 vs. 0.48 +/- 0.29, respectively, p = 0.027). The binary restenosis rate among the three groups was 33%, 29% and 20%, respectively, (p = 0.072). Group B had higher restenotic rate as compared to group C (p = 0.036). During a long-term follow-up period of 42+/-21 months, major adverse cardiac events were similar among the three groups (15.8% vs. 25.8% vs. 20.1%, respectively, p = 0.362), but group B had a higher incidence of recurrent angina as compared to group C (17.5% vs. 10.9%, p = 0.039). The cardiac event-free survival rate, as determined by Kaplan-Meier analysis, was similar among the three groups (56% vs. 57% vs. 67%, respectively, p = 0.149); a borderline significance was noted as compared group B to group C (p = 0.051). In conclusion, stenting in aorto-ostial or LAD-ostial lesions is safe, feasible and has a similar acute result as compared to stenting in nonostial lesions; however, it still has a higher 6-month angiographic restenosis rate. LAD-ostial stenoses may have a less favorable long-term clinical outcome than nonostial stenoses.
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Affiliation(s)
- Hsuan-Li Huang
- Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
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Kim YH, Hong MK, Lee SW, Lee CW, Han KH, Kim JJ, Park SW, Mintz GS, Park SJ. Randomized comparison of debulking followed by stenting versus stenting alone for ostial left anterior descending artery stenosis: intravascular ultrasound guidance. Am Heart J 2004; 148:663-9. [PMID: 15459598 DOI: 10.1016/j.ahj.2004.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although directional coronary atherectomy (DCA) before stenting has the advantage of combining substantial removal of atheromatous plaque and prevention of elastic recoil, there has been no randomized study to investigate its efficacy in ostial left anterior descending artery (LAD) lesions. This study was aimed to evaluate the effect of DCA followed by stenting on ostial LAD stenosis under the guidance of intravascular ultrasound (IVUS). METHODS Eighty-six patients with ostial LAD stenoses were randomly assigned to DCA followed by stenting (group I) or stenting alone (group II). Aggressive DCA or optimal stenting was performed in both groups under the guidance of IVUS. The primary end point was angiographic restenosis at 6 months. RESULTS Baseline clinical and angiographic characteristics were similar between the 2 groups. The postprocedural minimal lumen diameter was larger in group I than group II (4.0 +/- 0.4 mm vs. 3.5 +/- 0.5 mm, P <.001). However, the angiographic restenosis rates were not significantly different between the 2 groups (9/32 [28.1%] in group I vs. 11/30 [36.7%] in group II, P =.472). The postprocedural IVUS stent area was the only independent determinant of restenosis by multivariate analysis (odds ratio.61, 95% CI 0.41-0.92, P =.018). CONCLUSIONS DCA followed by stenting achieved greater lumen gain than stenting alone for ostial LAD stenosis. However, DCA did not improve angiographic restenosis.
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Affiliation(s)
- Young-Hak Kim
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Abstract
PURPOSE OF REVIEW Despite numerous advances in coronary interventional techniques, the frequent occurrence of restenosis continues to plague interventional cardiology. With the widespread use of drug-eluting stents, there is a need to reexamine critically the roles of the various interventional techniques currently available. RECENT FINDINGS Drug-eluting stents have dramatically reduced the rates of restenosis and target vessel revascularization in a wide spectrum of patients with varying lesion morphologies. However, when restenosis does occur, it still tends to be dependent on the same factors that predict restenosis with bare metal stenting. The routine use of drug-eluting stents entails high initial costs to the health care system. Debulking as a means to improve outcomes after angioplasty has not lived up to expectations. Gene therapy is rapidly evolving into a viable means to reduce neointimal proliferation after angioplasty. SUMMARY Careful patient selection and attention to the procedure of stent deployment optimize the results of angioplasty with drug-eluting stents. Because of cost considerations, drug-eluting stents should be used in patients who are expected to have the greatest absolute benefit. In this context, when judiciously used, conventional balloon angioplasty and bare metal stenting still have a definite role in the management of patients with obstructive coronary artery disease.
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Affiliation(s)
- Ganesan Karthikeyan
- Department of Cardiology, Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India
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32
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Ziaee A, Parham WA, Herrmann SC, Stewart RE, Lim MJ, Kern MJ. Lack of relation between imaging and physiology in ostial coronary artery narrowings. Am J Cardiol 2004; 93:1404-7, A9. [PMID: 15165925 DOI: 10.1016/j.amjcard.2004.02.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2003] [Revised: 02/12/2004] [Accepted: 02/12/2004] [Indexed: 10/26/2022]
Abstract
This study compared ostial lesion angiographic severity with physiologic assessment and showed that, for diameter narrowings >70%, fractional flow reserves were >0.75 in 20 of 25 lesions and >0.75 in 30 of 30 lesions with <70% diameter narrowings. Using fractional flow reserve in all ostial narrowings > or =70% may prevent patients from undergoing unnecessary interventions.
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Affiliation(s)
- Ali Ziaee
- J. Gerard Mudd Cardiac Catheterization Laboratory, St. Louis University Health Sciences Center, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO 63110-0250, USA
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Abstract
Despite the increasing use of percutaneous transluminal coronary angioplasty and intracoronary stent placement for the treatment of obstructive coronary artery disease, a large subset of coronary lesions cannot be adequately treated with balloon angioplasty and/or intracoronary stenting alone. Such lesions are often heavily calcified or fibrotic and undilatable with the present balloon technology and attempts to treat them with balloon angioplasty or intracoronary stent placement often lead to vessel dissection or incomplete stent deployment with resultant adverse outcomes. Rotational atherectomy remains a useful niche device for the percutaneous treatment of such complex lesions, usually as an adjunct to subsequent balloon angioplasty and/or intracoronary stent placement. In contrast to balloon angioplasty or stent placement that widen the coronary lumen by displacing atherosclerotic plaque, rotational atherectomy removes plaque by ablating the atherosclerotic material, which is dispersed into the distal coronary circulation. Other lesion subtypes amenable to treatment with this modality include ostial and branch-ostial lesions, chronic total occlusions, and in-stent restenosis. This review discusses the technique and principles of rotational atherectomy, the various treatment strategies for its use (including adjunctive pharmacotherapy), the lesion-specific applications for this device, and the complications unique to this modality. Recommendations are also made for its use in the current interventional era.
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Affiliation(s)
- Erdal Cavusoglu
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA
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Hirose M, Kobayashi Y, Kreps EM, Stone GW, Moussa I, Leon MB, Moses JW. Luminal narrowing due to intramural hematoma shift from left anterior descending coronary artery to left circumflex artery. Catheter Cardiovasc Interv 2004; 62:461-5. [PMID: 15274154 DOI: 10.1002/ccd.20138] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This case report demonstrates subacute luminal narrowing 20 days after balloon angioplasty in the left anterior descending coronary artery due to an intramural hematoma. Stenting was performed and resulted in side-branch compromise caused by squeezing the hematoma from the left anterior descending coronary artery into the left circumflex artery. Another stent was deployed to treat the stenosis in the left circumflex artery.
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Affiliation(s)
- Makoto Hirose
- Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York, USA
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35
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Albuquerque FC, Fiorella D, Han P, Spetzler RF, McDougall CG. A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. Neurosurgery 2003; 53:607-14; discussion 614-6. [PMID: 12943577 DOI: 10.1227/01.neu.0000079494.87390.28] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2002] [Accepted: 04/22/2003] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess the rate of restenosis after vertebral origin angioplasty and stenting (VOAS). METHODS We reviewed the records of 33 patients (24 men, 9 women; age range, 49-81 yr; mean, 64.5 yr) who underwent VOAS during a period of 5 years and followed each for the development of adverse sequelae through a prospectively maintained database. A neuroradiologist not involved in the stenting procedures assessed original and follow-up angiograms for evidence of restenosis. Restenosis was quantified as insignificant (0-24%), mild (25-49%), moderate (50-74%), or severe (75-100%). RESULTS Of the 33 patients, 30 presented with transient ischemic attacks or stroke. Most (31 of 33 patients) manifested other brachiocephalic stenoses, including 27 patients with occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Angiographic follow-up (mean, 16.2 mo) was obtained in 30 patients (2 patients died before follow-up, and 1 refused). Restenosis was mild in seven patients, moderate in eight, and severe in five. The combined rate of moderate-to-severe restenosis was 43.3%. No complications resulted in permanent morbidity. One patient died as a result of a stroke in a different vascular distribution 4 months after VOAS. Another patient died as a result of basilar thrombosis in which emergent stenting had been undertaken in an effort to perform thrombolysis. CONCLUSION Despite a technical success rate of 97% and a low incidence of complications, VOAS is associated with a high rate of moderate-to-severe restenosis.
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Affiliation(s)
- Felipe C Albuquerque
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
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Badak O, Schoenhagen P, Tsunoda T, Magyar W, Coughlin J, Kapadia S, Nissen S, Tuzcu E. Coron Artery Dis 2003; 14:309-316. [DOI: 10.1097/00019501-200306000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register]
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37
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Almeda FQ, Chua DY, Nathan S, Kim S, Meyer PM, Nguyen C, Chu JCH, Kavinsky CJ, Snell RJ, Schaer GL. Correlates of failure following treatment with Sr-90 beta irradiation for in-stent restenosis. Catheter Cardiovasc Interv 2003; 59:176-83. [PMID: 12772235 DOI: 10.1002/ccd.10496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We sought to determine the correlates of failure following intracoronary radiation therapy (IRT) with Sr-90 using the Novoste Beta-Cath system for the treatment of in-stent restenosis (ISR) in a broad range of patients. IRT has been shown to be more efficacious compared to placebo for the treatment of ISR in large randomized trials. However, even in patients treated with IRT, major adverse cardiac events occur in approximately 20% of cases on follow-up. This trial sought to elucidate the correlates of failure following successful IRT for ISR. To determine the correlates of IRT failure, we retrospectively compared the demographics, lesion characteristics, and clinical outcomes of 102 consecutive patients with ISR treated with Sr-90 from September 1998 to July 2001. IRT failure was defined as death, myocardial infarction (MI), or target vessel revascularization (TVR) due to repeat ISR on follow-up. A comparison of the clinical and angiographic profile of IRT failures (n = 16) vs. IRT successes (n = 86) revealed that a history of smoking (75% vs. 40%; P = 0.012), current use of calcium channel blockers (84% vs. 45%; P = 0.013), ostial location of target lesion (44% vs. 16%; P = 0.020), and mean posttreatment minimal luminal diameter (MLD; 1.64 +/- 0.19 vs. 2.21 +/- 0.29 mm; P < 0.001), respectively, were correlated with failure using univariate analysis. After multivariate regression analysis, the correlates of failure that remained significant were treatment of an ostial lesion (OR = 31.2; 95% CI = 2.6-382.7; P = 0.007) and final posttreatment MLD (P < 0.001). Ostial location of target lesion and smaller posttreatment MLD are correlated with subsequent death, MI, and TVR following therapy with Sr-90 for ISR.
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Affiliation(s)
- Francis Q Almeda
- Rush Heart Institute, Rush-Presbyterian-St. Luke's Medical Center and Rush Medical College, Chicago, Illinois 60612, USA.
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Badak O, Schoenhagen P, Tsunoda T, Magyar WA, Coughlin J, Kapadia S, Nissen SE, Tuzcu EM. Characteristics of atherosclerotic plaque distribution in coronary artery bifurcations: an intravascular ultrasound analysis. Coron Artery Dis 2003; 14:309-16. [PMID: 12826930 DOI: 10.1097/01.mca.0000076511.29238.f1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Vessel bifurcations are prone to atherosclerotic plaque accumulation. Using volumetric intravascular ultrasound analysis, we investigated atheroma distribution at human coronary bifurcations in vivo. METHODS We analyzed plaque distribution in 49 left anterior descending coronary artery-diagonal and 20 left circumflex coronary artery-obtuse marginal bifurcations with <50% angiographic stenosis. Cross-sections were analyzed at 1 mm intervals in segments 5 mm proximal and distal from the bifurcation. Planimetry of the lumen and external elastic membrane (EEM) was performed and plaque thickness measured at four different points relative to the branch: 0 degrees, 90 degrees, 180 degrees and 270 degrees. EEM, lumen and plaque volume and percentage plaque burden (plaque volume/EEM volume) were calculated in the proximal and distal segments. The side-branch take-off angle was analyzed in the cross-sectional images. RESULTS Volumetric analysis showed that EEM, lumen and plaque were larger (P<0.001) in proximal segments than distal segments, whereas percent plaque burden was similar in these segments. Plaque accumulated on the opposite wall to the flow divider. Plaque distribution tended to be more eccentric in distal segments (P=0.05) compared to proximal segments. In 26 of 69 lesions, an asymmetric side-branch take-off was found and was associated with asymmetric plaque distribution compared to those lesions that had a symmetric side-branch take-off (P<0.01). CONCLUSION We found characteristic patterns of plaque distribution at coronary bifurcations. Proximal segments demonstrated larger plaque volume than distal segments, despite similar percentages of plaque burden. Plaque volume accumulated opposite to the flow divider, especially in distal segments. The side-branch take-off angle in the cross-sectional plane influenced the plaque distribution in bifurcation lesions.
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Affiliation(s)
- Ozer Badak
- Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA
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Costantini CO, Lansky AJ, Mintz GS, Shirai K, Dangas G, Mehran R, Fahy M, Slack S, Coral M, Teirstein PS, Waksman R, Stone G, Moses J, Leon MB. Intravascular brachytherapy for native coronary ostial in-stent restenotic lesions. J Am Coll Cardiol 2003; 41:1725-31. [PMID: 12767655 DOI: 10.1016/s0735-1097(03)00298-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We analyzed the effects of vascular brachytherapy (VBT) on ostial in-stent restenosis (ISR). BACKGROUND In-stent restenosis has a high recurrence rate after percutaneous reintervention. The recurrence rate of ostial ISR lesions and the impact of VBT remain unknown. METHODS We evaluated 133 patients with native coronary ostial ISR from a pooled database of 990 patients enrolled in randomized VBT trials. Independent quantitative angiography was performed at baseline and follow-up in 45 gamma, 27 beta, and 61 placebo patients. RESULTS Binary restenosis was significantly higher in placebo than radiated patients (75.4% vs. 17.8% in gamma vs. 22.2% in beta, p < 0.0001). The treatment effect of both gamma (odds ratio [OR] 0.06; 95% confidence interval [CI] 0.02 to 0.17) and beta VBT (OR 0.10; 95% CI 0.03 to 0.31) was maintained after controlling for differences in baseline lesion length. Proximal and distal radiation edge restenosis rates were similar among the groups. Vascular brachytherapy of true aorto-ostial lesions (n = 34) was similarly beneficial: restenosis rates of placebo versus gamma or beta patients of 83.3% versus 6.7% versus 28.6%, p = 0.0002. CONCLUSIONS Conventional treatment of ostial ISR is associated with a recurrence rate of over 75%. Vascular brachytherapy with either gamma or beta sources results in significant and similar reductions in restenosis compared with placebo. Similar benefits after VBT prevail in true aorto-ostial lesions.
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Affiliation(s)
- Costantino O Costantini
- Cardiovascular Research Foundation, Lenox Hill Hospital, 55 East 59th Street, 6th Floor, New York, New York, NY 10022, USA
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Toutouzas K, Stankovic G, Takagi T, Albiero R, Corvaja N, Milici C, Di Mario C, Finci L, Colombo A. A new dedicated stent and delivery system for the treatment of bifurcation lesions: preliminary experience. Catheter Cardiovasc Interv 2003; 58:34-42. [PMID: 12508194 DOI: 10.1002/ccd.10345] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We report the first clinical experience in eight patients with a new stent and delivery system specifically designed for the treatment of bifurcational lesions. The device (AST SLK-View system) consists of a premounted stent and a delivery system. The stent has a side aperture, which orients toward the ostium of the side branch. The system allows deployment of the stent while the access to both main and side branches is maintained by two wires. We evaluated this system in nine bifurcations. The location of bifurcations was left descending artery/diagonal branch in four lesions, left circumflex/obtuse marginal branch in three lesions, and postero-lateral branch/posterior descending artery in two lesions. Predilation was performed in six lesions of the main branches and in five lesions of the side branches. The stent was effectively delivered to all bifurcations except for one, in which the target lesion was located at a distal segment and the device could not be delivered. Following stent implantation in the main branch, two lesions at the side branches were treated by stent, while the other lesions were treated by balloon angioplasty without difficulty. Final kissing balloon was performed in four bifurcation lesions. No adverse event was observed during 1 month of clinical follow-up. Treatment of bifurcation lesions with this new dedicated device appears to be feasible. This new device may introduce a new approach for the treatment of coronary bifurcation lesions.
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Chung CM, Nakamura S, Tanaka K, Tanigawa J, Kitano K, Akiyama T, Matoba Y, Katoh O. Comparison of cutting balloon vs stenting alone in small branch ostial lesions of native coronary arteries. Circ J 2003; 67:21-5. [PMID: 12520146 DOI: 10.1253/circj.67.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Angioplasty of small vessels is associated with a higher rate of restenosis, even in the ostium. The present study compared the acute, late results of cutting balloon vs those of stenting alone in small branch ostial lesions of native coronary arteries and the effect on the parent vessel. The study group comprised 61 patients with successful angioplasty of smaller branch ostial lesions in native coronary arteries. The reference vessel diameter was between 2.5 and 3.0 mm. Patients were divided into 2 groups: group I (cutting balloon, n=30) and group II (stenting alone, n=31). After intervention, patients in group II achieved significant acute lumen gain, larger minimal lumen diameter (MLD) and less diameter stenosis. At 3-month follow-up, the MLD and diameter stenosis of the 2 groups were almost identical; however, late loss was lower in group I. At the 6-month follow up, the cumulative restenosis rate was 41% (11/27) in group I compared with 63% (19/31) in group II (p=0.05), and the target lesion revascularization was also lower in the cutting balloon group [29% (8/27) vs 53% (16/30) p=0.05]. In group 1, the MLD of the parent vessel did not change before, after cutting balloon or at follow-up. In contrast, there were significant reductions in parent vessel MLD following stenting alone and at follow-up. Plaque shift did not occur in the cutting balloon group. Cutting balloon angioplasty is a feasible approach for the treatment of small branch ostial lesions and does not cause significant narrowing of the parent vessel.
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Affiliation(s)
- Chang-Min Chung
- Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan.
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Park SJ, Lee CW, Kim YH, Lee JH, Hong MK, Kim JJ, Park SW. Technical feasibility, safety, and clinical outcome of stenting of unprotected left main coronary artery bifurcation narrowing. Am J Cardiol 2002; 90:374-8. [PMID: 12161225 DOI: 10.1016/s0002-9149(02)02492-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was performed to evaluate the acute and long-term results of stenting for unprotected left main coronary artery (LMCA) bifurcation lesions. Sixty-three consecutive patients with an unprotected LMCA bifurcation lesion and normal left ventricular function were included. Stenting was performed with (n = 32) or without debulking atherectomy (n = 31) at the operator's discretion. Slotted-tube stents, coil stents, or bifurcation stents were used. The procedural success rate was 100%. In-hospital events including stent thrombosis, Q-wave myocardial infarction, and emergency bypass surgery did not occur in any patients. The angiographic follow-up rate was 86% (43 of the 50 eligible patients), and the restenosis rate was 28% (parent vessel only 14%, side branch only 9%, and both 5%). Restenosis at the parent vessel occurred less frequently in the debulking group than in the nondebulking group (5% vs 33%, respectively, p = 0.02). In multivariate analysis, the debulking procedure was an independent predictive factor of restenosis for the parent vessel (odds ratio 0.10, 95% confidence intervals 0.01 to 0.91, p = 0.04). Clinical follow-up was obtained in all patients at 19.9 +/- 13.7 months. There were 2 deaths (noncardiac origin), but no myocardial infarction during follow-up. Target lesion revascularization was required in 6 patients. The event-free survival rate (death, nonfatal myocardial infarction, and repeat revascularization) was 86% at the end of the follow-up period. In conclusion, stenting for an unprotected LMCA bifurcation lesion may be performed with a high procedural success rate and a favorable clinical outcome in selected patients with normal left ventricular function, suggesting that stenting would be an effective alternative to surgery in these patients.
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Affiliation(s)
- Seung-Jung Park
- Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, South Korea
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Chio FL, Liu MW, Al-Saif SM, Khan MA, Lawson D, Al-Mubarak N. Long-term clinical outcome after implantation of medium Palmaz (biliary) stents in very large native coronary arteries. Catheter Cardiovasc Interv 2002; 56:35-9. [PMID: 11979531 DOI: 10.1002/ccd.10177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intracoronary stenting has been shown to improve acute and long-term clinical results compared with coronary angioplasty. However, clinical outcome after medium Palmaz biliary (PB) stent implantation in very large native coronary arteries (> 4 mm in diameter) is unknown. This study evaluated restenosis and long-term clinical outcome after PB stenting in large native coronary arteries. Between June 1993 and December 1998, 55 patients with 56 lesions were treated with PB stents. Intracoronary stent deployment was successful in all 56 vessels attempted (100%). The mean stenosis was reduced from 65% +/- 10% to 4% +/- 14%. In 48 of the 56 vessels (86%), vessel size was greater than 4.0 mm in diameter and the mean reference vessel diameter was 4.73 +/- 0.7 mm after stenting. Angiographic success was achieved in 100%. Five patients had postprocedural cardiac enzyme elevation. There was no periprocedural death, emergency coronary artery bypass surgery, repeat target lesion revascularization, or acute stent thrombosis. Long-term clinical follow-up at mean of 28 +/- 15 months was obtained in 96% of the patients. Clinical restenosis rate occurred in 18% of ostial (6/34) and 0% of nonostial (0/22) lesions (P < 0.0001) with an overall clinical restenosis rate of 11%. Repeat angioplasty were performed in these six patients. There were three cardiac and three noncardiac deaths. The overall event-free survival at 1 and 3 years was 92% +/- 4% and 80% +/- 6%, respectively. PB stent implantation in very large native coronary arteries can be performed with a high degree of procedural success and low in-hospital complications. The long-term clinical outcome of patients undergoing PB stenting is associated with excellent event-free survival. However, stenting of ostial lesions remains as an important factor for restenosis even in very large coronary artery stenting.
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Affiliation(s)
- Francisco L Chio
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
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Gobeil F, Lefèvre T, Guyon P, Louvard Y, Chevalier B, Dumas P, Glatt B, Loubeyre C, Royer T, Morice MC. Stenting of bifurcation lesions using the Bestent: a prospective dual-center study. Catheter Cardiovasc Interv 2002; 55:427-33. [PMID: 11948886 DOI: 10.1002/ccd.10091] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treatment of bifurcation lesions remains a technical challenge. Among 13 stents previously tested in a bench study, the Bestent seemed of particular interest in this indication as it provided good access to the side branch after stent implantation in the main branch associated with a satisfactory coverage of the lesion after kissing balloon inflation. The use of Bestent implanted in the main branch or both branches for treatment of bifurcation lesions involving a side branch > or = 2.2 mm in diameter was prospectively evaluated in a dual-center prospective study with a prospective 6-month clinical follow-up. All angiographic documents were analyzed by an independent corelab (CORISIS). Between 11 September 1997 and 21 February 1998, 96 patients were consecutively included (mean age, 63.7 +/- 11.4 years; 81.3% male; 58.3% with unstable angina and 6.3% acute myocardial infarction). The lesion involved the left anterior descending-diagonal coronary bifurcation in 55% of cases, left circumflex-marginal 23%, posterior descending-postero-lateral 12%, distal left main 6%, and others 4%. The main branch (proximal reference diameter: 3.43 +/- 0.45 mm) was stented in 98% of cases and the side branch (2.72 +/- 0.38 mm) in 38% (both branches in 34% of cases). T-stenting or provisional T-stenting was used in 88% of cases and final kissing balloon inflation was performed in 78% of cases. Procedural success was obtained in 100% of cases in the main branch and 98% in both branches. Major cardiac and cerebral events (MACCE) during hospitalization occurred in 4.2% of cases, non-Q-wave myocardial infarction (MI) in 3.1%, Q-wave MI in 1.0%, repeat PTCA in 2.1%; there were no major access site complication, no emergency coronary artery bypass grafting operation, no death. At 6-month follow-up, total MACCE rate was 14.6% (Q-wave MI, 3.1%; non-Q-wave MI, 3.1%; target vessel revascularization, 9.4%; death, 2.1%). Patients with target vessel revascularization (TVR) had restenosis of both branches in 22.2% of cases, main branch in 22.2%, and side branch in 55.6%. This study shows that using a simple strategy of provisional T-stenting of the side branch in the majority of cases, the Bestent can be used for treating bifurcation lesions with a high rate of success and an acceptable rate of TVR at 6-month follow-up.
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Timurkaynak T, Ozdemir M, Ciftci H, Cemri M, Cengel A, Dortlemez O. Recanalization of an occluded major side branch after stenting with intracoronary adenosine. JAPANESE HEART JOURNAL 2002; 43:43-8. [PMID: 12041888 DOI: 10.1536/jhj.43.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Adenosine is a powerful direct coronary vasodilator with a very short half-life that has been shown to be effective in avoiding and reversing no reflow. We report an immediate successful recanalization of an occluded major side branch after stenting with acute intracoronary adenosine administration. The beneficial effect of adenosine may imply that the side branch occlusion (SBO) in this case could be due to spasm or distal embolization of the atherosclerotic debris ending up with no flow. We believe that adenosine could be helpful in at least some cases of SBO and therefore may be worth attempting.
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Affiliation(s)
- Timur Timurkaynak
- Department of Cardiology, Gazi University Medical School, Ankara, Turkey
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Tan RP, Kini A, Shalouh E, Marmur JD, Sharma SK. Optimal treatment of nonaorto ostial coronary lesions in large vessels: acute and long-term results. Catheter Cardiovasc Interv 2001; 54:283-8. [PMID: 11747150 DOI: 10.1002/ccd.1285] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Percutaneous interventions of nonaorto ostial coronary lesions are usually complex, often requiring a combined approach of debulking and stenting, insertion of multiple guidewires and long procedure duration. Debulking with atherectomy device preserves side-branch patency by reducing plaque shift while coronary stenting minimizes vessel recoil and restenosis. We retrospectively evaluated the acute and long-term results of rotational atherectomy (group R, n = 94), coronary stenting (group S, n = 39), and combination of rotational atherectomy and stenting (group R-S, n = 59) in a total of 192 patients with nonaorto ostial lesions. The number of patients with diabetes mellitus and rest angina was significantly higher in groups S and R-S. Clinical success rates were high and procedural complication rates were low and comparable in all three groups. Despite the similar reference vessel size and preprocedure minimal lumen diameter (MLD), postprocedure MLD showed a trend toward larger lumen in groups S (3.15 +/- 0.18 mm) and R-S (3.21 +/- 0.16 mm). Group S had significantly higher incidence of side-branch narrowing (30.7%), requiring intervention (15.4%). At long-term follow-up (mean of 9 +/- 4 months), target lesion revascularization rate was significantly lower in groups R-S (11.9%) and S (15.4%) compared to group R (28.9%; P = 0.02). Our nonrandomized data suggest that stenting with or without rotational atherectomy provides the best long-term approach for the interventional treatment of nonaorto ostial coronary lesions. The clinical benefit and cost effectiveness of performing rotational atherectomy before stent implantation to reduce the incidence of side-branch closure requires further study.
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Affiliation(s)
- R P Tan
- The Zena and Michael Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
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47
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Meerkin D, Almagor Y. Provisional bifurcation stenting. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2001; 4:87-90. [PMID: 12036477 DOI: 10.1080/146288401753258330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Obstructive coronary lesions involving a branch origin or extending into the branch itself, remain one of the main challenges in the rapidly developing world of interventional cardiology. Acutely, these lesions are prone to the complications resulting in significant residual stenosis or loss of one of the branches. Long-term follow up has also been disappointing with a high incidence of restenosis. Numerous techniques have been developed, aimed at optimizing the acute and long-term results by adapting standard angioplasty hardware, with limited success, particularly in the long term. This article describes a fully dedicated system for bifurcation lesions with stenting of the main vessel to the main branch, yet ensuring side branch patency, with limited risk of branch origin stenosis or stent jailing, allowing for provisional stenting of the branch as dictated by the angiographic outcome.
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Affiliation(s)
- David Meerkin
- Cardiac Catheterization And Coronary Intervention Laboratories, Shaare Zedek Medical Center, Jerusalem, Israel
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48
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Robinson NM, Balcon R, Layton CA, Mills PG, Timmis AD, Rothman MT. Intravascular ultrasound assessment of culotte stent deployment for the treatment of stenoses at major coronary bifurcations. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2001; 4:21-27. [PMID: 12431336 DOI: 10.1080/146288401316922652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND: The mechanism for the disappointing late outcome following stenting of bifurcation lesions is unclear. This prospective observational study aims to evaluate culotte stent deployment and dimensions with intravascular ultrasound (IVUS). PATIENTS AND METHODS: Patients with bifurcation stenoses were treated using two stents in a culotte configuration. After optimizing the angiographic appearance of both stents, IVUS was used to evaluate both limbs of the culotte. The main outcome measures were cross-sectional area (CSA) and minimal lumen diameter (MLD) assessed by IVUS. RESULTS: Within the culotte stent, the final mean CSA in the main limb was 6.1 mm(2) (97% of reference) and in the side-limb was 5.9 mm(2) (97% of reference). However, in each case, the minimum CSA and IVUS MLD of both limbs was at the bifurcation point. For all patients, the final mean CSA at the bifurcation point of the main limb was 4.3 mm(2) (70% of main stent) and of the side-limb was 4.4 mm(2) (75% of side stent). The IVUS MLD at the bifurcation point of the main limb was 2.1 mm (78% of main stent) and of the side-limb was 2.1 mm (84% of the side stent). Importantly, this significant residual stenosis was not detectable with quantitative coronary angiography. CONCLUSIONS: IVUS evaluation of culotte stents is feasible. The minimum IVUS CSA and MLD of both limbs of the culotte stent is at the bifurcation point. Despite an optimal angiographic appearance a significant residual stenosis was noted with IVUS at each bifurcation point.
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Yip HK, Wu CJ, Yeh KH, Hang CL, Fang CY, Hsieh KY, Fu M. Unusual complication of retrograde dissection to the coronary sinus of valsalva during percutaneous revascularization: a single-center experience and literature review. Chest 2001; 119:493-501. [PMID: 11171728 DOI: 10.1378/chest.119.2.493] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND While coronary dissection, which is one of the most frequently occurring complications during interventional procedures, has various forms, extensive coronary dissection retrograde to the coronary sinus of Valsalva (CSV) is very rarely observed. METHODS AND RESULTS Within the last 5 years, we retrospectively reviewed our experience with 4,700 consecutive patients who underwent angioplasty procedures, 7 of whom (0.15%) developed extensive coronary dissection retrograde to the CSV. Six of the seven patients developed retrograde dissection of the right CSV during angioplasty to the right coronary artery. One of the seven patents developed retrograde dissection of the left CSV during angioplasty to the left anterior descending artery. Retrograde dissection, which extended to the ascending aorta in two patients, was observed by transthoracic echocardiography and surgical findings, respectively. Five patients were successfully treated by coronary stenting. However, this complication caused four patients to have acute myocardial infarctions, resulting in emergency surgery for one patient and in-hospital death for another. CONCLUSIONS Our experience increased our understanding of this very rare complication. However, this complication may be life threatening, and patients in this clinical setting may have a potential risk for acute myocardial infarction, emergency surgery, or even sudden cardiac death. Therefore, it is important to learn how to promptly diagnose and manage this complication.
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Affiliation(s)
- H K Yip
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan, Republic of China
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Cho GY, Lee CW, Hong MK, Kim JJ, Park SW, Park SJ. Effects of stent design on side branch occlusion after coronary stent placement. Catheter Cardiovasc Interv 2001; 52:18-23. [PMID: 11146516 DOI: 10.1002/1522-726x(200101)52:1<18::aid-ccd1006>3.0.co;2-#] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study was performed to assess the immediate and long-term patency of stent-associated side branches (SB) according to the types of stent. A total of 314 patients with 332 lesions (CrossFlex stent 86, NIR 100, GFX 146) had 365 SB (>1 mm) covered by coronary stents. Side branch occlusion (SBO) occurred in 7.7% of CrossFlex stent, in 10.5% of NIR stent and in 8.8% of GFX stent (P = NS). SBO primarily occurred in SB with ostial disease, and the presence of SB ostial disease was the only independent predictors of SBO after stenting (OR 22.1, 95% CI 9.47-51.49, P < 0.001). At 6 months follow-up, 11 of 31 SBO regained the patency, but the remaining SB had persistent SBO. Delayed SBO occurred in 8 SB, being associated with the presence of SB ostial disease and in-stent restenosis. In conclusions, SBO was not associated with the types of stent design, but with the SB lesion morphology.
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Affiliation(s)
- G Y Cho
- Department of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
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