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Wang Y, Li G, Yang L, Luo R, Guo G. Development of Innovative Biomaterials and Devices for the Treatment of Cardiovascular Diseases. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2201971. [PMID: 35654586 DOI: 10.1002/adma.202201971] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/29/2022] [Indexed: 06/15/2023]
Abstract
Cardiovascular diseases have become the leading cause of death worldwide. The increasing burden of cardiovascular diseases has become a major public health problem and how to carry out efficient and reliable treatment of cardiovascular diseases has become an urgent global problem to be solved. Recently, implantable biomaterials and devices, especially minimally invasive interventional ones, such as vascular stents, artificial heart valves, bioprosthetic cardiac occluders, artificial graft cardiac patches, atrial shunts, and injectable hydrogels against heart failure, have become the most effective means in the treatment of cardiovascular diseases. Herein, an overview of the challenges and research frontier of innovative biomaterials and devices for the treatment of cardiovascular diseases is provided, and their future development directions are discussed.
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Affiliation(s)
- Yunbing Wang
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, 29 Wangjiang Road, Chengdu, 610064, China
| | - Gaocan Li
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, 29 Wangjiang Road, Chengdu, 610064, China
| | - Li Yang
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, 29 Wangjiang Road, Chengdu, 610064, China
| | - Rifang Luo
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, 29 Wangjiang Road, Chengdu, 610064, China
| | - Gaoyang Guo
- National Engineering Research Center for Biomaterials and College of Biomedical Engineering, Sichuan University, 29 Wangjiang Road, Chengdu, 610064, China
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Impact of directional coronary atherectomy followed by drug-coated balloon strategy to avoid the complex stenting for bifurcation lesions. Heart Vessels 2022; 37:919-930. [PMID: 34981167 DOI: 10.1007/s00380-021-02000-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/26/2021] [Indexed: 01/25/2023]
Abstract
Although the simple single stenting rather than complex double stenting is recommended on percutaneous coronary intervention (PCI) for bifurcation lesions, double stenting cannot always be avoided. We investigated the impact of directional coronary atherectomy (DCA), followed by drug-coated balloon (DCB) treatment to reduce the number of stents and avoid complex stenting in PCI for bifurcation lesions and short-term patency. DCA treatment without stents was attempted for 27 bifurcation lesions in 25 patients, of those, 26 bifurcation lesions in 24 patients were successfully treated and 3-month follow-up angiography and optical coherence tomography (OCT) were performed. Sixteen lesions (59.3%) were related to left main trunk distal bifurcations, and 7 (25.9%) were true bifurcation lesions. Among the true bifurcation lesions, 4 lesions (57.1%) needed 1 stent, and the other 3 lesions (42.9%) needed no stents. Among the non-true bifurcation lesions, 1 lesion (5.0%) needed bailout stent and other lesions (95.0%) needed no stents. According to DCA followed by DCB treatment, the angiographic mean diameter stenosis improved from 65.5 ± 15.0% to 7.8 ± 9.8%, and the mean plaque area in intravascular ultrasound improved from 80.4 ± 10.5% to 39.0 ± 11.5%, respectively. Angiographic and OCT late lumen loss values were 0.2 ± 0.6 mm and 1.4 ± 1.9 mm, respectively. No patient had in-hospital major adverse cardiac events (MACE) and 3-month MACE. In conclusion, compared with standard provisional side branch stenting strategy, DCA followed by DCB treatment might reduce the number of stents, avoid complex stenting for major bifurcation lesions and provide good short-term outcomes.
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Buiten RA, Warta S, Ploumen EH, Doggen CJM, van der Heijden LC, Hartmann M, Danse PW, Schotborgh CE, Scholte M, Linssen GCM, Zocca P, von Birgelen C. Coronary bifurcations treated with thin-strut drug-eluting stents: a prespecified analysis of the randomized BIO-RESORT trial. Coron Artery Dis 2021; 32:51-57. [PMID: 33278175 DOI: 10.1097/mca.0000000000000891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treatment of a coronary bifurcation lesion is often required in routine clinical practice, but data on the performance of very thin-strut biodegradable polymer drug-eluting stents are scarce. METHODS Comparison of biodegradable polymer and durable polymer drug-eluting stents in an all comers population (BIO-RESORT) is a prospective, multicenter randomized clinical trial that included 3514 all-comer patients, who were randomized to very thin-strut biodegradable polymer-coated sirolimus- or everolimus-eluting stents, versus thin-strut durable polymer-coated zotarolimus-eluting stents. The approach of bifurcation stenting was left at the operator's discretion, and provisional stenting was generally preferred. This prespecified analysis assessed 3-year clinical outcome of all patients in whom treatment involved at least one bifurcation with a side-branch diameter ≥1.5 mm. RESULTS Of all BIO-RESORT trial participants, 1236 patients were treated in bifurcation lesions and analyzed. Single- and two-stent techniques were used in 85.8% and 14.2%, respectively. 'True' bifurcation lesions (main vessel and side-branch obstructed) were treated in 31.1%. Three-year follow-up was available in 1200/1236 (97.1%) patients. The main endpoint target vessel failure (composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization) occurred in sirolimus-eluting stents in 42/412 (10.3%) and in zotarolimus-eluting stents in 49/409 (12.1%) patients (P-logrank = 0.40). In everolimus-eluting stents, target vessel failure occurred in 40/415 (9.8%) patients (vs. zotarolimus-eluting stents: P-logrank = 0.26). There was no between-stent difference in individual components of target vessel failure. Findings were consistent in patients with single-vessel treatment and patients treated with a single-stent technique. CONCLUSIONS Three years after stenting all-comers with bifurcation lesions, clinical outcome was similar with the sirolimus-eluting and everolimus-eluting stents versus the zotarolimus-eluting stent.
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Affiliation(s)
- Rosaly A Buiten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede
| | - Sanne Warta
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente
| | - Eline H Ploumen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede
| | - Carine J M Doggen
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede
| | | | - Marc Hartmann
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente
| | - Peter W Danse
- Department of Cardiology, Rijnstate Hospital, Arnhem
| | | | - Martijn Scholte
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht
| | - Gerard C M Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, the Netherlands
| | - Paolo Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede
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Kitani S, Igarashi Y, Tsuchikane E, Nakamura S, Seino Y, Habara M, Takeda Y, Shimoji K, Yasaka Y, Kijima M. Efficacy of drug-coated balloon angioplasty after directional coronary atherectomy for coronary bifurcation lesions (DCA/DCB registry). Catheter Cardiovasc Interv 2020; 97:E614-E623. [PMID: 32776689 DOI: 10.1002/ccd.29185] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/27/2020] [Accepted: 07/19/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of additional drug-coated balloon (DCB) angioplasty after directional coronary atherectomy (DCA) for coronary bifurcation lesions. BACKGROUND The optimal therapy for bifurcation lesions has not been established, even in the drug-eluting stent era. DCA possibly prevents plaque and carina shift in bifurcation lesions by plaque debulking; however, the efficacy of combined DCA and DCB (DCA/DCB) for bifurcation lesions remains unclear. METHODS This multicenter registry retrospectively recruited patients with bifurcation lesions who underwent DCA/DCB and follow-up angiogram at 6-15 months. The primary endpoint was the 12-month target vessel failure (TVF) rate. The secondary endpoints were procedure-related major complications, major cardiovascular events at 12 months, restenosis at 12 months, target lesion revascularization (TLR) at 12 months, and target vessel revascularization (TVR) at 12 months. RESULTS We enrolled 129 patients from 16 Japanese centers. One hundred and four lesions (80.6%) were located around the left main trunk bifurcations. No side branch compromise was found intraoperatively. Restenosis was observed in three patients (2.3%) at 12 months. TLR occurred in four patients (3.1%): 3 (2.3%) in the main vessel and 1 (0.8%) in the ostium of the side branch at 12 months. TVF incidence at 12 months was slightly higher in 14 patients (10.9%), and only two patients (1.6%) had symptomatic TVR. One patient (0.8%) had non-target vessel-related myocardial infarction. CONCLUSIONS Our data suggested that DCA/DCB provided good clinical outcomes and minimal side branch damage and could be an optimal non-stent percutaneous coronary intervention strategy for bifurcation lesions.
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Affiliation(s)
- Shunsuke Kitani
- Department of Cardiology, Tokeidai Memorial Hospital, Hokkaido, Japan
| | - Yasumi Igarashi
- Department of Cardiology, Tokeidai Memorial Hospital, Hokkaido, Japan
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | | | - Yoshitane Seino
- Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
| | - Maoto Habara
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | - Yoshihiro Takeda
- Department of Cardiology, Rinku General Medical Center, Osaka, Japan
| | - Kenichiro Shimoji
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Yoshinori Yasaka
- Department of Cardiology, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Mikihiro Kijima
- Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
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Perl L, Witberg G, Greenberg G, Vaknin-Assa H, Kornowski R, Assali A. Prognostic significance of the Medina classification in bifurcation lesion percutaneous coronary intervention with second-generation drug-eluting stents. Heart Vessels 2020; 35:331-339. [PMID: 31529179 DOI: 10.1007/s00380-019-01504-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/06/2019] [Indexed: 01/24/2023]
Abstract
The Medina classification is the most widespread method to describe bifurcation lesions. However, little is known regarding its prognostic impact. Therefore, the aim of this study is to assess the prognostic significance of the Medina classification following percutaneous coronary intervention (PCI). From a prospective registry of 738 consecutive patients undergoing PCI for bifurcation lesions, 505 were treated with second-generation drug-eluting stents (DES). Of these, 407 (80.6%) presented with "true bifurcation" (TB) lesions (Medina class 1.0.1, 1.1.1, 0.1.1) and 98 (19.4%) in all other categories ("non-true bifurcation" = NTB). We compared rates of death and major adverse cardiac events (MACE: cardiac death, myocardial infarction, or target vessel revascularization) at 12 months and 3 years. Patients with TB had lower rates of previous bypass surgery (7.4% vs. 11.2%, p = 0.043). TB lesions were more likely to be calcified (33.9% vs. 28.6%, p = 0.003) and ulcerated (8.8% vs. 4.1%, p < 0.01). At 12 months, mortality was numerically higher for TB PCI (4.1% vs. 2.1%, p = 0.052) and MACE rates were higher (19.2% vs. 10.2%, p < 0.001). At 3 years, both all-cause death (10.1% vs. 5.1%, p = 0.002) and rates of MACE (37.2% vs. 17.6%, p < 0.001) were higher for TB PCI. After performing regression analysis, TB remained an independent predictor for poor outcomes (OR-2.28 at 12 months, CI 1.45-9.50, p = 0.007, OR-3.75 at 3 years, CI 1.52-6.77, p = 0.001 for MACE). In conclusion, TB lesions, according to the Medina classification, portend worse prognosis for patients undergoing bifurcation PCI. This may guide prognostication and decision-making in treatment.
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Affiliation(s)
- Leor Perl
- Cardiology Department, Rabin Medical Center and The "Sackler" Faculty of Medicine, Tel-Aviv University, 39 Jabotinsky St., 49100, Petah-Tikva, Israel.
| | - Guy Witberg
- Cardiology Department, Rabin Medical Center and The "Sackler" Faculty of Medicine, Tel-Aviv University, 39 Jabotinsky St., 49100, Petah-Tikva, Israel
| | - Gabriel Greenberg
- Cardiology Department, Rabin Medical Center and The "Sackler" Faculty of Medicine, Tel-Aviv University, 39 Jabotinsky St., 49100, Petah-Tikva, Israel
| | - Hana Vaknin-Assa
- Cardiology Department, Rabin Medical Center and The "Sackler" Faculty of Medicine, Tel-Aviv University, 39 Jabotinsky St., 49100, Petah-Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center and The "Sackler" Faculty of Medicine, Tel-Aviv University, 39 Jabotinsky St., 49100, Petah-Tikva, Israel
| | - Abid Assali
- Cardiology Department, Rabin Medical Center and The "Sackler" Faculty of Medicine, Tel-Aviv University, 39 Jabotinsky St., 49100, Petah-Tikva, Israel
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Lee SH, Song YB, Lee JM, Park TK, Yang JH, Hahn JY, Choi JH, Choi SH, Lee SH, Ahn JH, Carriere KC, Jeong MH, Kim HS, Oh JH, Jang Y, Gwon HC. Effect of Side Branch Predilation in Coronary Bifurcation Stenting With the Provisional Approach ― Results From the COBIS (Coronary Bifurcation Stenting) II Registry ―. Circ J 2018; 82:1293-1301. [DOI: 10.1253/circj.cj-17-0921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Seung Hwa Lee
- Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo Myung Lee
- Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Taek Kyu Park
- Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jeong Hoon Yang
- Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo-Yong Hahn
- Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Ho Choi
- Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Hyuk Choi
- Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Sang Hoon Lee
- Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joong Hyun Ahn
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Keumhee C. Carriere
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
- Department of Mathematical and Statistical Sciences, University of Alberta
| | | | | | - Ju Hyeon Oh
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
| | | | - Hyeon-Cheol Gwon
- Department of Medicine, Heart, Stroke and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
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7
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Zhou Y, Chen S, Huang L, Hildick-Smith D, Ferenc M, Jabbour RJ, Azzalini L, Colombo A, Chieffo A, Zhao X. Definite stent thrombosis after drug-eluting stent implantation in coronary bifurcation lesions: A meta-analysis of 3,107 patients from 14 randomized trials. Catheter Cardiovasc Interv 2017; 92:680-691. [PMID: 29214736 DOI: 10.1002/ccd.27443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/06/2017] [Accepted: 11/11/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Yu Zhou
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
| | - Shengda Chen
- State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University; China
- IBiTech, bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT Department; Ghent University; De Pintelaan Ghent Belgium
| | - Lan Huang
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
| | - David Hildick-Smith
- Sussex Cardiac Centre; Brighton and Sussex University Hospitals; Brighton United Kingdom
| | - Miroslaw Ferenc
- The Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen, Suedring 15, Bad Krozingen; Germany
| | | | | | | | - Alaide Chieffo
- Cardiology Department; San Raffaele Hospital; Milan Italy
| | - Xiaohui Zhao
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
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van Houwelingen KG, van der Heijden LC, Lam MK, Kok MM, Löwik MM, Louwerenburg JW, Linssen GCM, IJzerman MJ, Doggen CJM, von Birgelen C. Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial. Heart Vessels 2016; 31:1731-1739. [PMID: 26747438 PMCID: PMC5085988 DOI: 10.1007/s00380-015-0786-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/16/2015] [Indexed: 12/31/2022]
Abstract
The objective of this study is to assess 3-year clinical outcome of patients with true bifurcation lesions (TBLs) versus non-true bifurcation lesions (non-TBLs) following treatment with second-generation drug-eluting stents (DES). TBLs are characterized by the obstruction of both main vessel and side-branch. Limited data are available on long-term clinical outcome following TBL treatment with newer-generation DES. We performed an explorative sub-study of the randomized TWENTE trial among 287 patients who had bifurcated target lesions with side-branches ≥2.0 mm. Patients were categorized into TBL (Medina classes: 1.1.1; 1.0.1; 0.1.1) versus non-TBL to compare long-term clinical outcome. A total of 116 (40.4 %) patients had TBL, while 171 (59.6 %) had non-TBL only. Target-lesion revascularization rates were similar (3.5 vs. 3.5 %; p = 1.0), and definite-or-probable stent thrombosis rates were low (both <1.0 %). The target-vessel myocardial infarction (MI) rate was 11.3 versus 5.3 % (p = 0.06), mostly driven by (periprocedural) MI ≤48 h from PCI. All-cause mortality and cardiac death rates were 8.7 versus 3.5 % (p = 0.06) and 3.5 versus 1.2 % (p = 0.22), respectively. The 3-year major adverse cardiac event rate for patients with TBL versus non-TBL was 20.0 versus 11.7 % (p = 0.05). At 1-, 2-, and 3-year follow-up, 6.5, 13.0, and 11.0 % of patients reported chest pain at less than or equal moderate physical effort, respectively, without any between-group difference. Patients treated with second-generation DES for TBL had somewhat higher adverse event rates than patients with non-TBL, but dissimilarities did not reach statistical significance. Up to 3-year follow-up, the vast majority of patients of both groups remained free from chest pain.
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Affiliation(s)
- K Gert van Houwelingen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Liefke C van der Heijden
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Ming Kai Lam
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Marlies M Kok
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Marije M Löwik
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - J W Louwerenburg
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands. .,Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
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Abstract
There is growing evidence that optimally performed two-stent techniques may provide similar or better results compared with the simple techniques for bifurcation lesions, with an observed trend towards improvements in clinical and/or angiographic outcomes with a two-stent strategy. Yet, provisional stenting remains the treatment of choice. Here, the author discusses the evidence - and controversies - concerning when and how to use complex techniques.
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Affiliation(s)
- Maciej Lesiak
- Poznan University of Medical Sciences, Poznan, Poland
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10
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Habara M, Tsuchikane E, Nasu K, Kinoshita Y, Yaguchi T, Suzuki Y, Matsuo H, Terashima M, Matsubara T, Suzuki T. The first clinical experience with a novel directional coronary atherectomy catheter: Preliminary Japanese multicenter experience. Catheter Cardiovasc Interv 2016; 89:880-887. [DOI: 10.1002/ccd.26627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/25/2016] [Accepted: 05/22/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Maoto Habara
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
| | - Kenya Nasu
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
| | | | - Tomonori Yaguchi
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
| | - Yoriyasu Suzuki
- Department of Cardiovascular Medicine; Nagoya Heart Center; Aichi Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine; Gifu Heart Center; Gifu Japan
| | | | - Tetsuo Matsubara
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
| | - Takahiko Suzuki
- Department of Cardiovascular Medicine; Toyohashi Heart Center; Aichi Japan
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11
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Grundeken MJ, Wykrzykowska JJ, Ishibashi Y, Garg S, de Vries T, Garcia-Garcia HM, Onuma Y, de Winter RJ, Buszman P, Linke A, Ischinger T, Klauss V, Eberli F, Corti R, Wijns W, Morice MC, di Mario C, Meier B, Jüni P, Yazdani A, Copt S, Windecker S, Serruys PW. First generation versus second generation drug-eluting stents for the treatment of bifurcations: 5-year follow-up of the LEADERS all-comers randomized trial. Catheter Cardiovasc Interv 2015; 87:E248-60. [DOI: 10.1002/ccd.26344] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/21/2015] [Accepted: 11/08/2015] [Indexed: 01/12/2023]
Affiliation(s)
| | | | - Yuki Ishibashi
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
| | - Scot Garg
- East Lancashire Hospitals NHS Trust; Blackburn United Kingdom
| | | | - Hector M. Garcia-Garcia
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis BV; Rotterdam The Netherlands
| | - Yoshinobu Onuma
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis BV; Rotterdam The Netherlands
| | | | | | | | | | | | - Franz Eberli
- Department of Cardiology; Triemli Spital, Zurich; Switzerland
| | | | - William Wijns
- Department of Cardiology; Onze Lieve Vrouw Ziekenhuis; Aalst Belgium
| | - Marie-Claude Morice
- Institut Hospitalier Jacques-Cartier; Institut Cardiovasculaire Paris-Sud; Massy France
| | | | - Bernhard Meier
- Department of Cardiology; University of Bern; Bern Switzerland
| | - Peter Jüni
- Department of Cardiology/University of Bern; CTU Bern and Institute of Social and Preventive Medicine; Bern Switzerland
| | | | | | | | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London; London the United Kingdom
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12
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13
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Bifurcation treatment with novel, highly flexible drug-eluting coronary stents in all-comers: 2-year outcome in patients of the DUTCH PEERS trial. Clin Res Cardiol 2015; 105:206-15. [PMID: 26329584 PMCID: PMC4759225 DOI: 10.1007/s00392-015-0907-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/18/2015] [Indexed: 11/04/2022]
Abstract
Background Percutaneous coronary intervention (PCI) in bifurcated lesions with second-generation drug-eluting stents (DES) was associated with increased myocardial infarction (MI) rates. Flexible stent designs that accommodate well to vessel tapering may be of benefit in challenging anatomies such as bifurcated target lesions, but so far data are scarce. Methods We analyzed the 2-year follow-up data of the DUTCH PEERS (TWENTE II) trial, which randomized 1811 all-comer patients to PCI with newer generation resolute integrity zotarolimus-eluting (Medtronic) or promus element everolimus-eluting stents (Boston Scientific). In bifurcated lesions, provisional stenting was generally performed. Target vessel failure is a composite endpoint, consisting of cardiac death, target vessel MI, or target vessel revascularization. Results Patients with at least one bifurcated lesion (n = 465, 25.7 %) versus patients with non-bifurcated target lesions only (n = 1346, 74.3 %) showed similar rates of clinical endpoints including target vessel failure (9.2 versus 7.9 %, p = 0.36) and definite stent thrombosis (0.4 versus 1.0 %, p = 0.38). Target vessel MI was more common in patients with bifurcated lesions (3.4 versus 1.6 %, p = 0.02); but after multivariate analysis with propensity score adjustment, bifurcation treatment was found not to be an independent predictor of target vessel MI (HR 1.40, 95 % CI 0.71–2.76; p = 0.34). Among patients with bifurcated lesions, DES type and side-branch size did not affect outcome, but periprocedural MI occurred more often after two-stent approaches (9.0 versus 2.1 %; p = 0.002). Conclusion All-comer patients treated for bifurcated and non-bifurcated target lesions showed similar and low rates of clinical endpoints, suggesting that the DES used are efficacious and safe for treating bifurcated target lesions.
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Ferenc M, Buettner HJ, Gick M, Comberg T, Rothe J, Khoury F, Valina C, Toma A, Kuebler P, Riede F, Neumann FJ. Clinical outcome after percutaneous treatment of de novo coronary bifurcation lesions using first or second generation of drug-eluting stents. Clin Res Cardiol 2015; 105:230-8. [DOI: 10.1007/s00392-015-0911-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/24/2015] [Indexed: 01/23/2023]
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Regular Drug-Eluting Stent vs Dedicated Coronary Bifurcation BiOSS Expert Stent: Multicenter Open-Label Randomized Controlled POLBOS I Trial. Can J Cardiol 2015; 31:671-8. [DOI: 10.1016/j.cjca.2014.12.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 01/01/2023] Open
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Safety and efficacy of everolimus-eluting stents for bare-metal in-stent restenosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:151-5. [DOI: 10.1016/j.carrev.2015.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 11/19/2022]
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Ota H, Mahmoudi M, Kitabata H, Torguson R, Chen F, Satler LF, Suddath WO, Pichard AD, Waksman R. Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:84-9. [DOI: 10.1016/j.carrev.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
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GIL ROBERTJ, BIL JACEK, VASSILIEV DOBRIN, IÑIGO GARCIA LUISA. First-in-Man Study of Dedicated Bifurcation Sirolimus-eluting Stent: 12-month Results of BiOSS LIM® Registry. J Interv Cardiol 2015; 28:51-60. [DOI: 10.1111/joic.12180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- ROBERT J. GIL
- Invasive Cardiology Department; Central Clinical Hospital of the Ministry of Internal Affairs; Warsaw Poland
- Institute of Experimental and Clinical Medicine; Polish Academy of Science; Warsaw Poland
| | - JACEK BIL
- Invasive Cardiology Department; Central Clinical Hospital of the Ministry of Internal Affairs; Warsaw Poland
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Lam MK, Sen H, van Houwelingen KG, Löwik MM, van der Heijden LC, Kok MM, de Man FH, Linssen GC, Tandjung K, Doggen CJ, von Birgelen C. Three-year clinical outcome of patients with bifurcation treatment with second-generation Resolute and Xience V stents in the randomized TWENTE trial. Am Heart J 2015; 169:69-77. [PMID: 25497250 DOI: 10.1016/j.ahj.2014.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Only limited data from large randomized clinical trials have been published on the long-term performance of second-generation drug-eluting stents in bifurcation lesions. METHODS We investigated in patients in the randomized TWENTE trial the long-term safety and efficacy of treating bifurcation lesions with 2 widely applied second-generation drug-eluting stents, the zotarolimus-eluting Resolute stent (Medtronic Inc, Santa Rosa, CA) and the everolimus-eluting Xience V stent (Abbott Vascular, Santa Clara, CA). Three-year follow-up was available in 99.3%. Patients were categorized into treatment for ≥1 bifurcation lesion versus treatment for nonbifurcation lesions only. RESULTS Among the 1,391 patients of the TWENTE trial, 362 (26%) were treated for bifurcation lesions. At 3-year follow-up, target-vessel failure did not differ between patients treated for bifurcation versus nonbifurcation lesions (13.1% vs 12.6%; P = .84), whereas the periprocedural myocardial infarction rate was higher in patients with bifurcation lesions (6.9% vs 3.1%; P < .01). Of the 362 patients with bifurcation lesion treatment, 179 (49.4%) were treated with Resolute and 183 (50.6%) with Xience V. There was no significant difference in target-vessel failure between the Resolute and Xience V groups with bifurcation treatment (13.6% vs 12.6%; P = .78), and their incidence of definite-or-probable stent thrombosis was low and similar (1.1% vs 0.5%, respectively; P = .62). CONCLUSION Despite a significant difference in periprocedural myocardial infarction, 3-year clinical outcome after implantation of second-generation stents was favorable and similar for patients with and without bifurcation lesions. In addition, we observed no difference in long-term clinical outcome after bifurcation lesion treatment with Resolute and Xience V stents.
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