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Numasawa Y, Kamata K, Tamura T, Yokokura S, Kojima H, Tanaka M. Effect of the jailed Corsair technique on the polymer of drug-eluting stents: insights from electron microscopy analyses. Cardiovasc Interv Ther 2024; 39:314-315. [PMID: 38522036 DOI: 10.1007/s12928-024-00992-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-Cho, Ashikaga, Tochigi, 326-0843, Japan.
| | - Kei Kamata
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-Cho, Ashikaga, Tochigi, 326-0843, Japan
| | - Tadafumi Tamura
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-Cho, Ashikaga, Tochigi, 326-0843, Japan
| | - Souichi Yokokura
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-Cho, Ashikaga, Tochigi, 326-0843, Japan
| | - Hidenori Kojima
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-Cho, Ashikaga, Tochigi, 326-0843, Japan
| | - Makoto Tanaka
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-Cho, Ashikaga, Tochigi, 326-0843, Japan
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Pan M, Lassen JF, Burzotta F, Ojeda S, Albiero R, Lefèvre T, Hildick-Smith D, Johnson TW, Chieffo A, Banning AP, Ferenc M, Darremont O, Chatzizisis YS, Louvard Y, Stankovic G. The 17th expert consensus document of the European Bifurcation Club - techniques to preserve access to the side branch during stepwise provisional stenting. EUROINTERVENTION 2023; 19:26-36. [PMID: 37170568 PMCID: PMC10173756 DOI: 10.4244/eij-d-23-00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/28/2023] [Indexed: 05/13/2023]
Abstract
Provisional stenting has become the default technique for the treatment of most coronary bifurcation lesions. However, the side branch (SB) can become compromised after main vessel (MV) stenting and restoring SB patency can be difficult in challenging anatomies. Angiographic and intracoronary imaging criteria can predict the risk of side branch closure and may encourage use of side branch protection strategies. These protective approaches provide strategies to avoid SB closure or overcome compromise following MV stenting, minimising periprocedural injury. In this article, we analyse the strategies of SB preservation discussed and developed during the most recent European Bifurcation Club (EBC) meetings.
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Affiliation(s)
- Manuel Pan
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba (IMIBIC), Cordoba, Spain
| | - Jens Flensted Lassen
- Department of Cardiology B, Odense University Hospital & University of Southern Denmark, Odense C, Denmark
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Soledad Ojeda
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba (IMIBIC), Cordoba, Spain
| | - Remo Albiero
- Interventional Cardiology Unit, Ospedale Civile di Sondrio, Sondrio, Italy
| | - Thierry Lefèvre
- Ramsay Générale de Santé - Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - David Hildick-Smith
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton and Sussex University Hospitals Trust, Brighton, UK
| | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol and Weston NHSFT & University of Bristol, Bristol, UK
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Adrian P Banning
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, UK
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | | | - Yves Louvard
- Ramsay Générale de Santé - Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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3
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Fujisaki T, Kuno T, Numasawa Y, Takagi H, Briasoulis A, Kwan T, Latib A, Tamis-Holland J, Bangalore S. Provisional or 2-Stent Technique for Bifurcation Lesions in the Second-Generation Drug-Eluting Stent Era. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100410. [PMID: 39131456 PMCID: PMC11307680 DOI: 10.1016/j.jscai.2022.100410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 08/13/2024]
Abstract
Background For bifurcating coronary lesions, a provisional stent technique is recommended compared with a routine 2-stent strategy. However, much of these data are from trials involving first-generation drug-eluting stents (DES) or bare-metal stents where the risk of restenosis with the 2-stent technique is higher. We investigated the efficacy of various 2-stent techniques versus a provisional stent technique for bifurcation lesions with newer-generation DES. Methods PubMed and Embase were searched through May 2022 for randomized control trials investigating bifurcation percutaneous coronary intervention techniques using newer-generation DES, and a meta-analysis was conducted. The primary end point was major adverse cardiovascular events (MACE) at the longest reported follow-up time. Results Our study identified 13 randomized control trials including 4041 patients. Compared with the provisional technique, 2-stent techniques significantly decreased MACE (hazard ratio [HR], 0.76; 95% CI, 0.59-0.97; P = .03), target vessel myocardial infarction (HR, 0.38; 95% CI, 0.20-0.71; P = .002), and target vessel revascularization (HR, 0.66; 95% CI, 0.47-0.93; P = .02). There were no significant differences in all-cause mortality (HR, 0.94; 95% CI, 0.62-1.45; P = .79), cardiovascular mortality (HR, 0.82; 95% CI, 0.49-1.38; P = .45), myocardial infarction (HR, 1.00; 95% CI, 0.73-1.37; P = .99), and stent thrombosis (HR, 0.86; 95% CI, 0.52-1.44; P = .58). Of the 2-stent techniques, the double kissing crush technique significantly decreased MACE and target lesion revascularization than other 2-stent techniques. Conclusions In this era of newer-generation DES, a 2-stent approach, especially the double kissing crush technique, is superior to a provisional stenting technique for a bifurcation lesion, with a significant reduction in MACE, target vessel myocardial infarction, and revascularization.
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Affiliation(s)
- Tomohiro Fujisaki
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, New York
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Alexandros Briasoulis
- Division of Cardiology, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Tak Kwan
- Department of Cardiology, Lenox Health Greenwich Village/Northwell Health, New York, New York
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | - Jacqueline Tamis-Holland
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside, New York, New York
| | - Sripal Bangalore
- Division of Cardiovascular Medicine, New York University Grossman School of Medicine, New York, New York
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6
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Qin Q, Zheng B, Liu J, Zhang B, Chen M, Li J, Huo Y. Active Versus Conventional Side Branch Protection Strategy for Coronary Bifurcation Lesions. Int Heart J 2021; 62:1241-1248. [PMID: 34789648 DOI: 10.1536/ihj.21-467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The side branch (SB) provisional stenting strategy is currently the recommended approach for most coronary bifurcation lesions. However, this strategy may result in SB deterioration, which is associated with an increased incidence of periprocedural myocardial infarction (PMI) and may adversely affect the long-term prognosis. Various techniques for SB protection (SB-P) have been developed to reduce SB occlusion and improve the clinical prognosis. This meta-analysis was performed to compare the outcomes of an active SB-P strategy of jailed balloon technique, balloon-stent kissing technique, and jailed Corsair technique versus the conventional SB-P strategy based on jailed wire technique.This meta-analysis included 5 studies (4 randomized and 1 observational) involving a total of 1,174 patients in whom the active and conventional SB-P strategies were compared. Fixed- and random-effects models were used to calculate summary risk ratios (RRs).The risk of SB occlusion was significantly lower in active SB-P strategy [RR 0.47, 95% confidence interval (CI) 0.30-0.73 in fixed-effect model; RR 0.52, 95% CI 0.31-0.87 in random-effect model]. The risk of PMI was similar between the two strategies (RR 0.63, 95% CI 0.30-1.33 in fixed-effect model; RR 0.71, 95%CI 0.20-2.48 in random-effect model). The rate of long-term major adverse cardiovascular events was similar between the groups (RR 0.48, 95% CI 0.15-1.48 in fixed-effect model; RR 0.49, 95% CI 0.16-1.52 in random-effect model).The active SB-P strategy in coronary bifurcation lesions is associated with reduced SB deterioration, but it does not decrease PMI or improve the long-term prognosis.
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Affiliation(s)
- Qiao Qin
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Bo Zheng
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Jiahui Liu
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Bin Zhang
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Ming Chen
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Jianping Li
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Yong Huo
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
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7
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Zhang JJ, Ye F, Xu K, Kan J, Tao L, Santoso T, Munawar M, Tresukosol D, Li L, Sheiban I, Li F, Tian NL, Rodríguez AE, Paiboon C, Lavarra F, Lu S, Vichairuangthum K, Zeng H, Chen L, Zhang R, Ding S, Gao F, Jin Z, Hong L, Ma L, Wen S, Wu X, Yang S, Yin WH, Zhang J, Wang Y, Zheng Y, Zhou L, Zhou L, Zhu Y, Xu T, Wang X, Qu H, Tian Y, Lin S, Liu L, Lu Q, Li Q, Li B, Jiang Q, Han L, Gan G, Yu M, Pan D, Shang Z, Zhao Y, Liu Z, Yuan Y, Chen C, Stone GW, Han Y, Chen SL. Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial. Eur Heart J 2021; 41:2523-2536. [PMID: 32588060 DOI: 10.1093/eurheartj/ehaa543] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/28/2020] [Accepted: 06/12/2020] [Indexed: 12/29/2022] Open
Abstract
AIM The present study aimed to assess the benefits of two-stent techniques for patients with DEFINITION criteria-defined complex coronary bifurcation lesions. METHODS AND RESULTS In total, 653 patients with complex bifurcation lesions at 49 international centres were randomly assigned to undergo the systematic two-stent technique (two-stent group) or provisional stenting (provisional group). The primary endpoint was the composite of target lesion failure (TLF) at the 1-year follow-up, including cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularization (TLR). The safety endpoint was definite or probable stent thrombosis. At the 1-year follow-up, TLF occurred in 37 (11.4%) and 20 (6.1%) patients in the provisional and two-stent groups, respectively [77.8%: double-kissing crush; hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.30-0.90; P = 0.019], largely driven by increased TVMI (7.1%, HR 0.43, 95% CI 0.20-0.90; P = 0.025) and clinically driven TLR (5.5%, HR 0.43, 95% CI 0.19-1.00; P = 0.049) in the provisional group. At the 1 year after indexed procedures, the incidence of cardiac death was 2.5% in the provisional group, non-significant to 2.1% in the two-stent group (HR 0.86, 95% CI 0.31-2.37; P = 0.772). CONCLUSION For DEFINITION criteria-defined complex coronary bifurcation lesions, the systematic two-stent approach was associated with a significant improvement in clinical outcomes compared with the provisional stenting approach. Further study is urgently warranted to identify the mechanisms contributing to the increased rate of TVMI after provisional stenting. STUDY REGISTRATION http://www.clinicaltrials.com; Identifier: NCT02284750.
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Affiliation(s)
- Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Kai Xu
- Division of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jing Kan
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Ling Tao
- Division of Cardiology, Xijing Hospital, 4th Military Medical University, Xi'an, China
| | - Teguh Santoso
- Division of Cardiology, Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia
| | - Muhammad Munawar
- Division of Cardiology, Binawaluya Cardiac Center, Jakarta, Indonesia
| | - Damras Tresukosol
- Division of Cardiology, Medicine Siriraj Hospital, Bangkok, Thailand
| | - Li Li
- Division of Cardiology, Guangzhou Red Cross Hospital, Guangzhou, China
| | - Imad Sheiban
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Feng Li
- Division of Cardiology, Oriental General Hospital, Huainan, China
| | - Nai-Liang Tian
- Division of Cardiology, Nanjing Heart Center, Nanjing, China
| | | | | | - Francesco Lavarra
- Division of Cardiology, Jilin Cardiovascular Hospital, Changchun, China
| | - Shu Lu
- Division of Cardiology, Taicang 1st People's Hospital, Taicang, China
| | | | - Hesong Zeng
- Division of Cardiology, Wuhan Tongji Hospital, United Medical University, Wuhan, China
| | - Lianglong Chen
- Division of Cardiology, Fujian Medical University Union Hospital, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fuzhou, China
| | - Ruiyan Zhang
- Division of Cardiology, Shanghai Ruijin Hospital, Shanghai Communication University, Shanghai, China
| | - Shiqin Ding
- Division of Cardiology, Xinhua Hospital, Huainan, China
| | - Fengtang Gao
- Division of Cardiology, Gansu Provincial People's Hospital, Lanzhou, China
| | - Zening Jin
- Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lang Hong
- Division of Cardiology, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Likun Ma
- Division of Cardiology, Anhui Provincial Hospital, Hefei, China
| | - Shangyu Wen
- Division of Cardiology, Tianjin 4th Central Hospital, Tianjin, China
| | - Xueming Wu
- Division of Cardiology, Wuxi 3rd People's Hospital, Wuxi, China
| | - Song Yang
- Division of Cardiology, Yixing People's Hospital, Yixing, China
| | - Wei-Hsian Yin
- Division of Cardiology, Cheng-Hsin General Hospital, Taipei, China
| | - Jun Zhang
- Division of Cardiology, Cangzhou Central Hospital, Cangzhou, China
| | - Yan Wang
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Yonghong Zheng
- Division of Cardiology, Jintan Traditional Chinese Medicine Hospital, Jintan, China
| | - Lei Zhou
- Division of Cardiology, Liyang Hospital of Traditional Chinese Medicine, Liyang, China
| | - Limin Zhou
- Division of Cardiology, Chuzhou People's Hospital, Chuzhou, China
| | - Yuansheng Zhu
- Division of Cardiology, Huaian 2nd People's Hospital, Huaian, China
| | - Tan Xu
- Division of Cardiology, Xinyang Central Hospital, Xinyang, China
| | - Xin Wang
- Division of Cardiology, Lianyungang Traditional Chinese Medicine Hospital, Lianyungang, China
| | - Hong Qu
- Division of Cardiology, XuanCheng Central Hospital, Xuancheng, China
| | - Yulong Tian
- Division of Cardiology, Xuyi People's Hospital, Xuyi, China
| | - Song Lin
- Division of Cardiology, Jintan People's Hospital, Jintan, China
| | - Lijun Liu
- Division of Cardiology, Huainan People's Hospital, Huainan, China
| | - Qinghua Lu
- Division of Cardiology, 2nd People's Hospital, Shandong University, Jinan, China
| | - Qihua Li
- Division of Cardiology, Changzhou Traditional Chinese Medicine Hospital, China
| | - Bo Li
- Division of Cardiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Qing Jiang
- Division of Cardiology, Anqing 1st People's Hospital, Anqing, China
| | - Leng Han
- Division of Cardiology, Changshu People's Hospital, Changshu, China
| | - Guojun Gan
- Division of Cardiology, 17th Metallurgical Hospital, Maanshan, China
| | - Mengyue Yu
- Division of Cardiology, Qingdao Campus of Fuwai Hospital, Qingdao, China
| | - Defeng Pan
- Division of Cardiology, Xuzhou 2nd People's Hospital, Xuzhou, China
| | - Zhenglu Shang
- Division of Cardiology, Wuxi Huishan District People's Hospital, Wuxi, China
| | - Yanfang Zhao
- Division of Cardiology, Nanjing 81 Hospital, Nanjing, China
| | - Zhizhong Liu
- Division of Cardiology, Hongze People's Hospital, Huai'an, China
| | - Ye Yuan
- Trinity College, University of Toronto, Toronto, Canada
| | - Cynthia Chen
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Ican School of Medicine at Mount Sinai, New York, NY, USA and The Cardiovascular Research Foundation, New York, NY, USA
| | - Yaling Han
- Division of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China.,College of Pharmacy, Nanjing Medical University, Nanjing, China
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