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Wienemann H, Meincke F, Vach M, Heeger CH, Meyer A, Spangenberg T, Kuck KH, Ghanem A. Outcome of a polymer-free drug-coated coronary stent in bifurcation lesions-Pilot registry with serial OCT imaging. Herz 2023; 48:292-300. [PMID: 35397659 DOI: 10.1007/s00059-022-05109-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/24/2022] [Accepted: 03/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Polymer-free and carrier-free drug-coated stents (DCS) represent a novel therapeutic option for the treatment of coronary artery disease. The objective of this pilot registry is to evaluate the safety and efficacy of DCS implantation in bifurcation lesions. METHODS Overall, 23 consecutive patients with 24 lesions received a Biolimus A9-coated DCS for coronary bifurcation lesions. Patients were examined with quantitative coronary angiography (QCA) and optical coherence tomography (OCT) at 3-6 months of follow-up. RESULTS A total of 23 patients with 24 bifurcation lesions were included in this study. Nine (33.3%) lesions of eight patients revealed angiographical target lesion failure due to in-stent restenosis (ISR). In total, 19 patients with 20 bifurcation lesions were suitable for OCT analysis. A total of 2936 struts were analyzed and 14 struts (0.47%) were classified as malapposed. The mean luminal area (mm2) was not different in lesions with ISR vs. lesions with no ISR (5.07 ± 2.0 vs. 5.73 ± 1.34, p = 0.39) at follow-up. Lesions with ISR showed higher mean neointimal burden (27.11 ± 10.59 vs. 13.93 ± 9.16%, respectively; p = 0.009). All of the patients who presented with significant ISR required percutaneous re-intervention. CONCLUSIONS We observed a high rate of DCS ISR in bifurcation lesions, possibly related to increased inflammation and neoatherosclerosis. The small size of the study warrants careful interpretation of our results. Larger trials are necessary to expand knowledge of these findings.
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Affiliation(s)
- Hendrik Wienemann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany.
| | - Felix Meincke
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Cardiology, Asklepios Klinik Altona, Hamburg, Germany
| | - Marius Vach
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Christian-Hendrik Heeger
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Rhythmology, University Heart Center Lübeck, UKSH Lübeck, Lübeck, Germany
| | - Annika Meyer
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Tobias Spangenberg
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Cardiology, Asklepios Klinik Altona, Hamburg, Germany
| | - Karl Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Rhythmology, University Heart Center Lübeck, UKSH Lübeck, Lübeck, Germany
| | - Alexander Ghanem
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
- Department of Cardiology, Asklepios Klinik Nord, Hamburg, Germany
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Yamawaki M, Okamura T, Nagoshi R, Fujimura T, Murasato Y, Ono S, Serikawa T, Hikichi Y, Norita H, Nakao F, Sakamoto T, Shinke T, Shite J. Vascular healing after kissing balloon inflation: Nine-month 3D optical coherence tomography analysis in corelab. IJC HEART & VASCULATURE 2022; 40:101034. [PMID: 35495581 PMCID: PMC9052145 DOI: 10.1016/j.ijcha.2022.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/12/2022] [Accepted: 04/14/2022] [Indexed: 11/23/2022]
Abstract
Background The jailing strut configuration with link-free and distal guidewire recrossing (LFD) at the side branch orifice (SBO) reduces incomplete stent apposition (ISA) after kissing balloon technique (KBT) in crossover stenting of coronary bifurcation lesions (CBLs). However, data regarding vascular healing after KBT are lacking. We investigated vascular healing 9 months after crossover stenting followed by KBT with optical coherence tomography (OCT) guidance in a prospective multicenter registry. Methods Fifty-nine patients with CBLs (LFD, 35 patients; non-LFD, 24 patients) were studied. The jailing configuration of the SB and the wire-recrossing position, incidence of ISA and uncovered struts, and neointima unevenness score (NUS) in the main vessel (MV) after 9 months were determined by off-line 3D-OCT in the core laboratory. Results The ISA rate was significantly higher at the SB ostium and distal MV after KBT in the non-LFD group, compared to the LFD group. After 9 months, incidence of ISA (18.3 ± 18.2 vs. 6.0 ± 8.7%, p < 0.01) and uncovered struts (8.7 ± 9.9 vs. 4.7 ± 7.3 %, p = 0.08) were higher at the SB ostium with higher SB restenosis in the non-LFD group. In distal MV, NUS was significantly higher (3.1 ± 1.1 vs. 2.5 ± 0.6, p < 0.05). In true-CBLs, an increase in uncovered struts and ISA rate was prominent in the proximal MV and opposite SB. No differences were observed in the 9-month clinical outcomes. Conclusion Visualization of the wire recrossing point and the SB-jailing strut pattern by OCT plays an important role to optimize the KBT in CBL stenting, resulting in favorable mid-term vascular healing.
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Key Words
- CBLs, coronary bifurcation lesions
- Coronary bifurcation lesions
- DS, diameter stenosis
- Drug eluting stent
- ISA, incomplete stent apposition
- KBT, kissing balloon technique
- Kissing balloon technique
- LA, lumen area
- LFD, link-free and distal guidewire recrossing
- MEI, minimum expansion index
- MSA, Minimum stent area
- MV, main vessel
- NIA, neointima area
- NIT, neointima thickness
- NUS, neointima unevenness score
- OCT, optical coherence tomography
- Optical coherence tomography
- PCI, Percutaneous coronary intervention
- POT, proximal optimization technique
- Percutaneous coronary intervention
- QCA, quantitative coronary angiographic analysis
- SA, stent area
- SB, side branch
- SBO, side branch orifice
- SEI, stent eccentricity index
- WSS, wall shear stress
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Affiliation(s)
- Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan
| | - Takayuki Okamura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Japan
| | - Ryoji Nagoshi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan
| | - Tatsuhiro Fujimura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Japan
| | - Yoshinobu Murasato
- Department of Cardiology, National Hospital Organization Kyusyu Medical Center, Japan
| | - Shiro Ono
- Department of Cardiology, Saiseikai Yamaguchi General Hospital, Japan
| | | | - Yutaka Hikichi
- Department of Cardiovascular Medicine, Saga Medical Center KOSEIKAN, Japan
| | | | - Fumiaki Nakao
- Department of Cardiology, Yamaguchi Grand Medical Center, Japan
| | - Tomohiro Sakamoto
- Department of Cardiology, Saiseikai Kumamoto General Hospital, Japan
| | - Toshiro Shinke
- Department of Cardiology, Showa University Graduate School of Medicine, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan
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Kumsars I, Holm NR, Niemelä M, Erglis A, Kervinen K, Christiansen EH, Maeng M, Dombrovskis A, Abraitis V, Kibarskis A, Trovik T, Latkovskis G, Sondore D, Narbute I, Terkelsen CJ, Eskola M, Romppanen H, Laine M, Jensen LO, Pietila M, Gunnes P, Hebsgaard L, Frobert O, Calais F, Hartikainen J, Aarøe J, Ravkilde J, Engstrøm T, Steigen TK, Thuesen L, Lassen JF. Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV. Open Heart 2020; 7:e000947. [PMID: 32076558 PMCID: PMC6999681 DOI: 10.1136/openhrt-2018-000947] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 08/05/2019] [Accepted: 09/11/2019] [Indexed: 01/25/2023] Open
Abstract
Background It is still uncertain whether coronary bifurcations with lesions involving a large side branch (SB) should be treated by stenting the main vessel and provisional stenting of the SB (simple) or by routine two-stent techniques (complex). We aimed to compare clinical outcome after treatment of lesions in large bifurcations by simple or complex stent implantation. Methods The study was a randomised, superiority trial. Enrolment required a SB≥2.75 mm, ≥50% diameter stenosis in both vessels, and allowed SB lesion length up to 15 mm. The primary endpoint was a composite of cardiac death, non-procedural myocardial infarction and target lesion revascularisation at 6 months. Two-year clinical follow-up was included in this primary reporting due to lower than expected event rates. Results A total of 450 patients were assigned to simple stenting (n=221) or complex stenting (n=229) in 14 Nordic and Baltic centres. Two-year follow-up was available in 218 (98.6%) and 228 (99.5%) patients, respectively. The primary endpoint of major adverse cardiac events (MACE) at 6 months was 5.5% vs 2.2% (risk differences 3.2%, 95% CI -0.2 to 6.8, p=0.07) and at 2 years 12.9% vs 8.4% (HR 0.63, 95% CI 0.35 to 1.13, p=0.12) after simple versus complex treatment. In the subgroup treated by newer generation drug-eluting stents, MACE was 12.0% vs 5.6% (HR 0.45, 95% CI 0.17 to 1.17, p=0.10) after simple versus complex treatment. Conclusion In the treatment of bifurcation lesions involving a large SB with ostial stenosis, routine two-stent techniques did not improve outcome significantly compared with treatment by the simpler main vessel stenting technique after 2 years. Trial registration number NCT01496638.
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Affiliation(s)
- Indulis Kumsars
- Department of Cardiology, Latvia Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | - Matti Niemelä
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Andrejs Erglis
- Research Institute of Cardiology and Regenerative Medicine, Latvia Centre of Cardiology, Riga, Latvia
| | - Kari Kervinen
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Andis Dombrovskis
- Department of Cardiology, Latvia Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Vytautas Abraitis
- Department of Cardiology, Vilnius University Hospital, Vilnius, Lithuania
| | | | - Thor Trovik
- Department of Cardiology, University of North Norway, Tromsoe, Norway
| | - Gustavs Latkovskis
- Research Institute of Cardiology and Regenerative Medicine, Latvia Centre of Cardiology, Riga, Latvia
| | - Dace Sondore
- Department of Cardiology, Latvia Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Inga Narbute
- Research Institute of Cardiology and Regenerative Medicine, Latvia Centre of Cardiology, Riga, Latvia
| | | | - Markku Eskola
- Department of Cardiology, Heart Center, Tampere University Hospital, Tampere, Finland
| | - Hannu Romppanen
- Department of cardiology, Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Mika Laine
- Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Mikko Pietila
- Department of Cardiology, Turku University Hospital, Turku, Finland
| | - Pål Gunnes
- Heart Center, Sørlandet Hospital, Arendal, Norway
| | - Lasse Hebsgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Frobert
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Fredrik Calais
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Juha Hartikainen
- Department of cardiology, Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Jens Aarøe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Terje K Steigen
- Department of Cardiology, University Hospital of North Norway, Tromsoe and Cardiovascular Diseases Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Leif Thuesen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens F Lassen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Early and Mid-Term Vascular Responses to Optical Coherence Tomography-Guided Everolimus-Eluting Stent Implantation in Stable Coronary Artery Disease. Can J Cardiol 2019; 35:1513-1522. [PMID: 31679621 DOI: 10.1016/j.cjca.2019.07.633] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/21/2019] [Accepted: 07/28/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Analysis of pooled clinical data has shown the safety of 3 months of dual antiplatelet therapy with everolimus-eluting cobalt-chromium stents (Co-Cr EESs). This study evaluated early and mid-term vascular responses to Co-Cr EESs in patients with stable coronary artery disease. METHODS The Multicenter Comparison of Early and Late Vascular Responses to Everolimus-Eluting Cobalt-Chromium Stent and Platelet Aggregation Studies in Patients With Stable Angina Managed as Elective Case (MECHANISM-Elective) study (NCT02014818) is a multicenter optical coherence tomography (OCT) registry. Enrolled patients were evaluated by OCT immediately after everolimus-eluting stent implantation were prospectively allocated to 1 month (n = 50) or 3 months (n = 50) OCT follow-up and then received a 12-month OCT evaluation. The incidences of intrastent thrombus (IS-Th) and irregular protrusion (IRP) were also assessed. RESULTS The percentage of uncovered struts was 6.4% ± 10.3% at 1 month (P < 0.001 vs. postprocedure) and 0.5% ± 0.9% at 12 months (P < 0.001 vs. 1 month). The corresponding values in the 3-month cohort were 2.0% ± 2.5% (P < 0.001 vs. postprocedure) and 0.5% ± 1.5% (P < 0.001 vs. 3 months). The incidence of IS-Th was 32.7% at 1 month, 5.4% at 3 months, and 2.0% at 12 months. IRP was observed in 21.8% of patients post-EES but had totally resolved at 1, 3, and 12 months. CONCLUSION Early and mid-term vascular reactions after Co-Cr EES implantation in stable patients with coronary artery disease in the MECHANISM-Elective included dynamic resolution of IS-Th and IRP and rapid decrease in uncovered struts. Thus, EES may allow shortening of dual antiplatelet therapy duration less than 3 months in this patient subset.
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Fujino Y, Attizzani GF, Tahara S, Naganuma T, Takagi K, Yabushita H, Wang W, Tanaka K, Matsumoto T, Kawamoto H, Yamada Y, Amano S, Watanabe Y, Warisawa T, Sato T, Mitomo S, Kurita N, Ishiguro H, Hozawa K, Tsukahara T, Motosuke M, Bezerra HG, Nakamura S, Nakamura S. Difference in vascular response between sirolimus-eluting- and everolimus-eluting stents in ostial left circumflex artery after unprotected left main as observed by optical coherence tomography. Int J Cardiol 2016; 230:284-292. [PMID: 28065691 DOI: 10.1016/j.ijcard.2016.12.122] [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: 08/15/2016] [Revised: 12/01/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Kissing-balloon technique (KBT) is commonly performed during percutaneous coronary intervention of distal unprotected left main coronary artery (ULM) aiming at obtaining optimal opening of the side branch (left circumflex artery; LCX) ostium. Nonetheless, detailed evaluation of vascular response to stents in LCX ostium is lacking. We therefore evaluated the vascular response to different drug-eluting stents (DES) in ostial LCX after ULM by means of optical coherence tomography (OCT). METHODS We prospectively enrolled 38 consecutive patients with ULM disease, who were treated with single-stent procedure using DES, crossover the ULM-left anterior descending artery (LAD) followed by KBT. Twelve patients were treated with sirolimus-eluting stents (SES) and 26 patients were treated with everolimus-eluting stents (EES). OCT was conducted at post-PCI and 9-month follow-up. We evaluated the DES-vessel interactions and number of stent struts at the side branch (LCX) ostium (SO) at post-PCI, and compared the narrowing of ostial area at LCX between SES and EES. RESULTS Post-procedure, the number of stent struts at SO was significantly higher in SES compared to EES (median 14.47% vs 0.19%, p<0.001). The narrowing of LCX ostial area at follow-up was more pronounced in SES compared with EES (29.16% vs 2.46%, respectively, p<0.001). Linear regression analysis showed a high correlation between the number of stent struts in LCX ostium and ostial area narrowing (r=0.771, p<0.001). CONCLUSIONS OCT showed differences between EES- and SES-vessel interactions at ULM bifurcation PCI. Number of LCX ostium struts at post-PCI impacted the narrowing of ostial area at 9-month follow-up.
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Affiliation(s)
- Yusuke Fujino
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
| | - Guilherme F Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Satoko Tahara
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Kensuke Takagi
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Wei Wang
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Kentaro Tanaka
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | | | - Yuya Yamada
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Shinnosuke Amano
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | | | | | - Tomohiko Sato
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Satoru Mitomo
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Naoyuki Kurita
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Takahiro Tsukahara
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Masahiro Motosuke
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Hiram G Bezerra
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | | | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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