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Takagi R, Kubo T. Clinical Value of Optical Coherence Tomography in Guiding Bifurcation Percutaneous Coronary Intervention. Circ J 2024; 88:970-971. [PMID: 37866910 DOI: 10.1253/circj.cj-23-0689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Affiliation(s)
- Ryu Takagi
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center
| | - Takashi Kubo
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center
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2
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Akase H, Okamura T, Nagoshi R, Fujimura T, Miyazaki Y, Takenaka H, Matsuyama T, Murasato Y, Yamawaki M, Ono S, Serikawa T, Hikichi Y, Norita H, Nakao F, Sakamoto T, Shinke T, Yano M, Shite J. Risk Assessment of Side Branch Compromise After Coronary Bifurcation Stenting - A Substudy of the 3D-OCT Bifurcation Registry. Circ J 2024; 88:959-969. [PMID: 37839862 DOI: 10.1253/circj.cj-22-0723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Side branch (SB) occlusion during bifurcation stenting is a serious complication. This study aimed to predict SB compromise (SBC) using optical coherence tomography (OCT).Methods and Results: Among the 168 patients who enrolled in the 3D-OCT Bifurcation Registry, 111 bifurcation lesions were analyzed to develop an OCT risk score for predicting SBC. SBC was defined as worsening of angiographic SB ostial stenosis (≥90%) immediately after stenting. On the basis of OCT before stenting, geometric parameters (SB diameter [SBd], length from proximal branching point to carina tip [BP-CT length], and distance of the polygon of confluence [dPOC]) and 3-dimensional bifurcation types (parallel or perpendicular) were evaluated. SBC occurred in 36 (32%) lesions. The parallel-type bifurcation was significantly more frequent in lesions with SBC. The receiver operating characteristic curve indicated SBd ≤1.77 mm (area under the curve [AUC]=0.73, sensitivity 64%, specificity 75%), BP-CT length ≤1.8 mm (AUC=0.83, sensitivity 86%, specificity 68%), and dPOC ≤3.96 mm (AUC=0.68, sensitivity 63%, specificity 69%) as the best cut-off values for predicting SBC. To create the OCT risk score, we assigned 1 point to each of these factors. As the score increased, the frequency of SBC increased significantly (Score 0, 0%; Score 1, 8.7%; Score 2, 28%; Score 3, 58%; Score 4, 85%; P<0.0001). CONCLUSIONS Prediction of SBC using OCT is feasible with high probability.
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Affiliation(s)
- Hideaki Akase
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Takayuki Okamura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Ryoji Nagoshi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Tatsuhiro Fujimura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Yosuke Miyazaki
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Hitoshi Takenaka
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Tetsuya Matsuyama
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Yoshinobu Murasato
- Department of Cardiology, National Hospital Organization Kyusyu Medical Center
| | | | - Shiro Ono
- Department of Cardiology, Saiseikai Yamaguchi General Hospital
| | | | - Yutaka Hikichi
- Department of Cardiovascular Medicine, Saga-Ken Medical Center Koseikan
| | | | - Fumiaki Nakao
- Department of Cardiology, Yamaguchi Grand Medical Center
| | | | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Masafumi Yano
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
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Barbato E, Gallinoro E, Abdel-Wahab M, Andreini D, Carrié D, Di Mario C, Dudek D, Escaned J, Fajadet J, Guagliumi G, Hill J, McEntegart M, Mashayekhi K, Mezilis N, Onuma Y, Reczuch K, Shlofmitz R, Stefanini G, Tarantini G, Toth GG, Vaquerizo B, Wijns W, Ribichini FL. Management strategies for heavily calcified coronary stenoses: an EAPCI clinical consensus statement in collaboration with the EURO4C-PCR group. Eur Heart J 2023; 44:4340-4356. [PMID: 37208199 DOI: 10.1093/eurheartj/ehad342] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
Since the publication of the 2015 EAPCI consensus on rotational atherectomy, the number of percutaneous coronary interventions (PCI) performed in patients with severely calcified coronary artery disease has grown substantially. This has been prompted on one side by the clinical demand for the continuous increase in life expectancy, the sustained expansion of the primary PCI networks worldwide, and the routine performance of revascularization procedures in elderly patients; on the other side, the availability of new and dedicated technologies such as orbital atherectomy and intravascular lithotripsy, as well as the optimization of the rotational atherectomy system, has increased operators' confidence in attempting more challenging PCI. This current EAPCI clinical consensus statement prepared in collaboration with the EURO4C-PCR group describes the comprehensive management of patients with heavily calcified coronary stenoses, starting with how to use non-invasive and invasive imaging to assess calcium burden and inform procedural planning. Objective and practical guidance is provided on the selection of the optimal interventional tool and technique based on the specific calcium morphology and anatomic location. Finally, the specific clinical implications of treating these patients are considered, including the prevention and management of complications and the importance of adequate training and education.
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Affiliation(s)
- Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa n. 1035, Rome, 00189, Italy
| | - Emanuele Gallinoro
- Division of University Cardiology, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
| | | | - Daniele Andreini
- Division of University Cardiology, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Didier Carrié
- Service de Cardiologie B, CHU Rangueil, Université Paul Sabatier, Toulouse, France
| | - Carlo Di Mario
- Interventional Structural Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | | | | | - Jonathan Hill
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, MediClin Heart Institute Lahr/Baden, Lahr & Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Yoshinobu Onuma
- Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, Toyoake, Japan
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Krzyszstof Reczuch
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Giulio Stefanini
- Humanitas Clinical and Research Hospital IRCCS & Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gabor G Toth
- University Heart Center Graz, Medical University of Graz, Graz, Austria
| | - Beatriz Vaquerizo
- Unidad de Cardiología Intervencionista, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory, Corrib Core Laboratory and Curam, National University of Ireland, Galway, Ireland
| | - Flavio L Ribichini
- Cardiovascular Section of the Department of Medicine, University of Verona, Verona, Italy
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4
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Allali A, Abdel-Wahab M, Elbasha K, Mankerious N, Traboulsi H, Kastrati A, El-Mawardy M, Hemetsberger R, Sulimov DS, Neumann FJ, Toelg R, Richardt G. Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials. Clin Res Cardiol 2023; 112:1143-1163. [PMID: 35482101 PMCID: PMC10450020 DOI: 10.1007/s00392-022-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
With growing experience, technical improvements and use of newer generation drug-eluting stents (DES), recent data showed satisfactory acute and long-term results after rotational atherectomy (RA) in calcified coronary lesions. The randomized ROTAXUS and PREPARE-CALC trials compared RA to balloon-based strategies in two different time periods in the DES era. In this manuscript, we assessed the technical evolution in RA practice from a pooled analysis of the RA groups of both trials and established a link to further recent literature. Furthermore, we sought to summarize and analyze the available experience with RA in different patient and lesion subsets, and propose recommendations to improve RA practice. We also illustrated the combination of RA with other methods of lesion preparation. Finally, based on the available evidence, we propose a simple and practical approach to treat severely calcified lesions.
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Affiliation(s)
- Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany.
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Hussein Traboulsi
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Adnan Kastrati
- Cardiology Department, German Heart Center, Technical University of Munich, Munich, Germany
| | | | - Rayyan Hemetsberger
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Dmitriy S Sulimov
- Cardiology Department, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Franz-Josef Neumann
- Cardiology Department, Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken, Bad Segeberg, Germany
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5
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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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Safety Assessment of Microcatheter-Protected Rotational Atherectomy with the Double Guiding Catheter Technique for Severely Calcified Left Main Bifurcation. J Interv Cardiol 2022; 2022:1399510. [PMID: 36072361 PMCID: PMC9381278 DOI: 10.1155/2022/1399510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Rotational atherectomy (RA) is a tool for calcium modification, but there is a risk of losing the side branch in left main coronary artery (LM) bifurcation lesions, resulting in disastrous consequences. Microcatheter-protected RA with the double guiding catheter (GC) technique for severely calcified LM bifurcations has been described previously, but its safety warrants further investigation. Methods. Various sizes of coronary calcification vascular simulators were utilized to model calcified LM bifurcation lesions for RA in in vitro. The damage to the side branch protective microcatheters and guidewires was accessed after microcatheter-protected RA with the double GC technique. In clinical practice, microcatheter-protected RA with the double GC technique was carried out in two patients. Results. In vitro, none of the protective microcatheters or guidewires were completely fractured, although the majority of them were damaged to varying degrees. In clinical practice, we successfully carried out two cases of percutaneous coronary intervention for severely calcified LM bifurcation with microcatheter-protected RA using the double GC technique. Conclusion. RA of severely calcified LM bifurcation lesions may be successfully performed using microcatheter-protected RA with the double GC technique, potentially reducing the risk of side branch occlusion. Since majority of protective microcatheters or guidewires were damaged, there was still some risk, and it is recommended to use this technique only in highly selected patient population of severely calcified true (Medina 1, 1, 1) LM bifurcations.
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7
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Mizuno Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Impact of rotational atherectomy on the incidence of side branch compromise in calcified bifurcation lesions undergoing elective percutaneous coronary intervention. J Cardiol 2022; 80:518-524. [PMID: 35882614 DOI: 10.1016/j.jjcc.2022.07.004] [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] [Received: 06/11/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) to the calcified bifurcation lesion is still a challenging issue even for experienced interventional cardiologists. In such bifurcation lesions, side branch compromise caused by carina-shift or plaque shift just following stent implantation or balloon dilatation is one of the most important complications. It remains unclear whether rotational atherectomy (RA) to the main vessel reduces the incidence of side branch compromise in the calcified bifurcation lesions. The aim of this retrospective study was to compare the incidence of side branch compromise/occlusion between PCI with versus without RA. METHODS This was a retrospective, single-center study. Side branch compromise/occlusion was defined as final Thrombolysis in Myocardial Infarction flow grade of side branch ≤2/≤1. We included 302 calcified bifurcation lesions, and divided those into the RA group (n = 140) and the non-RA group (n = 162) according to use of RA to the main vessel. RESULTS The incidence of side branch compromise/occlusion was significantly less in the RA group than in the non-RA group (compromise: 6.4 % versus 14.2 %, p = 0.038; occlusion: 3.6 % versus 10.5 %, p = 0.017). RA was inversely associated with the incidence of side branch compromise [odds ratio (OR) 0.272, 95 % confidence interval (CI) 0.096-0.772, p = 0.014] and occlusion (OR 0.175, 95 % CI 0.049-0.628, p = 0.008). CONCLUSIONS RA to the main vessel was associated with a lower incidence of side branch compromise/occlusion. RA to the main vessel only may be a reasonable approach to reduce the risk of side branch compromise/occlusion in calcified bifurcation lesions.
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Affiliation(s)
- Yusuke Mizuno
- 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.
| | - Hiroyuki Jinnouchi
- 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
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Seguchi
- 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
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Difference in basic concept of coronary bifurcation intervention between Korea and Japan. Insight from questionnaire in experts of Korean and Japanese bifurcation clubs. Cardiovasc Interv Ther 2021; 37:89-100. [PMID: 33453035 PMCID: PMC8789730 DOI: 10.1007/s12928-020-00742-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/30/2020] [Indexed: 11/27/2022]
Abstract
The coronary bifurcation intervention varies among countries due to the differences in assessment of lesion severity and treatment devices. We sought to clarify the difference in basic strategy between South Korea and Japan. A total of 19 and 32 experts from Korean (KBC) and Japanese Bifurcation Clubs (JBC), respectively, answered a survey questionnaire concerning their usual procedure of coronary bifurcation intervention. JBC experts performed less two-stent deployment in the left main (LM) bifurcation compared to KBC experts (JBC vs. KBC: median, 1–10% vs. 21–30%, p < 0.0001) instead of higher performance of side branch dilation after cross-over stenting in both LM (60% vs. 21%, p = 0.001) and non-LM bifurcations (30% vs. 5%, p = 0.037). KBC experts more frequently performed proximal optimization technique (POT) in non-LM bifurcation (41–60% vs. 81–99%, p = 0.028) and re-POT in both LM (1–20% vs. 81–99%, p = 0.017) and non-LM bifurcations (1–20% vs. 81–99%, p = 0.0003). JBC experts more frequently performed imaging-guided percutaneous coronary intervention, whereas KBC experts more often used a pressure wire to assess side branch ischemia. JBC experts used a rotablator more aggressively under the guidance of optical coherence tomography. We clarified the difference in the basic strategy of coronary bifurcation intervention between South Korea and Japan for better understanding the trend in each country.
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The Impact of Aortic Valvular Calcium on Transcatheter Heart Valve Distortion. J Interv Cardiol 2021; 2021:8829906. [PMID: 33500684 PMCID: PMC7803404 DOI: 10.1155/2021/8829906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/10/2020] [Accepted: 12/26/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives To investigate the relationship between the eccentric calcification of aortic valve and transcatheter heart valve (THV) distortion and the impact of THV distortion on echo parameters and clinical outcomes. Background The effects of eccentric calcification of the aortic valve on the THV distortion and the relationship between THV distortion and clinical impact were not fully understood. Methods Patients with symptomatic severe aortic stenosis who were undergoing THV implantation were enrolled. Patients underwent preprocedural, postprocedural multislice computed tomography (MSCT), and follow-up transthoracic echocardiogram (TTE). Delta calcium score (ΔCS) is defined as the difference between the maximum and minimal calcium scores of the three cusps, while valve distortion score (VDS) is defined as the difference between the longest and shortest stent frame, as obtained using MSCT. Patients were divided into two groups according to ΔCS: “noneccentric calcification group” and “eccentric calcification group.” Results A total of 118 patients were enrolled (59 patients in noneccentric and 59 in eccentric calcification groups). VDS was significantly lower in the noneccentric calcification group than in the eccentric calcification group (1.31 ± 0.82 mm vs. 1.73 ± 0.76 mm, p=0.004). VDS was not associated with the degree of paravalvular leak (PVL) and aortic valvular mean pressure gradient (AVPG) at 30-day and 1-year follow-up TTE and the cumulative rates of all-cause death and rehospitalization at 2-year clinical follow-up. Conclusions Eccentric valvular calcification was associated with longitudinal THV distortion. However, THV distortion was not associated with PVL, AVPG, and adverse clinical events during midterm follow-up.
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Impact of Lesion Preparation Technique on Side Branch Compromise in Calcified Coronary Bifurcations: A Subgroup Analysis of the PREPARE-CALC Trial. J Interv Cardiol 2020; 2020:9740938. [PMID: 33223974 PMCID: PMC7673940 DOI: 10.1155/2020/9740938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/15/2020] [Accepted: 10/24/2020] [Indexed: 01/16/2023] Open
Abstract
Objectives To analyze the impact of different techniques of lesion preparation of severely calcified coronary bifurcation lesions. Background The impact of different techniques of lesion preparation of severely calcified coronary bifurcation lesions is poorly investigated. Methods We performed an as-treated analysis on 47 calcified bifurcation lesions treated with scoring/cutting balloons (SCB) and 68 lesions treated with rotational atherectomy (RA) in the PREPARE-CALC trial. Compromised side branch (SB) as assessed in the final angiogram was the primary outcome measure and was defined as any significant stenosis, dissection, or thrombolysis in myocardial infarction flow <3. Results True bifurcation lesions were present in 49% vs. 43% of cases in the SCB and RA groups, respectively. After stent implantation, SB balloon dilatation was necessary in around one-third of cases (36% vs. 38%; p = 0.82), and a two-stent technique was performed in 21.3% vs. 25% (p = 0.75). At the end of the procedure, the SB remained compromised in 15 lesions (32%) in the SCB group and 5 lesions (7%) in the RA group (p = 0.001). Large coronary dissections were more frequently observed in the SCB group (13% vs. 2%; p = 0.02). Postprocedural levels of cardiac biomarkers were significantly higher in patients with a compromised SB at the end of the procedure. Conclusions In the PREPARE-CALC trial, side branch compromise was more frequently observed after lesion preparation with SCB as compared with RA. Consequently, in calcified bifurcation lesions, an upfront debulking with an RA-based strategy might optimize the result in the side branch.
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Takagi K, Nagoshi R, Kim BK, Kim W, Kinoshita Y, Shite J, Hikichi Y, Song YB, Nam CW, Koo BK, Kim SJ, Murasato Y. Efficacy of coronary imaging on bifurcation intervention. Cardiovasc Interv Ther 2020; 36:54-66. [PMID: 32894433 PMCID: PMC7829226 DOI: 10.1007/s12928-020-00701-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/14/2023]
Abstract
During the coronary bifurcation intervention procedure, imaging including intravascular ultrasound and optical coherence tomography is essential to provide precise anatomy of the lesion and morphological information. This consensus document between the Korean Bifurcation Club and the Japanese Bifurcation Club summarizes practical guidelines and current evidences on lesion assessment, device selection, procedural guidance, and the optimization of bifurcation intervention by the imaging.
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Affiliation(s)
- Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ryoji Nagoshi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Byeong-Keuk Kim
- Department of Cardiology, Yonsei Severance Hospital, Seoul, South Korea
| | - Woong Kim
- Department of Cardiology, Yeungnam Medical Center, Daegu, South Korea
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | | | - Young Bin Song
- Department of Cardiology, Samsung Medical Center, Seoul, South Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Soo-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Center, National Hospital Organization, Kyushu Medical Center, 1-8-1, Jigyohama, Chuo, Fukuoka, 810-8563, Japan.
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Perfetti M, Fulgenzi F, Radico F, Toro A, Procopio A, Maddestra N, Zimarino M. Calcific lesion preparation for coronary bifurcation stenting. Cardiol J 2019; 26:429-437. [PMID: 31565792 DOI: 10.5603/cj.a2019.0094] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 12/21/2022] Open
Abstract
Bifurcating coronary lesions are a very common challenge in interventional cardiology because of the technical complexity in their treatment, the risk of side branch occlusion and an overall worse outcome when compared to non-bifurcating lesions. The presence of calcifications represents further complexity due to the difficulty in device delivery and stent expansion as well as enhanced risk of side branch occlusion. Rotational and orbital atherectomy, scoring and cutting balloons, coronary lithoplasty are available tools which have been introduced over the last three decades to overcome such issue. Nevertheless, their application in different contexts of bifurcations presents specific caveats and the studies directed at comparing such techniques have never been expressly oriented in the subset of the bifurcating lesion. In this paper, we review these devices and their usefulness in bifurcations by analyzing consistent data from clinical trials, and we propose a practical algorithm for the treatment of severely calcified bifurcating lesions according to their anatomical features.
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Affiliation(s)
- Matteo Perfetti
- Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy, Italy
| | - Fabio Fulgenzi
- Institute of Cardiology "G. d'Annunzio University", Chieti, Italy, Italy
| | - Francesco Radico
- Institute of Cardiology "G. d'Annunzio University", Chieti, Italy, Italy
| | - Alessandro Toro
- Institute of Cardiology "G. d'Annunzio University", Chieti, Italy, Italy
| | - Antonio Procopio
- Institute of Cardiology "G. d'Annunzio University", Chieti, Italy, Italy
| | - Nicola Maddestra
- Institute of Cardiology "G. d'Annunzio University", Chieti, Italy, Italy
| | - Marco Zimarino
- Institute of Cardiology, "G. d'Annunzio University", Chieti, Italy. .,Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy, Italy.
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Barman N, Okamoto N, Ueda H, Chamaria S, Bhatheja S, Vengrenyuk Y, Gupta E, Sweeny J, Kapur V, Hasan C, Baber U, Moreno P, Sharma S, Kini AS. Predictors of side branch compromise in calcified bifurcation lesions treated with orbital atherectomy. Catheter Cardiovasc Interv 2018; 94:45-52. [DOI: 10.1002/ccd.27992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/29/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Nitin Barman
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Naotaka Okamoto
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Hiroshi Ueda
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Surbhi Chamaria
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Samit Bhatheja
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Yuliya Vengrenyuk
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Eisha Gupta
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Joseph Sweeny
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Vishal Kapur
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Choudhury Hasan
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Usman Baber
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Pedro Moreno
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Samin Sharma
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
| | - Annapoorna S. Kini
- Division of Cardiology; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai; New York New York
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Collet C, Onuma Y, Grundeken MJ, Miyazaki Y, Bittercourt M, Kitslaar P, Motoyama S, Ozaki Y, Asano T, Wentzel JJ, Streekstra GJ, Serruys PW, de Winter RJ, Planken RN. In vitro validation of coronary CT angiography for the evaluation of complex lesions. EUROINTERVENTION 2018. [PMID: 28649954 DOI: 10.4244/eij-d-17-00326] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to assess in vitro the diagnostic accuracy of computed tomography angiography (CTA) for the evaluation of complex coronary lesions. METHODS AND RESULTS Five Plexiglas phantoms with three bifurcation lesions each were designed to mimic the anatomic variations and fractal phenomena of the coronary tree. In addition, luminal stenoses were scaled up with increases of 10% from 40% to 80%, corresponding to luminal areas ranging from 3.0 mm2 to 0.22 mm2. Third-generation dual-source computed tomography was used. Automated quantitative CTA analysis was performed according to the bifurcation segment model. The primary objective was to determine the diagnostic accuracy of quantitative CTA in assessing bifurcation lesions with the phantoms as a reference. The accuracy of CTA for the assessment of minimal luminal diameter was -0.07 mm (limits of agreement -0.75 to 0.61), for reference vessel diameter 0.19 mm (limits of agreement -0.25 to 0.63) and diameter stenosis 8.2% (limits of agreement -13.2 to 29.5) with no difference regarding the location within the bifurcation (i.e., proximal and distal main vessel and side branch). In stenosis with minimal luminal diameter ≥1 mm, CTA overestimated the lesion severity (bias 0.19 mm, limits of agreement -0.09 to 0.47), whereas in lesions with severe stenosis and minimal luminal diameter ≤1 mm, CTA underestimated the lesion severity (bias -0.48 mm, limits of agreement -0.55 to -0.41). CTA was able to identify the contrast-filled lumen in all degrees of lesion severity. CONCLUSIONS In vitro, CTA is accurate for the evaluation of bifurcation lesions. CTA was able to distinguish contrast-filled lumen even in severe obstructive lesions. These findings require further validation in the clinical setting.
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Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Iannaccone F, Chiastra C, Karanasos A, Migliavacca F, Gijsen F, Segers P, Mortier P, Verhegghe B, Dubini G, De Beule M, Regar E, Wentzel J. Impact of plaque type and side branch geometry on side branch compromise after provisional stent implantation: a simulation study. EUROINTERVENTION 2017; 13:e236-e245. [DOI: 10.4244/eij-d-16-00498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Acute and chronic total occlusion of the left circumflex artery following unprotected left main stenting. Coron Artery Dis 2015; 26:548-50. [DOI: 10.1097/mca.0000000000000238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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ZHANG DONG, DOU KEFEI. Coronary Bifurcation Intervention: What Role Do Bifurcation Angles Play? J Interv Cardiol 2015; 28:236-48. [DOI: 10.1111/joic.12203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- DONG ZHANG
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute; Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 China
| | - KEFEI DOU
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute; Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 China
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Migliavacca F, Chiastra C, Chatzizisis YS, Dubini G. Virtual bench testing to study coronary bifurcation stenting. EUROINTERVENTION 2015; 11 Suppl V:V31-4. [DOI: 10.4244/eijv11sva7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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