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Suleiman S, Coughlan JJ, Touma G, Szirt R. Contemporary Management of Isolated Ostial Side Branch Disease: An Evidence-based Approach to Medina 001 Bifurcations. Interv Cardiol 2021; 16:e06. [PMID: 33897832 PMCID: PMC8054348 DOI: 10.15420/icr.2020.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/25/2021] [Indexed: 01/09/2023] Open
Abstract
The optimal management of bifurcation lesions has received significant interest in recent years and remains a matter of debate among the interventional cardiology community. Bifurcation lesions are encountered in approximately 21% of percutaneous coronary intervention procedures and are associated with an increased risk of major adverse cardiac events. The Medina classification has been developed in an attempt to standardise the terminology when describing bifurcation lesions. The focus of this article is on the management of the Medina 0,0,1 lesion (‘Medina 001’), an uncommon lesion encountered in <5% of all bifurcations. Technical considerations, management options and interventional techniques relating to the Medina 001 lesion are discussed. In addition, current published data supporting the various proposed interventional treatment strategies are examined in an attempt to delineate an evidence-based approach to this uncommon lesion.
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Affiliation(s)
- Suleiman Suleiman
- Department of Cardiology, Tallaght University Hospital Dublin, Ireland
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2
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Vincent D, Erwin S, Hanet C, Guédès A, Samir P. Double guide double wrist 5F left coronary artery transradial percutaneous coronary intervention and the X-Kiss technique. ACTA ACUST UNITED AC 2017; 18:45-52. [PMID: 29116819 DOI: 10.1080/17482941.2017.1369126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Percutaneous coronary intervention for bifurcated anatomy, particularly at the proximal left coronary artery site, requires guide catheters (GC) of at least 6 french and preferably larger in diameter. We describe a new trans-radial approach more suitable for small artery size: the simultaneous use of both radial arteries for double cannulation of the LMCA with 5F GC: each GC will target either the LM/LAD or the LM/CX artery (or LM-LAD/LM-LAD-1st diagonal branch) stenoses. The technique successfully was applied to 5 cases. When the technique was used for distal left main coronary artery stenoses (3 cases), a special crogss-like configuration obtained when guide catheters, coronary wires and balloons kissed was observed.
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Affiliation(s)
- Dangoisse Vincent
- a From the Cardiology Service , Centre Hospitalier Universitaire de Mont Godinne-Dinant , Yvoir , Belgium
| | - Schroëder Erwin
- a From the Cardiology Service , Centre Hospitalier Universitaire de Mont Godinne-Dinant , Yvoir , Belgium
| | - Claude Hanet
- a From the Cardiology Service , Centre Hospitalier Universitaire de Mont Godinne-Dinant , Yvoir , Belgium
| | - Antoine Guédès
- a From the Cardiology Service , Centre Hospitalier Universitaire de Mont Godinne-Dinant , Yvoir , Belgium
| | - Pancholy Samir
- b Commonwealth Medical College and The Wright Center for Graduate Medical Education , Scranton , PA , USA
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Pagiatakis C, Tardif JC, L'Allier PL, Mongrain R. Effect of stenosis eccentricity on the functionality of coronary bifurcation lesions-a numerical study. Med Biol Eng Comput 2017; 55:2079-2095. [PMID: 28500478 DOI: 10.1007/s11517-017-1653-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 04/25/2017] [Indexed: 01/10/2023]
Abstract
Interventional cardiologists still rely heavily on angiography for the evaluation of coronary lesion severity, despite its poor correlation with the presence of ischemia. In order to improve the accuracy of the current diagnostic procedures, an understanding of the relative influence of geometric characteristics on the induction of ischemia is required. This idea is especially important for coronary bifurcation lesions (CBLs), whose treatment is complex and is associated with high rates of peri- and post-procedural clinical events. Overall, it is unclear which geometric and morphological parameters of CBLs influence the onset of ischemia. More specifically, the effect of stenosis eccentricity is unknown. Computational fluid dynamic simulations, under a geometric multiscale framework, were executed for seven CBL configurations within the left main coronary artery bifurcation. Both concentric and eccentric stenosis profiles of mild to severe constriction were considered. By using a geometric multiscale framework, the fractional flow reserve, which is the gold-standard clinical diagnostic index, could be calculated and was compared between the eccentric and concentric profiles for each case. The results suggested that for configurations where the supplying vessel is stenosed, eccentricity could have a notable effect on and therefore be an important factor that influences configuration functionality.
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Affiliation(s)
- Catherine Pagiatakis
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Montreal, Quebec, H3A 0C3, Canada. .,Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, H1T 1C8, Canada.
| | - Jean-Claude Tardif
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, H1T 1C8, Canada.,Faculty of Medicine, Université de Montréal - Pavillon Roger-Gaudry, 2900 Edouard-Montpetit Boulevard, Montreal, Quebec, H3T 1J4, Canada
| | - Philippe L L'Allier
- Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, H1T 1C8, Canada.,Faculty of Medicine, Université de Montréal - Pavillon Roger-Gaudry, 2900 Edouard-Montpetit Boulevard, Montreal, Quebec, H3T 1J4, Canada
| | - Rosaire Mongrain
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Montreal, Quebec, H3A 0C3, Canada.,Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, H1T 1C8, Canada
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The outcomes of intravascular ultrasound-guided drug-eluting stent implantation among patients with complex coronary lesions: a comprehensive meta-analysis of 15 clinical trials and 8,084 patients. Anatol J Cardiol 2017; 17:258-268. [PMID: 28344214 PMCID: PMC5469105 DOI: 10.14744/anatoljcardiol.2016.7461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: The effects of intravascular ultrasound (IVUS)-guided drug-eluting stent (DES) implantation in patients with complex coronary artery lesions remains to be controversial. This study sought to evaluate the outcomes of IVUS guidance in these patients. Methods: The EMBASE, Medline, and other internet sources were searched for relevant articles. The primary endpoint was major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction (MI), and target-vessel revascularization (TVR). The incidence of definite/probable stent thrombosis (ST) was analyzed as the safety endpoint. Results: Fifteen clinical trials involving 8.084 patients were analyzed. MACE risk was significantly decreased following IVUS-guided DES implantation compared with coronary angiography (CAG) guidance (odds ratio [OR] 0.63, 95% confidence intervals [CI]: 0.53–0.73, p<0.001), which might mainly result from the lower all-cause mortality risk (OR 0.52, 95% CI: 0.40–0.67, p<0.001), MI (OR 0.70, 95% CI: 0.56–0.86, p=0.001), and TVR (OR 0.53, 95% CI: 0.40–0.70, p<0.001). The subgroup analyses indicated better outcomes of IVUS guidance in DES implantation for these patients with left main disease or bifurcation lesions. Conclusion: IVUS guidance in DES implantation is associated with a significant reduction in MACE risk in patients with complex lesions, particularly those with left main disease or bifurcation lesions. More large and powerful randomized trials are still warranted to guide stenting decision making. (Anatol J Cardiol 2017; 17: 258-68)
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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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Pagiatakis C, Tardif JC, L’Allier PL, Mongrain R. A numerical investigation of the functionality of coronary bifurcation lesions with respect to lesion configuration and stenosis severity. J Biomech 2015; 48:3103-11. [DOI: 10.1016/j.jbiomech.2015.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 07/15/2015] [Accepted: 07/18/2015] [Indexed: 10/23/2022]
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Sakamoto N, Hoshino Y, Mizukami H, Sugimoto K, Yamaki T, Kunii H, Nakazato K, Suzuki H, Saitoh SI, Takeishi Y. Intravascular ultrasound predictors of acute side branch occlusion in coronary artery bifurcation lesions just after single stent crossover. Catheter Cardiovasc Interv 2015; 87:243-50. [DOI: 10.1002/ccd.26021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/01/2015] [Accepted: 04/18/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Nobuo Sakamoto
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - Yasuto Hoshino
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - Hiroyuki Mizukami
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - Koichi Sugimoto
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - Takayoshi Yamaki
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - Hiroyuki Kunii
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - Kazuhiko Nakazato
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - Hitoshi Suzuki
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - Shu-ichi Saitoh
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - Yasuchika Takeishi
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
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9
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Alfonso F, Pan M. Do we know how to treat bifurcation coronary lesions? ACTA ACUST UNITED AC 2014; 67:790-3. [PMID: 25262124 DOI: 10.1016/j.rec.2014.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 05/09/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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López Mínguez JR, Nogales Asensio JM, Doncel Vecino LJ, Sandoval J, Romany S, Martínez Romero P, Fernández Díaz JA, Fernández Portales J, González Fernández R, Martínez Cáceres G, Merchán Herrera A, Alfonso Manterola F. A prospective randomised study of the paclitaxel-coated balloon catheter in bifurcated coronary lesions (BABILON trial): 24-month clinical and angiographic results. EUROINTERVENTION 2014; 10:50-7. [DOI: 10.4244/eijv10i1a10] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chen SL, Ye F, Zhang JJ, Tian NL, Liu ZZ, Santoso T, Zhou YJ, Jiang TM, Wen SY, Kwan TW. Intravascular ultrasound-guided systematic two-stent techniques for coronary bifurcation lesions and reduced late stent thrombosis. Catheter Cardiovasc Interv 2012; 81:456-63. [PMID: 22899562 DOI: 10.1002/ccd.24601] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 08/09/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The effects of intravascular ultrasound (IVUS)-guided complex approaches using drug-eluting stents (DES) for coronary bifurcation lesions on clinical outcomes has not yet been studied in detail. OBJECTIVE Our objective was to analyze the difference in 1-year outcomes following two-stent techniques involving implantation of DES for coronary bifurcation lesions between IVUS-guided and angiography-guided groups. METHODS From May 26, 2007 to March 24, 2010, 628 patients received two-stent techniques (324 in the IVUS-guided group and 304 angiography-guided) and were prospectively studied. We compared major adverse cardiac events (MACE, including cardiac death, stent thrombosis [ST], myocardial infarction [MI] and target lesion/vessel revascularization) at 12-months follow-up, before and after adjusting for propensity score matching. RESULTS At 12-months after the indexed procedure, patients in the angiography-guided group had significantly increased in-stent restenosis. Compared to the angiography-guided group, the IVUS-guided group had a significantly lower overall unadjusted ST rate (1.2% vs. 6.9%, P < 0.001), definite ST (0.6% vs. 5.3%, P < 0.001), late ST (0.6% vs. 4.3%, P = 0.003), MI (4.6% vs. 8.9%, P = 0.038) and cardiac death (0.9% vs. 3.3%, P = 0.049). By propensity score matching, 123 paired patients were matched. The late ST at 12-months follow-up was 0% in the IVUS-guided group versus 4.9% in the angiography-guided group (P = 0.029), resulting in significant differences in ST-elevation MI between the two groups (2.4% vs. 9.8%, P = 0.030). CONCLUSIONS The IVUS-guided two-stent technique was associated with significantly reduced late stent thrombosis, with a resultant reduction in ST-elevation MI. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Yoshitaka Goto Y, Kawasaki T, Koga N, Tanaka H, Koga H, Orita Y, Ikeda S, Shintani Y, Kajiwara M, Fukuyama T. Plaque distribution patterns in left main trunk bifurcations: prediction of branch vessel compromise by multidetector row computed topography after percutaneous coronary intervention. EUROINTERVENTION 2012; 8:708-16. [DOI: 10.4244/eijv8i6a110] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Suárez de Lezo J, Medina A, Martín P, Novoa J, Suárez de Lezo J, Pan M, Caballero E, Melián F, Mazuelos F, Quevedo V. Predictors of ostial side branch damage during provisional stenting of coronary bifurcation lesions not involving the side branch origin: an ultrasonographic study. EUROINTERVENTION 2012; 7:1147-54. [DOI: 10.4244/eijv7i10a185] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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