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Raphael CE, O'Kane PD. Contemporary approaches to bifurcation stenting. JRSM Cardiovasc Dis 2021; 10:2048004021992190. [PMID: 33717470 PMCID: PMC7917419 DOI: 10.1177/2048004021992190] [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] [Revised: 11/19/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022] Open
Abstract
Bifurcation lesions are common and associated with higher risks of major cardiac events and restenosis after percutaneous coronary intervention (PCI). Treatment requires understanding of lesion characteristics, stent design and therapeutic options. We review the evidence for provisional vs 2-stent techniques. We conclude that provisional stenting is suitable for most bifurcation lesions. We detail situations where a 2-stent technique should be considered and the steps for performing each of the 2-step techniques. We review the importance of lesion preparation, intracoronary imaging, proximal optimization (POT) and kissing balloon inflation.
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Tokuda T, Oba Y, Koshida R, Kagase A, Matsuda H, Suzuki Y, Murata A, Ito T. Validation of Global Limb Anatomical Staging System (GLASS) in patients with hemodialysis and Chronic Limb-Threatening Ischemia after endovascular treatment. Heart Vessels 2021; 36:809-817. [PMID: 33386921 DOI: 10.1007/s00380-020-01747-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022]
Abstract
Recently, Society for Vascular Surgery guideline recommends evaluating anatomic pattern with use of Global Limb Anatomic Staging System (GLASS) in Chronic Limb-Threatening Ischemia (CLTI) patients. The aim of this study is to validate GLASS stage into CLTI patients on hemodialysis (HD) and investigate the impact of GLASS stage to wound healing and amputation-free survival (AFS). Between April 2009 and March 2018, we performed EVT for 154 limbs in CLTI patients on HD. GLASS was defined as femoropopliteal (FP) and infrapopliteal (IP) segments separately graded (0-4), then combined into three GLASS stages for the limb (I-III). We divided them into three GLASS stages with using this system. We compared the clinical outcomes between three groups (GLASS I, GLASS II, and GLASS III). Patient characteristics were almost similar between the three groups. Lesion characteristics was more complex and the rate of success was lower in GLASS III. Cox regression multivariate analysis revealed that diabetes mellitus (HR 2.4, 95% CI 1.37-4.01, p < 0.01) and WIfI high (HR 2.3, 95% CI 1.04-6.01, p = 0.04) were the predictors of non-wound healing, whereas age (HR 1.6, 95% CI 1.09-2.29, p = 0.01), WIfI clinical stage 4 (HR 2.4, 95% CI 1.30-4.36, p < 0.01), and non-ambulatory status (HR 2.0, 95% CI 1.17-3.29, p = 0.01) were the predictors of AFS. GLASS stage in CLTI patient on HD could not predict wound healing, and AFS in this study.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan.
| | - Yasuhiro Oba
- Department of Cardiology, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Ryoji Koshida
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Hiroaki Matsuda
- Department of Cardiology, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Yoriyasu Suzuki
- Department of Cardiology, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Akira Murata
- Department of Cardiology, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
| | - Tatsuya Ito
- Department of Cardiology, Nagoya Heart Center, 1-1-14 Sunadabashi, Higashi-ku, Nagoya, Aichi, 461-0045, Japan
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Hara H, Gao C, Kogame N, Ono M, Kawashima H, Wang R, Morel MA, O'Leary N, Sharif F, Möllmann H, Reiber JH, Sabaté M, Zaman A, Wijns W, Onuma Y, Serruys PW. A randomised controlled trial of the sirolimus-eluting biodegradable polymer ultra-thin Supraflex stent versus the everolimus-eluting biodegradable polymer SYNERGY stent for three-vessel coronary artery disease: rationale and design of the Multivessel TALENT trial. EUROINTERVENTION 2020; 16:e997-e1004. [DOI: 10.4244/eij-d-20-00772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ramadan BA, Zaki MA, Etman WGED, Agha MM, Sobhy MA, Hassanein WM. Impact of preoperative SYNTAX Scores on short-term outcome following coronary artery bypass grafting surgery in the patients with multi-vessels coronary artery disease. Egypt Heart J 2020; 72:36. [PMID: 32613331 PMCID: PMC7329969 DOI: 10.1186/s43044-020-00071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/19/2020] [Indexed: 11/17/2022] Open
Abstract
Background SYNTAX Scores I (SSI) assesses the complexity of CAD; SYNTAX Score II (SSII) uses both SSI and other clinical variables, in estimation of 4 years mortality following both coronary artery bypass grafting surgery (CABG) and percutaneous coronary intervention (PCI) and gives recommendations for the best revascularization strategy in a specific patient. Our aim is to investigate the impact of both SYNTAX Scores on short-term outcome following CABG. Results Prospectively, we studied 150 patients with multi-vessels coronary artery disease, referred to perform, elective primary isolated CABG. All cases performed on pump CABG with aortic cross clamping, then followed up for 90 days postoperatively, for onset of mortality from all causes, myocardial infarction (MI), stroke, mediastinitis, and need for renal replacement therapy (RRT). SSI showed a statistically significant association with in-hospital and 90 days mortality, MI, and mediastinitis (P = < 0.001, 0.015, 0.045 respectively); SSII showed a statistically significant association with in-hospital mortality and 90 days mortality and need for renal replacement therapy (P = 0.007, 0.043, 0.012 respectively); SSI is independent risk factor for overall mortality (OR 1.192, 95% CI 1.018–1.396) (P = 0.029) and MI (OR 1.182, 95% CI 1.016–1.375). Conclusions SYNTAX Scores are good predictors of short-term outcome after CABG; increased SSI was associated with increased mortalities (in-hospital and total 90 days), MI and mediastinitis, increased SSII associated with increased mortalities (in-hospital and total 90 days), and need for RRT; SSI is independent risk factor for mortality and MI.
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Affiliation(s)
- Bassem Adel Ramadan
- Faculty of Medicine, Alexandria University, Sultan Hussein Street, Al Khartoum Square, Alexandria, Egypt
| | - Mohamed Ahmed Zaki
- Faculty of Medicine, Alexandria University, Sultan Hussein Street, Al Khartoum Square, Alexandria, Egypt.
| | - Wahid Gamal El Din Etman
- Faculty of Medicine, Alexandria University, Sultan Hussein Street, Al Khartoum Square, Alexandria, Egypt
| | - Mohamed Mostafa Agha
- Faculty of Medicine, Alexandria University, Sultan Hussein Street, Al Khartoum Square, Alexandria, Egypt
| | - Mohamed Ahmed Sobhy
- Faculty of Medicine, Alexandria University, Sultan Hussein Street, Al Khartoum Square, Alexandria, Egypt
| | - Wael Mahmoud Hassanein
- Faculty of Medicine, Alexandria University, Sultan Hussein Street, Al Khartoum Square, Alexandria, Egypt
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ApPropRiateness of myOcardial revascUlarization assessed by SYNTAX Scores in patients with type 2 diabetes melliTus: the PROUST study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:153-161. [PMID: 32636899 PMCID: PMC7333192 DOI: 10.5114/aic.2020.96058] [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: 01/22/2020] [Accepted: 03/26/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction Results of currently available trials have shown divergent outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Current guidelines do not recommend PCI in patients with diabetes and a SYNTAX score ≥ 23. Aim To compare all-cause 4-year mortality after revascularization for complex coronary artery disease (CAD) in diabetics. Material and methods The study group comprised consecutive patients with three-vessel CAD and/or unprotected left main CAD (≥ 50% diameter stenosis) without major hemodynamic instability, who were treated in two institutions with PCI or referred for CABG. Results Out of 342 diabetics, 177 patients underwent PCI and 165 patients were referred for CABG. The incidence of all-cause death was different between diabetics treated with PCI or CABG at 4 years (16/177, 9.0% vs. 26/165, 15.8%, respectively, p = 0.03). The difference was not evident in non-diabetics (PCI: 41/450, 9.1% vs. CABG: 19/249, 7.6%, p = 0.173). In diabetics, there was a higher incidence of all-cause mortality in PCI patients with intermediate-high (≥ 23) SYNTAX scores compared with those with low (0-22) SYNTAX scores (10/56, 17.9% vs. 6/121, 5.0%, respectively, p < 0.01). On the other hand, diabetics who underwent CABG showed similar mortality rates irrespective of the SYNTAX scores (SYNTAX 0-22: 3/29, 10.3%; SYNTAX ≥ 23: 23/136, 11.9%, p = 0.46). In the subgroup analysis, there was no interaction according to presence or absence of left main CAD (p for interaction = 0.12) as well as according to diabetes status (p for interaction = 0.38), whereas gender and SYNTAX scores were differentiators between PCI and CABG with a p for interaction < 0.1. Conclusions Our analysis supports recent evidence that diabetes is not a differentiator between PCI and CABG.
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Chevalier B. Left Main PCI Decision: Is it Time to Move on From the Original SYNTAX Score? JACC Cardiovasc Interv 2020; 13:372-374. [PMID: 32029255 DOI: 10.1016/j.jcin.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Bernard Chevalier
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France.
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