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Aedma SK, Naik A, Kanmanthareddy A. Coronary Bifurcation Stenting: Review of Current Techniques and Evidence. Curr Cardiol Rev 2023; 19:e060422203185. [PMID: 35388761 PMCID: PMC10201883 DOI: 10.2174/1573403x18666220406113517] [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: 09/22/2021] [Revised: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Coronary bifurcation stenting constitutes 20% of all PCI performed. Given the extensive prevalence of bifurcation lesions, various techniques have sought to optimally stent the bifurcation to improve revascularization while also decreasing rates of stent thrombosis and lesion recurrence. Advanced techniques, such as planned two-stent approaches, have been shown to have improved outcomes but also require fluoroscopy and procedure time, posing an economic argument as well as a patient-outcome one. OBJECTIVE Because of the many strategies posited in the literature, it becomes essential to objectively evaluate evidence from randomized controlled trials and meta-analyses to help determine the optimal stenting strategy. METHODS We reviewed the clinical evidence on the efficacy of coronary bifurcation stenting. RESULTS In this paper, we review the most recent randomized controlled trials and meta-analyses on the efficacy of various stenting techniques and advances in stenting technologies published to gauge the current state of understanding and chart where the field is heading. CONCLUSION Bifurcation stenting is a maturing problem in the field of interventional cardiology that is adapting to the needs of the patients and advances in technology.
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Affiliation(s)
- Surya Kiran Aedma
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, 61801, USA
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, Illinois, 61820, USA
| | - Arun Kanmanthareddy
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, 68198, USA
- CHI Health Heart Institute, Omaha, Nebraska, 68124, USA
- Division of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska, 68124, USA
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Wang M, Liu H, Xu B, Bian X, Liu L, Hu F, Chen J, Gao L, Zou T, Yang Y, Qiao S. Protective ballooning technique for prevention of side branch occlusion in coronary nonleft main true bifurcation lesions: A single-center study. Catheter Cardiovasc Interv 2022; 99 Suppl 1:1418-1423. [PMID: 35120269 DOI: 10.1002/ccd.30100] [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: 12/19/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We aimed to evaluate the efficacy of a protective ballooning technique in preventing side branch (SB) occlusion and to assess the long-term clinical outcomes for coronary nonleft main true bifurcation lesions. BACKGROUND SB occlusion is a major complication associated with percutaneous coronary intervention (PCI) for coronary bifurcation lesions. METHODS Patients were consecutively enrolled and randomly assigned to protective ballooning technique or jailed wire technique group. Periprocedural and long-term clinical outcomes were compared. RESULTS Patients in the protective ballooning technique (n = 173) and jailed wire technique (n = 167) groups were followed up for 12 months. SB occlusion occurred in one patient (0.6%) and nine patients (5.4%) in each group, respectively. The proportion of thrombolysis in myocardial infarction (TIMI) flow grade 3 of the SB was higher in the protective ballooning technique group (98.8% vs. 95.2%, p < 0.05). SB rewiring was necessary in one patient in the protective ballooning technique group (0.6%) with provisional stenting, significantly lower than that in the jailed wire technique group (seven patients, 4.2%; p = 0.03). Periprocedural myocardial infarction occurred in three (1.73%) and six (3.59%) patients in the protective ballooning technique and jailed wire technique groups without significant difference, respectively. Major adverse cardiovascular events at 12 months were similar in both groups. CONCLUSIONS Protective ballooning technique is effective for the prevention of SB occlusion in nonleft main true bifurcation lesions and had favorable long-term outcomes at the 12-month follow-up.
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Affiliation(s)
- Man Wang
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haibo Liu
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bo Xu
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoli Bian
- Department of Cardiology, Jiangdu People's Hospital, Yangzhou, China
| | - Lingan Liu
- Department of Cardiology, The Second People's Hospital of An Yang, Anyang, China
| | - Fenghuan Hu
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jue Chen
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lijian Gao
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tongqiang Zou
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Qin Q, Zheng B, Liu J, Zhang B, Chen M, Li J, Huo Y. Active Versus Conventional Side Branch Protection Strategy for Coronary Bifurcation Lesions. Int Heart J 2021; 62:1241-1248. [PMID: 34789648 DOI: 10.1536/ihj.21-467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The side branch (SB) provisional stenting strategy is currently the recommended approach for most coronary bifurcation lesions. However, this strategy may result in SB deterioration, which is associated with an increased incidence of periprocedural myocardial infarction (PMI) and may adversely affect the long-term prognosis. Various techniques for SB protection (SB-P) have been developed to reduce SB occlusion and improve the clinical prognosis. This meta-analysis was performed to compare the outcomes of an active SB-P strategy of jailed balloon technique, balloon-stent kissing technique, and jailed Corsair technique versus the conventional SB-P strategy based on jailed wire technique.This meta-analysis included 5 studies (4 randomized and 1 observational) involving a total of 1,174 patients in whom the active and conventional SB-P strategies were compared. Fixed- and random-effects models were used to calculate summary risk ratios (RRs).The risk of SB occlusion was significantly lower in active SB-P strategy [RR 0.47, 95% confidence interval (CI) 0.30-0.73 in fixed-effect model; RR 0.52, 95% CI 0.31-0.87 in random-effect model]. The risk of PMI was similar between the two strategies (RR 0.63, 95% CI 0.30-1.33 in fixed-effect model; RR 0.71, 95%CI 0.20-2.48 in random-effect model). The rate of long-term major adverse cardiovascular events was similar between the groups (RR 0.48, 95% CI 0.15-1.48 in fixed-effect model; RR 0.49, 95% CI 0.16-1.52 in random-effect model).The active SB-P strategy in coronary bifurcation lesions is associated with reduced SB deterioration, but it does not decrease PMI or improve the long-term prognosis.
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Affiliation(s)
- Qiao Qin
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Bo Zheng
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Jiahui Liu
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Bin Zhang
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Ming Chen
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Jianping Li
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
| | - Yong Huo
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital
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Inflation Pressure in Side Branch during Modified Jailed Balloon Technique Does Not Affect Side Branch Outcomes. J Interv Cardiol 2021; 2021:8839897. [PMID: 33679263 PMCID: PMC7906823 DOI: 10.1155/2021/8839897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives This study aimed to investigate the optimal jailed balloon inflation in the side branch during the modified jailed balloon technique for bifurcated lesions. Background The modified jailed balloon technique is one of the effective techniques to minimize the emergence of side branch (SB) compromise by preventing plaque or carina shifting during a single stent strategy in the main vessel with provisional SB treatment. However, there are no detailed studies on the method of optimal jailed balloon inflation. Methods We analyzed 51 consecutive patients who underwent percutaneous coronary intervention (PCI) for bifurcated lesions with a modified jailed balloon technique between September 2018 and December 2020. These 51 patients were divided into two groups according to the magnitude of inflation pressure of the jailed balloon: a higher pressure (HP) group and lower pressure (LP) group. Results No significant differences in procedural outcomes were observed between the two groups. The findings of SB compromise were relatively common with our procedure (30.0% in the HP group; 33.3% in the LP group). The patterns of SB compromise such as dissection or stenosis increase were observed at similar frequencies between them. In particular, SB dissection was noted in the SB lesion with some plaque burden, irrespective of the magnitude of the jailed balloon inflation pressure. Univariate analysis showed that calcification in the main vessel and SB lesion length was significantly associated with SB compromise. Finally, all PCI procedures were successfully completed without any provisional stent deployment in SB. Conclusions We speculate that lesion characteristics rather than the PCI procedural factors may be critical determinants to cause SB compromise.
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Khan BK, Rahman MN, Tai JM, Faheem O. Jailed balloons for side branch protection: a review of techniques and literature: Jailed balloons for side branch protection. ASIAINTERVENTION 2020; 6:15-24. [PMID: 34912980 DOI: 10.4244/aij-d-19-00025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/10/2020] [Indexed: 01/27/2023]
Abstract
Coronary bifurcation lesions are commonly encountered, and side branch compromise is a major complication of these bifurcation interventions. Jailing a wire in the side branch is the most common method of significant side branch protection. Jailing a balloon in the side branch is a less well known and seldom practiced strategy of side branch preservation but tends to have lower occlusion rates as compared to conventional jailed wires. Various modifications have been applied to the original jailed balloon technique to further improve side branch patency. Complications arising from this technique have been limited to case reports only and relate mainly to calcified vessels.
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Affiliation(s)
- Bilal Kabeer Khan
- Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan
| | - Muhammad Nasir Rahman
- Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan
| | - Javed Majid Tai
- Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan
| | - Osman Faheem
- Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan
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Percutaneous Coronary Intervention for Coronary Bifurcation Lesions: Latest Evidence. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22:6. [PMID: 32034505 DOI: 10.1007/s11936-020-0806-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW This paper provides a synopsis of the best evidence to guide bifurcation percutaneous coronary intervention (PCI), with a focus on recent studies. This is with the aim of guiding the interventional cardiologist in choosing the best, evidence-based technique, to treat commonly encountered coronary bifurcations. RECENT FINDINGS Current evidence supports the use of provisional stenting for most anatomically suitable bifurcation lesions. Newer techniques for side branch protection in provisional stenting have been developed. When a two-stent strategy is required, use of a double-kissing crush technique is favoured, particularly in left main bifurcations. For bifurcation PCI, as in all complex procedures, intravascular imaging plays a key adjunctive role in improving procedural success. PCI for coronary bifurcation lesions is an ever-growing field with significant advancements in techniques and technology.
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