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Kitani S, Igarashi Y, Tsuchikane E, Nakamura S, Koshida R, Habara M, Tan M, Shimoji K, Takaya T, Kijima M. Long-Term Clinical Outcomes of Drug-Coated Balloon Following Directional Coronary Atherectomy for Bifurcated or Ostial Lesions in the DCA/DCB Registry. Catheter Cardiovasc Interv 2025; 105:273-279. [PMID: 39498812 DOI: 10.1002/ccd.31283] [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: 09/24/2024] [Revised: 10/20/2024] [Accepted: 10/22/2024] [Indexed: 11/07/2024]
Abstract
BACKGROUND The long-term efficacy of drug-coated balloon (DCB) angioplasty for large bifurcation lesions, particularly those involving the left main trunk (LMT), remains unclear. AIMS This study aimed to evaluate the long-term outcomes of directional coronary atherectomy followed by DCB (DCA/DCB) for large bifurcation lesions. METHODS This retrospective multicenter study analyzed 129 cases from the DCA/DCB registry, with 80.4% involving LMT bifurcation lesions. Building on previously reported 12-month outcomes, this study assessed long-term results. The primary endpoint was clinically driven (CD) target lesion revascularization (TLR) at 36 months. Secondary endpoints included CD target vessel revascularization (TVR); CD target vessel failure (TVF); and adverse events, such as all-cause mortality, cardiac death, target vessel acute myocardial infarction (AMI), and the need for coronary artery bypass grafting (CABG), at 24 and 36 months. RESULTS The mean follow-up was 53.4 ± 23.9 months. The CD-TLR rate was 5.0% at 24 months, and the primary endpoint was 5.9% at 36 months. CD-TVR rates were 14.0% at 24 months and 15.0% at 36 months, while CD-TVF rates were 14.9% at 24 months and 16.7% at 36 months. Adverse events included all-cause mortality rates of 0.8% at 24 months and 1.8% at 36 months, and cardiac death rates of 0.8% at both 24 and 36 months. No target vessel AMI or CABG procedures were reported. CONCLUSION The consistently low CD-TLR rate at 36 months supports the efficacy of the DCA/DCB strategy for large bifurcation lesions, including LMT, indicating its sustained effectiveness. These findings highlight the viability of this treatment approach.
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Affiliation(s)
- Shunsuke Kitani
- Department of Cardiology, Sapporo Kosei General Hospital, Hokkaido, Japan
| | - Yasumi Igarashi
- Department of Cardiology, Sapporo Kosei General Hospital, Hokkaido, Japan
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | | | - Ryoji Koshida
- Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
| | - Maoto Habara
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | - Michinao Tan
- Cardiovascular Center, Tokeidai Memorial Hospital, Hokkaido, Japan
| | - Kenichiro Shimoji
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, Hyogo, Japan
| | - Mikihiro Kijima
- Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
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Servoz C, Matta A, Bataille V, Philippe J, Laszlo L, Blanco S, Elbaz M, Bouisset F, Campelo-Parada F, Carrié D, Lhermusier T. Outcomes of Provisional Stenting With Versus Without Side Branch Intervention in Patients With Bifurcation Lesion-Related ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2023; 208:190-194. [PMID: 37871531 DOI: 10.1016/j.amjcard.2023.09.049] [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: 06/29/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/25/2023]
Abstract
To date, the best approach to coronary bifurcation lesion remains unsettled, and the parameters to guide side branch ballooning or stenting are not yet defined. This study aimed to compare the survival outcomes after provisional stenting with versus without side branch intervention. A cohort was conducted on 132 patients who underwent coronary angiography at Toulouse University Hospital for ST-segment elevation myocardial infarction with large culprit nonleft main coronary bifurcation lesion. Study participants were divided into 2 groups depending on the performance or not of a side branch intervention. We observed the living status at 1-year after hospital discharge. Side branch intervention by balloon inflation or final balloon kissing technique was performed in 34.1% of study participants. At 1-year follow-up, the incidence of all-cause mortality was 7.8 per 100 person-years (95% confidence interval [CI] 4.1 to 15), and although it seemed higher in the side branch intervention group (10 per 100 person-years [95% CI 3.8 to 26.7] vs 6.6 per 100 persons-years [95% CI 2.8 to 15.9]), the survival analyses showed no differences in survival outcomes (hazard ratio side branch intervention 1.55 [0.42 to 5.78], p = 0.513). In conclusion, in the setting of a coronary bifurcation causing ST-segment elevation myocardial infarction, simple provisional stenting without side branch intervention showed a low mortality rate and no differences in the 1-year survival outcomes.
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Affiliation(s)
- Clément Servoz
- Department of Cardiology, Toulouse University Hospital, Toulouse, France.
| | - Anthony Matta
- Department of cardiology, Civilians Hospital of Colmar, Colmar, France
| | - Vincent Bataille
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - John Philippe
- Department of cardiology, Civilians Hospital of Colmar, Colmar, France
| | - Levai Laszlo
- Department of cardiology, Civilians Hospital of Colmar, Colmar, France
| | - Stéphanie Blanco
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Frédéric Bouisset
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | | | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
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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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Bhogal S, Zhang C, Aladin AI, Mintz GS, Waksman R. Provisional Versus Dual Stenting of Left Main Coronary Artery Bifurcation Lesions (from a Comprehensive Meta-Analysis). Am J Cardiol 2022; 185:10-17. [DOI: 10.1016/j.amjcard.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/24/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022]
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Zhang Q, Huan H, Han Y, Liu H, Sun S, Wang B, Wei S. Clinical Outcomes Following Simple or Complex Stenting for Coronary Bifurcation Lesions: A Meta-Analysis. Clin Med Insights Cardiol 2022; 16:11795468221116842. [PMID: 35982991 PMCID: PMC9379967 DOI: 10.1177/11795468221116842] [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: 02/10/2022] [Accepted: 06/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Stent placement remains a challenge for coronary bifurcation lesions. While both simple and complex stenting strategies are available, it is unclear which one results in better clinical outcomes. This meta-analysis aims to explore the long-term prognosis following treatment with the 2 stenting strategies. Method Randomized controlled trials found from searches of the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were included in this meta-analysis. The complex stent placement strategy was identified as the control group, and the simple stent placement strategy was identified as the experimental group. Data were synthesized with a random effects model. The quality of the randomized controlled trials was assessed by Jadad scale scores. The clinical endpoints at 6 months, 1 year, and 5 years were analyzed. Results A total of 11 randomized controlled trials met the inclusion criteria. A total of 2494 patients were included in this meta-analysis. The odds ratio [OR] of the major adverse cardiac events (MACEs) at 6 months was 0.85 (95% confidence interval [CI] 0.53-1.35; P = .49, I 2 = 0%). The OR of the MACEs at 1 year was 0.61 (95% CI 0.36-1.05; P = .08, I 2 = 0%). The OR of the MACEs at 5 years was 0.69 (95% CI 0.51-0.92; P = .01, I 2 = 0%). Compared with the complex strategy, the simple strategy was associated with a lower incidence of MACEs at 5 years. Conclusion Compared to the complex stenting strategy, the simple stenting strategy can better reduce the occurrence of long-term MACEs for coronary bifurcation lesions.
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Affiliation(s)
- Qun Zhang
- Department of Emergency and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Hengshan Huan
- Department of Emergency and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,The Forth People's Hospital of Linyi, Linyi, Shandong, China
| | - Yu Han
- Department of Emergency and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Han Liu
- Department of Emergency and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shukun Sun
- Department of Emergency and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Bailu Wang
- Clinical Trial Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shujian Wei
- Department of Emergency and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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6
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Adachi Y, Kinoshita Y, Murata A, Kawase Y, Okubo M, Suzuki Y, Ito T, Matsuo H, Suzuki T. The importance of side branch preservation in the treatment of chronic total occlusions with bifurcation lesions. IJC HEART & VASCULATURE 2021; 36:100873. [PMID: 34568542 PMCID: PMC8449161 DOI: 10.1016/j.ijcha.2021.100873] [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: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to identify the predictive factors for suboptimal result in side branch (SB) in chronic total occlusion (CTO) bifurcation lesions and clinical outcomes of patients with suboptimal result in SB. BACKGROUND There is little evidence on the optimal strategy for bifurcation lesions in CTO. METHODS We retrospectively reviewed 314 consecutive bifurcation lesions in CTO with SB ≥ 2.5 mm in 3 hospitals from March 2010 to June 2018. Patients were divided into the two groups based on the suboptimal SB treatment (SST) and optimal SB treatment (OST) groups. The baseline characteristics, procedural and clinical outcomes were compared between the two groups. This study also evaluated the predictors of suboptimal result in SB. RESULTS Suboptimal result in SB occurred in 47 cases. Presence of stenosis in SB, bifurcations located within the occluded segment and sub-intimal tracking at SB ostium was an independent predictor of suboptimal result in SB. The cumulative incidence of target lesion revascularization (TLR) in all lesions was not significantly different between the two groups, however, TLR in right coronary artery (RCA) was significantly higher in the SST group. In the Cox regression analysis, suboptimal result in SB in RCA and sub-intimal tracking were independent predictors of TLR for MB. In patients with bifurcations located within the occluded segment, usage of two-stent technique was significantly lower in the SST group. CONCLUSIONS Meticulous procedures are required for SB preservation to improve not only SB prognosis but also MB, especially in RCA.
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Affiliation(s)
- Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
| | | | - Akira Murata
- Department of Cardiology, Nagoya Heart Center, Aichi, Japan
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Munenori Okubo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | | | - Tatsuya Ito
- Department of Cardiology, Nagoya Heart Center, Aichi, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Takahiko Suzuki
- Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
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7
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A drug-eluting Balloon for the trEatment of coronarY bifurcatiON lesions in the side branch: a prospective multicenter ranDomized (BEYOND) clinical trial in China. Chin Med J (Engl) 2021; 133:899-908. [PMID: 32265425 PMCID: PMC7176447 DOI: 10.1097/cm9.0000000000000743] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Supplemental Digital Content is available in the text Background Treatment of coronary bifurcation lesions remains challenging; a simple strategy has been preferred as of late, but the disadvantage is ostium stenosis or even occlusion of the side branch (SB). Only a few single-center studies investigating the combination of a drug-eluting stent in the main branch followed by a drug-eluting balloon in the SB have been reported. This prospective, multicenter, randomized study aimed to investigate the safety and efficacy of a paclitaxel-eluting balloon (PEB) compared with regular balloon angioplasty (BA) in the treatment of non-left main coronary artery bifurcation lesions. Methods Between December 2014 and November 2015, a total of 222 consecutive patients with bifurcation lesions were enrolled in this study at ten Chinese centers. Patients were randomly allocated at a 1:1 ratio to a PEB group (n = 113) and a BA group (n = 109). The primary efficacy endpoint was angiographic target lesion stenosis at 9 months. Secondary efficacy and safety endpoints included target lesion revascularization, target vessel revascularization, target lesion failure, major adverse cardiac and cerebral events (MACCEs), all-cause death, cardiac death, non-fatal myocardial infarction, and thrombosis in target lesions. The main analyses performed in this clinical trial included case shedding analysis, base-value equilibrium analysis, effectiveness analysis, and safety analysis. SAS version 9.4 was used for the statistical analyses. Results At the 9-month angiographic follow-up, the difference in the primary efficacy endpoint of target lesion stenosis between the PEB (28.7% ± 18.7%) and BA groups (40.0% ± 19.0%) was –11.3% (95% confidence interval: –16.3% to –6.3%, Psuperiority <0.0001) in the intention-to-treat analysis, and similar results were recorded in the per-protocol analysis, demonstrating the superiority of PEB to BA. Late lumen loss was significantly lower in the PEB group than in the BA group (–0.06 ± 0.32 vs. 0.18 ± 0.34 mm, P < 0.0001). For intention-to-treat, there were no significant differences between PEB and BA in the 9-month percentages of MACCEs (0.9% vs. 3.7%, P = 0.16) or non-fatal myocardial infarctions (0 vs. 0.9%, P = 0.49). There were no clinical events of target lesion revascularization, target vessel revascularization, target lesion failure, all-cause death, cardiac death or target lesion thrombosis in either group. Conclusions In de novo non-left main coronary artery bifurcations treated with provisional T stenting, SB dilation with the PEB group demonstrated better angiographic results than treatment with regular BA at the 9-month follow-up in terms of reduced target lesion stenosis. Trial registration ClinicalTrials.gov, NCT02325817; https://clinicaltrials.gov
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Loh PH, Lassen JF, Jepson N, Koo BK, Chen S, Harding SA, Hu F, Lo S, Ahmad WAW, Ye F, Guagliumi G, Hiremath MS, Uemura S, Wang L, Whelan A, Low A. Asia Pacific consensus document on coronary bifurcation interventions. EUROINTERVENTION 2020; 16:e706-e714. [PMID: 32250248 DOI: 10.4244/eij-d-19-00977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Coronary bifurcation intervention is common but complex. Progress in this field has been made in recent years with considerable contribution from the Asia Pacific (APAC) region. However, the standard of practice varies across the APAC region due to differences in culture, socioeconomic state and healthcare set-up. Practice may also differ from the rest of the world. Hence, a panel of experts was invited to discuss topics relevant to bifurcation intervention in order to make a concerted effort to achieve consensus that is applicable within the region and in line with available evidence.
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Affiliation(s)
- Poay Huan Loh
- National University Heart Center Singapore and National University of Singapore, Singapore
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Mohamed MO, Polad J, Hildick-Smith D, Bizeau O, Baisebenov RK, Roffi M, Íñiguez-Romo A, Chevalier B, von Birgelen C, Roguin A, Aminian A, Angioi M, Mamas MA. Impact of coronary lesion complexity in percutaneous coronary intervention: one-year outcomes from the large, multicentre e-Ultimaster registry. EUROINTERVENTION 2020; 16:603-612. [DOI: 10.4244/eij-d-20-00361] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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10
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Kitani S, Igarashi Y, Tsuchikane E, Nakamura S, Seino Y, Habara M, Takeda Y, Shimoji K, Yasaka Y, Kijima M. Efficacy of drug-coated balloon angioplasty after directional coronary atherectomy for coronary bifurcation lesions (DCA/DCB registry). Catheter Cardiovasc Interv 2020; 97:E614-E623. [PMID: 32776689 DOI: 10.1002/ccd.29185] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/27/2020] [Accepted: 07/19/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of additional drug-coated balloon (DCB) angioplasty after directional coronary atherectomy (DCA) for coronary bifurcation lesions. BACKGROUND The optimal therapy for bifurcation lesions has not been established, even in the drug-eluting stent era. DCA possibly prevents plaque and carina shift in bifurcation lesions by plaque debulking; however, the efficacy of combined DCA and DCB (DCA/DCB) for bifurcation lesions remains unclear. METHODS This multicenter registry retrospectively recruited patients with bifurcation lesions who underwent DCA/DCB and follow-up angiogram at 6-15 months. The primary endpoint was the 12-month target vessel failure (TVF) rate. The secondary endpoints were procedure-related major complications, major cardiovascular events at 12 months, restenosis at 12 months, target lesion revascularization (TLR) at 12 months, and target vessel revascularization (TVR) at 12 months. RESULTS We enrolled 129 patients from 16 Japanese centers. One hundred and four lesions (80.6%) were located around the left main trunk bifurcations. No side branch compromise was found intraoperatively. Restenosis was observed in three patients (2.3%) at 12 months. TLR occurred in four patients (3.1%): 3 (2.3%) in the main vessel and 1 (0.8%) in the ostium of the side branch at 12 months. TVF incidence at 12 months was slightly higher in 14 patients (10.9%), and only two patients (1.6%) had symptomatic TVR. One patient (0.8%) had non-target vessel-related myocardial infarction. CONCLUSIONS Our data suggested that DCA/DCB provided good clinical outcomes and minimal side branch damage and could be an optimal non-stent percutaneous coronary intervention strategy for bifurcation lesions.
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Affiliation(s)
- Shunsuke Kitani
- Department of Cardiology, Tokeidai Memorial Hospital, Hokkaido, Japan
| | - Yasumi Igarashi
- Department of Cardiology, Tokeidai Memorial Hospital, Hokkaido, Japan
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | | | - Yoshitane Seino
- Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
| | - Maoto Habara
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
| | - Yoshihiro Takeda
- Department of Cardiology, Rinku General Medical Center, Osaka, Japan
| | - Kenichiro Shimoji
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Yoshinori Yasaka
- Department of Cardiology, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Mikihiro Kijima
- Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
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Konigstein M, Kandzari DE, Smits PC, Love MP, Banai S, Golomb M, Perlman GY, Ozan MO, Liu M, Ben-Yehuda O, Stone GW. Outcomes of Patients With Coronary Arterial Bifurcation Narrowings Undergoing Provisional 1-Stent Treatment (from the BIONICS Trial). Am J Cardiol 2020; 126:8-15. [PMID: 32317100 DOI: 10.1016/j.amjcard.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
Treatment of bifurcation lesions is technically challenging and has been associated with an increased risk of adverse events. We sought to evaluate the clinical and angiographic outcomes of patients who underwent bifurcation lesion provisional treatment in the BioNIR Ridaforolimus Eluting Coronary Stent System in Coronary Stenosis trial. A prospective, multicenter, 1:1 randomized trial was conducted to evaluate the safety and efficacy of ridaforolimus-eluting stents (RES) versus zotarolimus-eluting stents (ZES). Enrollment of bifurcation lesions treated with a provisional 1-stent technique was allowed. Bifurcation lesions were analyzed by an angiographic core laboratory. Outcomes were analyzed according to the presence of a bifurcation lesion treatment. Study population included 686 (35.8%) patients with and 1,228 (64.2%) patients without bifurcation lesion treatment. Procedural success was high and similar between groups. In 2 years, there was no difference in the rate of target lesion failure between the bifurcation and nonbifurcation groups (7.6% vs 7.3%, respectively, p = 0.81) regardless of the presence of side branch stenosis ≥50%. In 159 patients with angiographic follow-up, there was no difference in the rate of binary restenosis between groups (9.0% vs 9.2%, p = 0.96). Rates of target lesion failure at 1-year were similar with ZES and RES, and consistent in patients with and without bifurcation lesions (pinteraction = 0.61). In conclusion, patients with bifurcation lesions treated and a provisional strategy experienced similar outcomes as those with nonbifurcation lesions. RES performed as well as ZES in bifurcation and nonbifurcation lesions.
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Affiliation(s)
- Maayan Konigstein
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv, Israel
| | | | - Pieter C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Michael P Love
- University of Manitoba, St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Shmuel Banai
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv, Israel
| | - Mordechai Golomb
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Gidon Y Perlman
- Hadassah Hebrew University Medical Center, Jerusalem, Israel; Medinol Ltd., Tel Aviv, Israel
| | - Melek Ozgu Ozan
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Mengdan Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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12
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Nasr B, Della Schiava N, Thaveau F, Rosset E, Favre JP, Salomon du Mont L, Alsac JM, Hassen-Khodja R, Reix T, Allaire E, Ducasse E, Soler R, Guyomarc'h B, Gouëffic Y. The Common Femoral Artery Bifurcation Lesions: Clinical Outcome of Simple Versus Complex Stenting Techniques – An Analysis Based on the TECCO Trial. Ann Vasc Surg 2020; 64:2-10. [DOI: 10.1016/j.avsg.2019.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 11/16/2022]
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13
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Kogame N, Chichareon P, De Wilder K, Takahashi K, Modolo R, Chang CC, Tomaniak M, Komiyama H, Chieffo A, Colombo A, Garg S, Louvard Y, Jüni P, G. Steg P, Hamm C, Vranckx P, Valgimigli M, Windecker S, Stoll H, Onuma Y, Janssens L, Serruys PW. Clinical relevance of ticagrelor monotherapy following 1‐month dual antiplatelet therapy after bifurcation percutaneous coronary intervention: Insight from GLOBAL LEADERS trial. Catheter Cardiovasc Interv 2019; 96:100-111. [DOI: 10.1002/ccd.28428] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Norihiro Kogame
- Department of CardiologyAmsterdam University Medical Center Amsterdam The Netherlands
- Department of CardiologyToho University medical center Ohashi hospital Tokyo Japan
| | - Ply Chichareon
- Department of CardiologyAmsterdam University Medical Center Amsterdam The Netherlands
- Faculty of Medicine, Division of Cardiology, Department of Internal MedicinePrince of Songkla University Songkhla Thailand
| | | | - Kuniaki Takahashi
- Department of CardiologyAmsterdam University Medical Center Amsterdam The Netherlands
| | - Rodrigo Modolo
- Department of CardiologyAmsterdam University Medical Center Amsterdam The Netherlands
- Cardiology Division, Department of Internal MedicineUniversity of Campinas (UNICAMP) Campinas Brazil
| | - Chun Chin Chang
- Department of Interventional CardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Mariusz Tomaniak
- Department of Interventional CardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Hidenori Komiyama
- Department of CardiologyAmsterdam University Medical Center Amsterdam The Netherlands
| | - Alaide Chieffo
- Interventional Cardiology UnitIRCCS San Raffaele Scientific Institute Milan Italy
| | - Antonio Colombo
- Interventional Cardiology UnitVilla Maria Cecila Hospital GVM Cotignola (RA) Italy
| | - Scot Garg
- Department of CardiologyRoyal Blackburn Hospital Blackburn UK
| | - Yves Louvard
- Department of CardiologyRamsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier Massy France
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital Toronto Ontario Canada
- Department of Medicine and Institute of Health Policy, Management and EvaluationUniversity of Toronto Toronto Ontario Canada
| | - Philippe G. Steg
- French Alliance for Cardiovascular Trials (FACT), Université Paris‐Diderot Paris France
| | - Christian Hamm
- Kerckhoff Heart and Thorax Center, University of Giessen Giessen Germany
| | - Pascal Vranckx
- Faculty of Medicine and Life Sciences, Jessa Ziekenhuis, the Hasselt University Hasselt Belgium
| | - Marco Valgimigli
- Department of CardiologyInselspital, University of Bern Bern Switzerland
| | - Stephan Windecker
- Department of CardiologyInselspital, University of Bern Bern Switzerland
| | | | - Yoshinobu Onuma
- Department of Interventional CardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Luc Janssens
- Heart CentreImelda Hospital Bonheiden Bonheiden Belgium
| | - Patrick W. Serruys
- International Centre for Circulatory Health, Imperial College London London UK
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14
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Konigstein M, Srdanovic I, Gore AK, Rahim HM, Généreux P, Ben-Yehuda O, Kumsars I, Lesiak M, Kini A, Fontos G, Slagboom T, Ungi I, Christopher Metzger D, Crowley A, Leon MB, Ali ZA. Outcomes of the Tryton-dedicated bifurcation stent for the treatment of true coronary bifurcations: Individual-patient-data pooled analysis. Catheter Cardiovasc Interv 2019; 93:1255-1261. [PMID: 30489011 DOI: 10.1002/ccd.27952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/11/2018] [Accepted: 10/08/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We aimed to evaluate the safety and efficacy of the dedicated Tryton side branch (SB) stent for the treatment of true bifurcations involving large SBs. BACKGROUND Bifurcation lesions are associated with lower procedural success and a higher risk of adverse cardiac events. Provisional stenting (PS) is currently the default approach for the treatment of bifurcation lesions. The Tryton stent is a dedicated bifurcation stent system for the treatment of true bifurcation lesions. METHODS We performed an individual-patient-data pooled post-hoc analysis of the Tryton Pivotal randomized controlled trial and post-approval Confirmatory Study. Only patients with true bifurcations involving a SB ≥ 2.25 mm in diameter were included. The primary endpoint was non-inferiority of Tryton compared with PS for target vessel failure (TVF) at 1 year. RESULTS Of the 411 patients meeting the criteria for enrolment, 287 patients were treated with the Tryton stent and 124 with PS. Procedural success was higher in the Tryton group (95.4 versus 82.3%, P < 0.0001). TVF at 1 year was 8.1% in the Tryton group and 9.7% in the PS group, meeting the pre-specified criteria for non-inferiority established for the randomized controlled trail (pnon-inferiority = 0.02). At 9-month angiographic follow-up, SB diameter stenosis was significantly lower in the Tryton group (29.3 ± 21.9 versus 41.1 ± 17.5, P = 0.0008) and in-segment binary restenosis (diameter stenosis ≥ 50%) was higher in the PS group (19.0 versus 34.2%, respectively, P = 0.052). CONCLUSIONS In patients with true bifurcations involving a large SB, treatment with the Tryton SD Stent was clinically non-inferior to PS and showed favorable angiographic outcomes.
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Affiliation(s)
- Maayan Konigstein
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Iva Srdanovic
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Ankita K Gore
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Hussein M Rahim
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.,Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey.,Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Indulis Kumsars
- Latvian Center of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland
| | | | - Géza Fontos
- Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | - Ton Slagboom
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Imre Ungi
- 2nd Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | | | - Aaron Crowley
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
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15
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Impacto de la revascularización coronaria percutánea de lesiones coronarias graves en ramas secundarias. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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16
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Cano-García M, Millán-Gómez M, Sánchez-González C, Alonso-Briales JH, Muñoz-Jiménez LD, Carrasco-Chinchilla F, Domínguez-Franco A, Muñoz-García AJ, Bullones-Ramírez JA, Álvarez-Rubiera JM, de Mora-Martín M, de Teresa-Galván E, Hernández-García JM, Urbano-Carrillo CA, Jiménez-Navarro MF. Impact of Percutaneous Coronary Revascularization of Severe Coronary Lesions on Secondary Branches. ACTA ACUST UNITED AC 2018; 72:456-465. [PMID: 29859894 DOI: 10.1016/j.rec.2018.04.011] [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] [Received: 12/17/2017] [Accepted: 04/10/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES To analyze the percutaneous revascularization strategy for severe lesions in the secondary branches (SB) (diameter ≥ 2mm) of major epicardial arteries compared with conservative treatment. METHODS This study analyzed patients with severe SB lesions who underwent percutaneous revascularization treatment compared with patients who received pharmacological treatment. The study examined the percentage of branch-related events (cardiovascular death, myocardial infarction attributable to SB, or the need for revascularization of the SB). RESULTS We analyzed 679 SB lesions (662 patients). After a mean follow-up of 22.2±10.5 months, there were no significant differences between the 2 treatment groups regarding the percentage of death from cardiovascular causes (1.7% vs 0.4%; P=.14), nonfatal acute myocardial infarction (AMI) (1.7% vs 1.7%; P=.96), the need for SB revascularization (4.1% vs 5.4%; P=.45) or in the total percentage of events (5.1% vs 6.3%; P=.54). The variables showing an association with event occurrence on multivariate analysis were diabetes (SHR, 2.87; 95%CI, 1.37-5.47; P=.004), prior AMI (SHR, 3.54; 95%CI, 1.77-7.30; P<.0001), SB reference diameter (SHR, 0.16; 95%CI, 0.03-0.97; P=.047), and lesion length (SHR, 3.77; 95%CI, 1.03-1.13; P<.0001). These results remained the same after the propensity score analysis. CONCLUSIONS The percentage of SB-related events during follow-up is low, with no significant differences between the 2 treatment strategies. The variables associated with event occurrence in the multivariate analysis were the presence of diabetes mellitus, prior AMI, and greater lesion length.
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Affiliation(s)
- Macarena Cano-García
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Mercedes Millán-Gómez
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Carlos Sánchez-González
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Juan H Alonso-Briales
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Luz D Muñoz-Jiménez
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Fernando Carrasco-Chinchilla
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Antonio Domínguez-Franco
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Antonio J Muñoz-García
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Juan A Bullones-Ramírez
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jesús M Álvarez-Rubiera
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Manuel de Mora-Martín
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Eduardo de Teresa-Galván
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - José M Hernández-García
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | - Cristóbal A Urbano-Carrillo
- Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Manuel F Jiménez-Navarro
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain.
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17
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Ojeda S, Azzalini L, Chavarría J, Serra A, Hidalgo F, Benincasa S, Gheorghe LL, Diletti R, Romero M, Bellini B, Gutiérrez A, Suárez de Lezo J, Mazuelos F, Segura J, Carlino M, Colombo A, Pan M. Uno frente a 2 stents para el tratamiento de lesiones en bifurcación en el contexto de una oclusión coronaria crónica total. Registro multicéntrico. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Lassen J, Burzotta F, Banning A, Lefèvre T, Darremont O, Hildick-Smith D, Chieffo A, Pan M, Holm N, Louvard Y, Stankovic G. Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. EUROINTERVENTION 2018; 13:1540-1553. [DOI: 10.4244/eij-d-17-00622] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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19
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Zhou Y, Chen S, Huang L, Hildick-Smith D, Ferenc M, Jabbour RJ, Azzalini L, Colombo A, Chieffo A, Zhao X. Definite stent thrombosis after drug-eluting stent implantation in coronary bifurcation lesions: A meta-analysis of 3,107 patients from 14 randomized trials. Catheter Cardiovasc Interv 2017; 92:680-691. [PMID: 29214736 DOI: 10.1002/ccd.27443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/06/2017] [Accepted: 11/11/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Yu Zhou
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
| | - Shengda Chen
- State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University; China
- IBiTech, bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT Department; Ghent University; De Pintelaan Ghent Belgium
| | - Lan Huang
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
| | - David Hildick-Smith
- Sussex Cardiac Centre; Brighton and Sussex University Hospitals; Brighton United Kingdom
| | - Miroslaw Ferenc
- The Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen, Suedring 15, Bad Krozingen; Germany
| | | | | | | | - Alaide Chieffo
- Cardiology Department; San Raffaele Hospital; Milan Italy
| | - Xiaohui Zhao
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
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20
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Ojeda S, Azzalini L, Chavarría J, Serra A, Hidalgo F, Benincasa S, Gheorghe LL, Diletti R, Romero M, Bellini B, Gutiérrez A, Suárez de Lezo J, Mazuelos F, Segura J, Carlino M, Colombo A, Pan M. One Versus 2-stent Strategy for the Treatment of Bifurcation Lesions in the Context of a Coronary Chronic Total Occlusion. A Multicenter Registry. ACTA ACUST UNITED AC 2017; 71:432-439. [PMID: 29128364 DOI: 10.1016/j.rec.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/02/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is little evidence on the optimal strategy for bifurcation lesions in the context of a coronary chronic total occlusion (CTO). This study compared the procedural and mid-term outcomes of patients with bifurcation lesions in CTO treated with provisional stenting vs 2-stent techniques in a multicenter registry. METHODS Between January 2012 and June 2016, 922 CTO were recanalized at the 4 participating centers. Of these, 238 (25.8%) with a bifurcation lesion (side branch ≥ 2mm located proximally, distally, or within the occluded segment) were treated by a simple approach (n=201) or complex strategy (n=37). Propensity score matching was performed to account for selection bias between the 2 groups. Major adverse cardiac events (MACE) consisted of a composite of cardiac death, myocardial infarction, and clinically-driven target lesion revascularization. RESULTS Angiographic and procedural success were similar in the simple and complex groups (94.5% vs 97.3%; P=.48 and 85.6% vs 81.1%; P=.49). However, contrast volume, radiation dose, and fluoroscopy time were lower with the simple approach. At follow-up (25 months), the MACE rate was 8% in the simple and 10.8% in the complex group (P=.58). There was a trend toward a lower MACE-free survival in the complex group (80.1% vs 69.8%; P=.08). After propensity analysis, there were no differences between the groups regarding immediate and follow-up results. CONCLUSIONS Bifurcation lesions in CTO can be approached similarly to regular bifurcation lesions, for which provisional stenting is considered the technique of choice. After propensity score matching, there were no differences in procedural or mid-term clinical outcomes between the simple and complex strategies.
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Affiliation(s)
- Soledad Ojeda
- Unidad de Cardiología Intervencionista, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides para la Investigación en Biomedicina de Córdoba (IMIBIC), Córdoba, Spain.
| | - Lorenzo Azzalini
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Jorge Chavarría
- Unidad de Cardiología Intervencionista, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides para la Investigación en Biomedicina de Córdoba (IMIBIC), Córdoba, Spain
| | - Antonio Serra
- Unidad de Cardiología Intervencionista, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francisco Hidalgo
- Unidad de Cardiología Intervencionista, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides para la Investigación en Biomedicina de Córdoba (IMIBIC), Córdoba, Spain
| | - Susanna Benincasa
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Livia L Gheorghe
- Unidad de Cardiología Intervencionista, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Miguel Romero
- Unidad de Cardiología Intervencionista, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides para la Investigación en Biomedicina de Córdoba (IMIBIC), Córdoba, Spain
| | - Barbara Bellini
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Javier Suárez de Lezo
- Unidad de Cardiología Intervencionista, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides para la Investigación en Biomedicina de Córdoba (IMIBIC), Córdoba, Spain
| | - Francisco Mazuelos
- Unidad de Cardiología Intervencionista, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides para la Investigación en Biomedicina de Córdoba (IMIBIC), Córdoba, Spain
| | - José Segura
- Unidad de Cardiología Intervencionista, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides para la Investigación en Biomedicina de Córdoba (IMIBIC), Córdoba, Spain
| | - Mauro Carlino
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Manuel Pan
- Unidad de Cardiología Intervencionista, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides para la Investigación en Biomedicina de Córdoba (IMIBIC), Córdoba, Spain
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Nairooz R, Saad M, Elgendy IY, Mahmoud AN, Habash F, Sardar P, Anderson D, Shavelle DM, Abbott JD. Long-term outcomes of provisional stenting compared with a two-stent strategy for bifurcation lesions: a meta-analysis of randomised trials. Heart 2017; 103:1427-1434. [PMID: 28314731 DOI: 10.1136/heartjnl-2016-310929] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 01/17/2023] Open
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Abstract
Surgical endarterectomy has long been the standard approach for treating atherosclerotic stenosis in the common femoral artery. Its major advantage is the associated long-term patency, which approaches 95% at 5 years. Nevertheless, recent studies have suggested that percutaneous treatment may be a valid alternative to surgery.
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23
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Ojeda S, Pan M, Gutiérrez A, Romero M, Chavarría J, de Lezo JS, Mazuelos F, Pardo L, Hidalgo F, Carrasco F, Segura J, Durán E, Ferreiro C, Sánchez JJ, Rodríguez S, Oneto J, de Lezo JS. Bifurcation lesions involved in the recanalization process of coronary chronic total occlusions: Incidence, treatment and clinical implications. Int J Cardiol 2016; 230:432-438. [PMID: 28041711 DOI: 10.1016/j.ijcard.2016.12.088] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/20/2016] [Accepted: 12/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The presence of a bifurcation (BL) in the context of a coronary chronic total occlusion (CTO) represents an additional difficulty. This study analyzes the incidence of BLs in CTO recanalization, the treatment, predictors of bifurcation technical success and their clinical impact. METHODS AND RESULTS BLs with a side branch (SB) ≥2.0mm located proximally, distally or within the occluded segment were observed in 130 (33%) of 391 CTO. Provisional stenting was the strategy more frequently used (94%). Bifurcation success (stenosis <30% in main vessel and TIMI flow III in both branches) was achieved in 105 patients (81%). In the remaining 25 (19%), the TIMI flow at the SB was <III. Predictors of bifurcation success were baseline SB wiring (OR 0.01, 95% CI: 0.001-0.09; p<0.01), the absence of dissection across the bifurcation (OR 0.10, 95% CI: 0.02-0.49; p<0.01) and non-true BLs (OR 0.16, 95% CI: 0.04-0.68; p<0.05). Regarding in-hospital results, patients with final TIMI flow <III at the SB had a higher incidence of periprocedural MI (32% vs 4.8%; p<0.01). Subsequently, the rate of MI was higher in patients with CTO-BLs than in those without BLs. At follow-up, there were no differences in the event rate between CTO-BLs and non CTO-BLs (7.7% vs 9.5%, p=ns) CONCLUSIONS: BLs in CTO is a frequent finding and could be approached as regular bifurcations. The primary success was low and this was associated with a higher incidence of periprocedural MI. Baseline SB wiring was a powerful predictor of technical success.
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Affiliation(s)
- Soledad Ojeda
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
| | - Manuel Pan
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | | | - Miguel Romero
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Jorge Chavarría
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Javier Suárez de Lezo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Francisco Mazuelos
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Laura Pardo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Francisco Hidalgo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Francisco Carrasco
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - José Segura
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Enrique Durán
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Carlos Ferreiro
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - José J Sánchez
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Sara Rodríguez
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
| | - Jesús Oneto
- Jerez Hospital, Department of Cardiology, Jerez de la Frontera, Spain
| | - Jose Suárez de Lezo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain
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24
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Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, Interventional Cardiology Unit, San Giovanni Evangelista Hospital, Via A. Parrozzani 3, 00019 Tivoli, Rome, Italy
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25
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Computational replication of the patient-specific stenting procedure for coronary artery bifurcations: From OCT and CT imaging to structural and hemodynamics analyses. J Biomech 2016; 49:2102-2111. [DOI: 10.1016/j.jbiomech.2015.11.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/21/2015] [Indexed: 01/26/2023]
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26
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Everolimus-eluting bioresorbable scaffold implantation for the treatment of bifurcation lesions — Implications from early clinical experience during daily practice. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:313-7. [DOI: 10.1016/j.carrev.2016.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/11/2016] [Indexed: 11/22/2022]
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27
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Abstract
This article summarizes treatment alternatives for coronary bifurcation lesions. It also reviews current definitions and classifications pertaining to bifurcation lesions and provides an overview of the impact of bifurcation lesions on clinical outcomes.
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Affiliation(s)
- Björn Redfors
- Clinical Trial Center, Cardiovascular Research Foundation, 111 East 59th Street, New York, NY 10022, USA; Department of Cardiology, Sahlgrenska University Hospital, Bruna Straket 16, 413 45 Gothenburg, Sweden
| | - Philippe Généreux
- Clinical Trial Center, Cardiovascular Research Foundation, 111 East 59th Street, New York, NY 10022, USA; Department of Cardiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400, boul. Gouin Ouest, Montréal, Québec H4J 1C5, Canada.
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28
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Arokiaraj MC, De Santis G, De Beule M, Palacios IF. A Novel Tram Stent Method in the Treatment of Coronary Bifurcation Lesions - Finite Element Study. PLoS One 2016; 11:e0149838. [PMID: 26937643 PMCID: PMC4777498 DOI: 10.1371/journal.pone.0149838] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 02/06/2016] [Indexed: 12/27/2022] Open
Abstract
A novel stent was designed for the treatment of coronary bifurcation lesion, and it was investigated for its performance by finite element analysis. This study was performed in search of a novel method of treatment of bifurcation lesion with provisional stenting. A bifurcation model was created with the proximal vessel of 3.2 mm diameter, and the distal vessel after the side branch (2.3 mm) was 2.7 mm. A novel stent was designed with connection links that had a profile of a tram. Laser cutting and shape setting of the stent was performed, and thereafter it was crimped and deployed over a balloon. The contact pressure, stresses on the arterial wall, stresses on the stent, the maximal principal log strain of the main artery and the side-branch were studied. The study was performed in Abaqus, Simulia. The stresses on the main branch and the distal branch were minimally increased after deployment of this novel stent. The side branch was preserved, and the stresses on the side branch were lesser; and at the confluence of bifurcation on either side of the side branch origin the von-Mises stress was marginally increased. The stresses and strain at the bifurcation were significantly lesser than the stresses and strain of the currently existing techniques used in the treatment of bifurcation lesions though the study was primarily focused only on the utility of the new technology. There is a potential for a novel Tram-stent method in the treatment of coronary bifurcation lesions.
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Affiliation(s)
- Mark C. Arokiaraj
- Cardiology, Pondicherry Institute of Medical Sciences, Pondicherry, India
- * E-mail:
| | | | | | - Igor F. Palacios
- Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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29
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Song YB, Park TK, Hahn JY, Yang JH, Choi JH, Choi SH, Lee SH, Gwon HC. Optimal Strategy for Provisional Side Branch Intervention in Coronary Bifurcation Lesions. JACC Cardiovasc Interv 2016; 9:517-26. [DOI: 10.1016/j.jcin.2015.11.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/14/2015] [Accepted: 11/19/2015] [Indexed: 12/22/2022]
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30
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Lee JM, Park KW, Koo BK, Kim HS. Stenting of coronary bifurcation lesions: a literature and technical review. Curr Cardiol Rep 2016; 17:45. [PMID: 25929543 DOI: 10.1007/s11886-015-0595-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Newer generation drug-eluting stents have improved outcomes in various subsets of coronary lesions including bifurcation lesions. This article reviews the current literature on various issues in bifurcation percutaneous coronary intervention (PCI). Generally, the provisional approach of placing one stent in the main vessel is the preferred first-line treatment for most bifurcation lesions. However, some lesions require 2-stenting. It is unknown whether 2nd-generation DES have improved outcomes with 2-stenting. The use of fractional flow reserve (FFR) for the assessment of functional significance of the jailed side branch can help avoid unnecessary stenting in complex lesions. Skilled techniques in every step of the 2-stenting process and meticulous use of imaging techniques including IVUS or OCT are warranted to obtain optimal angiographic and clinical results. Dedicated bifurcation stents are feasible treatment options and may change future concepts in bifurcation PCI, although larger trials with control groups are required in order to widely apply these techniques into daily routine practice.
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Affiliation(s)
- Joo Myung Lee
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 DaeHak-Ro, JongRo-Gu, Seoul, 110-744, South Korea
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31
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Dai Y, Takagi A, Konishi H, Miyazaki T, Masuda H, Shimada K, Miyauchi K, Daida H. Long-term outcomes of rotational atherectomy in coronary bifurcation lesions. Exp Ther Med 2015; 10:2375-2383. [PMID: 26668644 DOI: 10.3892/etm.2015.2817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 07/23/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to determine the long-term outcomes of bifurcation lesions following a rotational atherectomy (ROTA). In this retrospective study, patients that had undergone a ROTA of the bifurcation coronary lesions in Juntendo University Hospital (Tokyo, Japan) were enrolled between January 2007 and December 2009, and received follow-up for a median duration of 48 months (range, 12-84 months). A total of 337 patients were enrolled. Each patient was treated with an average of 1.2±0.4 ROTA burrs (mean size, 2.9±0.3 mm). Baseline lesion length, reference diameter, minimal lumen diameter (MLD) and percentage of diameter stenosis (%DS) prior to the procedure were comparable between the DM and non-DM patients. Furthermore, MLD, %DS and acute gain following the procedure were similar between the two groups. At follow-up, DM patients exhibited a significantly decreased MLD (1.97±0.92 vs. 2.26±0.73 mm; P=0.0038), increased %DS (27.9±21.3 vs. 20.2±13.3%; P=0.022) and late loss (0.70±0.45 vs. 0.42±0.36 mm; P=0.0047) compared with the non-DM patients. Follow-up examinations (mean duration, 52.2±19.4 months) revealed that the DM patients experienced significantly higher rates of target lesion revascularization (TLR) [28 (15.7%) vs. 8 (5.0%); P=0.0011], target lesion (TL) restenosis [46 (25.8%) vs. 20 (12.6%); P=0.0019] and major adverse cardiac events (MACE) [36 (20.2%) vs. 19 (12.0%), P=0.039] compared with the non-DM patients. Although the usage of ROTA and drug-eluting stent evidently improved long-term outcomes in patients with bifurcation lesions, DM remained an independent risk factor for TLR, TL restenosis and MACE. Therefore, the management of DM in bifurcation lesions treated with ROTA requires increased investigation in future clinical practice.
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Affiliation(s)
- Yuxiang Dai
- Department of Cardiology, Juntendo University Hospital, Tokyo 113-8421, Japan ; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Atsutoshi Takagi
- Department of Cardiology, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Hakuoh Konishi
- Department of Cardiology, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Tetsuro Miyazaki
- Department of Cardiology, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Hiroshi Masuda
- Department of Cardiology, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Kazunori Shimada
- Department of Cardiology, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University Hospital, Tokyo 113-8421, Japan
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Naito R, Miyauchi K, Konishi H, Tsuboi S, Okazaki S, Daida H. Early definite stent thrombosis with everolimus‐eluting stents. Clin Case Rep 2015; 3:854-7. [PMID: 26509023 PMCID: PMC4614656 DOI: 10.1002/ccr3.364] [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: 07/13/2015] [Revised: 07/31/2015] [Accepted: 08/08/2015] [Indexed: 11/08/2022] Open
Abstract
Stent thrombosis (ST) is a serious complication of percutaneous coronary intervention. Several factors are associated with ST, and combination of these factors increase the risk, even in everolimus-eluting stents, which have low risk of ST. We experienced a case of ST caused by limited coronary flow and resistance to antiplatelet agent.
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Affiliation(s)
- Ryo Naito
- Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hirokazu Konishi
- Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Shuta Tsuboi
- Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
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33
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Lee JM, Hahn JY, Kang J, Park KW, Chun WJ, Rha SW, Yu CW, Jeong JO, Jeong MH, Yoon JH, Jang Y, Tahk SJ, Gwon HC, Koo BK, Kim HS. Differential Prognostic Effect Between First- and Second-Generation Drug-Eluting Stents in Coronary Bifurcation Lesions: Patient-Level Analysis of the Korean Bifurcation Pooled Cohorts. JACC Cardiovasc Interv 2015; 8:1318-1331. [PMID: 26315734 DOI: 10.1016/j.jcin.2015.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 04/28/2015] [Accepted: 05/07/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the differential clinical outcomes after percutaneous coronary intervention (PCI) for coronary bifurcation lesions with 1- or 2-stenting techniques using first- or second-generation drug-eluting stents (DES). BACKGROUND The 2-stenting technique has been regarded to have worse clinical outcomes than the 1-stenting technique after bifurcation PCI with first-generation DES. However, there has been a paucity of data comparing the 1- and 2-stenting techniques with the use of second-generation DES. METHODS Patient-level pooled analysis was performed with 3,162 patients undergoing PCI using first- or second-generation DES for bifurcation lesions from the "Korean Bifurcation Pooled Cohorts" (COBIS [Coronary Bifurcation Stenting] II, EXCELLENT [Registry to Evaluate Efficacy of Xience/Promus Versus Cypher in Reducing Late Loss After Stenting], and RESOLUTE-Korea [Registry to Evaluate the Efficacy of Zotarolimus-Eluting Stent]). The 3-year clinical outcomes were compared between 1- and 2-stenting techniques, stratified by the type of DES. RESULTS With first-generation DES, rates of target lesion failure (TLF) or patient-oriented composite outcome (POCO) (a composite of all death, any myocardial infarction, any repeat revascularization, and cerebrovascular accidents) at 3 years were significantly higher after the 2-stenting than the 1-stenting technique (TLF 8.6% vs. 17.5%; p < 0.001; POCO 18.1% vs. 28.5%, p < 0.001). With second-generation DES, however, there was no difference between 1- and 2-stenting techniques (TLF 5.4% vs. 5.8%; p = 0.768; POCO 11.2% vs. 12.9%; p = 0.995). The differential effects of 2-stenting technique on the prognosis according to the type of DES were also corroborated with similar results by the inverse probability weighted model. The 2-stenting technique was a significant independent predictor of TLF in first-generation DES (hazard ratio: 2.046; 95% confidence interval: 1.114 to 3.759; p < 0.001), but not in second-generation DES (hazard ratio: 0.667; 95% confidence interval: 0.247 to 1.802; p = 0.425). CONCLUSIONS Patient-level pooled analysis of 3,162 patients in Korean Bifurcation Pooled Cohorts demonstrated that the 2-stenting technique showed comparable outcomes to 1-stenting technique with second-generation DES, which is different from the results of first-generation DES favoring the 1-stenting technique.
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Affiliation(s)
- Joo Myung Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Jung Chun
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seung Woon Rha
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Myung-Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jung Han Yoon
- Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yangsoo Jang
- Yonsei University Severance Hospital, Seoul, Republic of Korea
| | | | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
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Darremont O, Leymarie JL, Lefèvre T, Albiero R, Mortier P, Louvard Y. Technical aspects of the provisional side branch stenting strategy. EUROINTERVENTION 2015; 11 Suppl V:V86-90. [DOI: 10.4244/eijv11sva19] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Sakata K, Koo BK, Waseda K, Nakatani D, Yock PG, Whitbourn R, Worthley SG, Ormiston J, Webster M, Wilkins GT, Honda Y, Meredith IT, Fitzgerald PJ. A Y-shaped bifurcation-dedicated stent for the treatment of de novo coronary bifurcation lesions: an IVUS analysis from the BRANCH trial. EUROINTERVENTION 2015; 10:e1-8. [PMID: 25169593 DOI: 10.4244/eijy14m08_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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 IVUS substudy was to assess the efficacy of the Y-shaped Medtronic bifurcation-dedicated stent (BDS) for the treatment of de novo coronary bifurcated lesions. METHODS AND RESULTS In the BRANCH trial, post-procedure IVUS was performed in 45 patients. IVUS was available in both branches in 19 lesions and only the main branch (MB) in 26 lesions. IVUS analysis included four distinct locations: proximal MB, bifurcation site, distal MB, and side branch (SB). Lumen symmetry was calculated as minimum/maximum lumen diameters. The quantity of isolated stent struts across the SB ostium was used to assess inadequate strut apposition to the carina resulting in partial jailing of the SB orifice. A minimum stent area (MSA) <4 mm2 was found in 0% of proximal and distal MB, and in 15.4% of SB. In SB, MSA was located mainly at mid or distal segments (84.6%), rather than at the SB ostium. Eccentric stent expansion and edge dissection were seen primarily at proximal MB. Isolated struts were seen in only 20.9% of SB ostia with a minimum length of 0.7±0.4 mm. CONCLUSIONS Implantation of BDS resulted in adequate stent dimensions and strut apposition at the carina and SB ostium. ClinicalTrials.gov Identifier: NCT00607321.
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Affiliation(s)
- Kenji Sakata
- Stanford University Medical Center, Stanford, CA, USA
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36
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Fan L, Chen L, Luo Y, Zhang L, Zhong W, Lin C, Chen Z, Peng Y, Zhen X, Dong X. DK mini-culotte stenting in the treatment of true coronary bifurcation lesions: a propensity score matching comparison with T-provisional stenting. Heart Vessels 2014; 31:308-21. [DOI: 10.1007/s00380-014-0611-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/01/2014] [Indexed: 12/28/2022]
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37
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Pan M, Medina A, Romero M, Ojeda S, Martin P, Suarez de Lezo J, Segura J, Mazuelos F, Novoa J, Suarez de Lezo J. Assessment of side branch predilation before a provisional T-stent strategy for bifurcation lesions. A randomized trial. Am Heart J 2014; 168:374-80. [PMID: 25173550 DOI: 10.1016/j.ahj.2014.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/19/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND A simple approach is the predominant strategy for the percutaneous coronary intervention of bifurcation lesions. Performing side branch (SB) predilation in this context is currently a matter of controversy. In this study, we assess the efficacy of SB predilatation before a provisional T-stent strategy for bifurcation lesions. METHODS Between February 2009 and November 2012, 372 patients with true bifurcation lesions were randomized to either predilation of the SB (n = 187) or no predilatation (n = 185) before main branch (MB) stent implantation and a subsequent SB provisional stent strategy. RESULTS There were no significant differences between the patient groups regarding the baseline characteristics. After MB stent implantation, the TIMI flow of the SB was higher in the patients with SB predilation: TIMI flow 0 to 1; 2 (1%) versus 18 (10%), P < .001; and TIMI flow III; 179 (96%) versus 152 (82%), P < .001. Side branch stenting rates were 4% versus 3%, P = not significant. In addition, 60 patients (32%) from the SB predilation group presented SB residual stenosis by visual inspection <50%, and TIMI flow ≥III did not require any additional treatment. The failure rate of SB rewiring, the time of rewiring, the number of wires used, and the incidence of major events were similar in both groups of patients. CONCLUSIONS Predilation of the SB resulted in improved TIMI flow after MB stenting and less indication to subsequently treat the SB. If rewiring of the SB is required, predilation did not hinder this maneuver.
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Affiliation(s)
- Manuel Pan
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain.
| | - Alfonso Medina
- Dr Negrin Hospital, Department of Cardiology, University of Las Palmas, Las Palmas de Gran Canaria, Spain
| | - Miguel Romero
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
| | - Soledad Ojeda
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
| | - Pedro Martin
- Dr Negrin Hospital, Department of Cardiology, University of Las Palmas, Las Palmas de Gran Canaria, Spain
| | - Javier Suarez de Lezo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
| | - Jose Segura
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
| | - Francisco Mazuelos
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
| | - Jose Novoa
- Dr Negrin Hospital, Department of Cardiology, University of Las Palmas, Las Palmas de Gran Canaria, Spain
| | - Jose Suarez de Lezo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
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Gao XF, Zhang YJ, Tian NL, Wu W, Li MH, Bourantas CV, Jiang XM, Wang ZM, Li B, Mao WX, Zhang JJ, Chen SL. Stenting strategy for coronary artery bifurcation with drug-eluting stents: a meta-analysis of nine randomised trials and systematic review. EUROINTERVENTION 2014; 10:561-9. [PMID: 24970736 DOI: 10.4244/eijy14m06_06] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The present study sought to compare angiographic and clinical outcomes of a simple strategy versus a complex strategy in patients with coronary bifurcation lesions undergoing drug-eluting stent implantation. METHODS AND RESULTS Medline, the Cochrane Library, and other internet sources were searched for randomised trials comparing simple strategy versus complex strategy for treating patients with bifurcation lesions. Nine eligible randomised trials including 2,569 patients were identified. The meta-analysis showed that cardiac death (odds ratio [OR]: 0.99, 95% confidence interval [CI]: 0.40- 2.41, p=0.98) and stent thrombosis (OR: 0.64, 95% CI: 0.31-1.34, p=0.24) were similar in the simple and the complex strategy. Compared with the complex strategy, the simple strategy was associated with a reduced risk of either early or follow-up myocardial infarction (OR: 0.53, 95% CI: 0.36-0.79, p=0.002; OR: 0.60, 95% CI: 0.43-0.86, p=0.01, respectively). The overall risks of side branch restenosis (OR: 1.44, 95% CI: 0.73-2.87, p=0.30), target lesion (OR: 1.72, 95% CI: 0.95-3.12, p=0.07) and target vessel revascularisation (OR: 1.59, 95% CI: 0.94-2.69, p=0.09) were comparable between the two groups. In the true bifurcation, with large side branches, and DK-crush subgroups, there were higher rates of reintervention seen in the simple strategy than in the complex strategy. CONCLUSIONS A complex strategy remains an optional treatment for patients with coronary bifurcation lesions without severe safety concerns. A complex strategy may be an optimal treatment for true bifurcation lesions with large side branches.
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Affiliation(s)
- Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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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: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Estrada JR, Paul JD, Shah AP, Nathan S. Overview of Technical and Cost Considerations in Complex Percutaneous Coronary Intervention. Interv Cardiol 2014; 9:17-22. [PMID: 29588772 PMCID: PMC5808630 DOI: 10.15420/icr.2011.9.1.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/23/2014] [Indexed: 11/04/2022] Open
Abstract
Complex percutaneous coronary intervention (PCI), encompassing an ever-expanding range of challenging lesion sets and patient populations, accounts for a significant proportion of PCI procedures being performed currently. Specific lesion types associated with lower rates of procedural success and higher rates of recurrence or major adverse cardiac events (MACE) include multivessel disease, unprotected left main coronary artery disease, fibrocalcific or undilatable lesions, chronic total occlusions, degenerated saphenous vein graft lesions, thrombotic lesions, and bifurcation disease. Validated tools and technical strategies currently exist to address most procedural scenarios encountered and should be familiar to the complex PCI operator. Anticipated clinical outcomes, projected resource utilization, and cost considerations should all factor into the decisions of when, how, and in whom to intervene.
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Affiliation(s)
- J Raider Estrada
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
| | - Jonathan D Paul
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
| | - Atman P Shah
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
| | - Sandeep Nathan
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
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Late Thrombosis After Double Versus Single Drug-Eluting Stent in the Treatment of Coronary Bifurcations. JACC Cardiovasc Interv 2013; 6:687-95. [DOI: 10.1016/j.jcin.2013.03.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/06/2013] [Accepted: 03/15/2013] [Indexed: 12/19/2022]
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Coronary computed tomography angiography in planning of percutaneous coronary interventions in bifurcation lesions - study design and rationale. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2013; 9:155-9. [PMID: 24570709 PMCID: PMC3915972 DOI: 10.5114/pwki.2013.35451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/15/2013] [Accepted: 04/22/2013] [Indexed: 01/14/2023] Open
Abstract
Percutaneous treatment of coronary bifurcations is a complex issue due to numerous possible techniques and high risk of complications. Because of increasing interest in non-invasive imaging in interventional cardiology and growing quality of obtained images, we designed a prospective, randomized, single-blinded trial to evaluate the role of coronary computed tomography angiography (CCTA) in the planning of percutaneous coronary interventions (PCI) of bifurcation lesions. Eighty eligible patients scheduled for PCI of bifurcations in stable coronary artery disease will undergo additional CCTA examination and will be randomized 1: 1 to either planning of PCI using angiography and CCTA or to PCI planning with use of angiography alone. Primary endpoints will include PCI strategy (one or two stents), technique, size of implanted stents and direct angiographic effect of the procedure. Immediate PCI effect measured with intravascular ultrasound (IVUS) and the effect on fractional flow reserve (FFR) in the side branch (in a subgroup of patients), as well as plaque morphology assessed in CCTA, patient radiation exposure and amount of contrast will be compared in secondary analysis. The study is intended to clarify the influence of CCTA analysis on the technique and direct effect of PCI of bifurcations and to provide evidence on the relevance of performing a CCTA scan prior to PCI of bifurcation lesions.
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A focused update on emerging prognostic determinants in distal left main percutaneous coronary intervention. Int J Cardiol 2012; 160:4-7. [DOI: 10.1016/j.ijcard.2011.08.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 08/08/2011] [Accepted: 08/17/2011] [Indexed: 11/17/2022]
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RIZIK DAVIDG, HERMILLER JAMESB, KLASSEN KEVINJ, SHAH MAULIK. Xience Side Branch Access Stent for Treatment of Bifurcation Coronary Disease: A Review of Preclinical Data. J Interv Cardiol 2012; 25:337-43. [DOI: 10.1111/j.1540-8183.2012.00736.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Želízko M, Janek B, Hrnčárek M, Pořízka V, Karmazín V. Percutaneous coronary interventions in bifurcation lesions: from theory to practical approach. COR ET VASA 2012. [DOI: 10.1016/j.crvasa.2012.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pan M, Medina A, Suárez de Lezo J, Romero M, Segura J, Martín P, Suárez de Lezo J, Hernandez E, Mazuelos F, Ojeda S. Randomized study comparing everolimus- and sirolimus-eluting stents in patients with bifurcation lesions treated by provisional side-branch stenting. Catheter Cardiovasc Interv 2012; 80:1165-70. [PMID: 22511299 DOI: 10.1002/ccd.24281] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 11/24/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare the efficacy of sirolimus- and everolimus-eluting stents in patients with bifurcation lesions treated with provisional side-branch stenting. BACKGROUND The efficacy of everolimus-eluting stents in bifurcation lesions has been poorly tested. METHODS Patients with all types of Medina bifurcation lesions were randomly assigned to treatment with either a sirolimus- (n = 145) or everolimus-eluting stent (n = 148). We included patients with main vessel diameter over 2.5 mm and side branches over 2.25 mm. Patients with diffuse side-branch stenosis were excluded. RESULTS There were no significant differences between patients from the sirolimus and everolimus groups in terms of age, risk factors, clinical status, location of the bifurcation lesions or angiographic variables. Immediate results and in-hospital outcome were also similar in both groups of patients. In-hospital death occurred in two patients, one from each group. Target lesion revascularization was required in nine patients: four patients (2.7%) from the sirolimus group and five patients (3.4%) from the everolimus group. Late cardiac mortality occurred in two patients from the sirolimus group and in one patient from the everolimus group. Major cardiac event rates at 1 year were similar in both groups: nine patients (6.2%) in the sirolimus group and nine patients (6.1%) from the everolimus group (p: ns). CONCLUSIONS In patients with bifurcation lesions, no significant differences in clinical outcome at 1-year follow-up were observed between sirolimus- and everolimus-eluting stent groups.
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Affiliation(s)
- Manuel Pan
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Avenida Melendez Pidal 1. 14001 Cordoba, Spain.
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Stella PR, Belkacemi A, Dubois C, Nathoe H, Dens J, Naber C, Adriaenssens T, van Belle E, Doevendans P, Agostoni P. A multicenter randomized comparison of drug-eluting balloon plus bare-metal stent versus bare-metal stent versus drug-eluting stent in bifurcation lesions treated with a single-stenting technique: Six-month angiographic and 12-month clinical results of th. Catheter Cardiovasc Interv 2012; 80:1138-46. [DOI: 10.1002/ccd.23499] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 11/21/2011] [Indexed: 11/09/2022]
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Henderson RA, Timmis AD. Almanac 2011: Stable coronary artery disease. The national society journals present selected research that has driven recent advances in clinical cardiology. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2012.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Sergie Z, Mehran R. The optimal approach to coronary bifurcations: systematic rather than simplified? Catheter Cardiovasc Interv 2012; 79:623-4. [PMID: 22344994 DOI: 10.1002/ccd.24318] [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: 11/06/2022]
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Sergie Z, Dangas GD. In-stent restenosis of bifurcation lesions: experience with drug-eluting balloons. Catheter Cardiovasc Interv 2012; 79:397-8. [PMID: 22328233 DOI: 10.1002/ccd.24315] [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: 11/07/2022]
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