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Ghosh P, Shah A, Sporn D, Kaluski E. Two-Step V-Stenting and Simultaneous Kissing Stent via 6F Guides: Simple Just Got Simpler. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 45:63-66. [PMID: 35705440 DOI: 10.1016/j.carrev.2022.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023]
Abstract
V-stenting (VS) and simultaneously kissing stents (SKS) upfront 2-stent strategies for treating large diameter bifurcations and especially distal left main coronary artery (LMCA) disease. Former teaching suggests that the minimal requirements for VS and SKS requires 8F guiding catheters or 7.5F sheathless guide. Presented is the "2-Step refinement" of SKS and VS that can be executed via conventional 6F guide without any additional equipment. In view of the simplicity and suitability for unstable subjects with acute coronary syndromes; "2 Step SKS and VS" should be in the armamentarium of all advanced interventionalists.
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Affiliation(s)
- Priyanka Ghosh
- Division of Cardiovascular Disease, Robert Packer Hospital and the Guthrie Health Services, Sayre, PA USA; The Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Amit Shah
- Division of Cardiovascular Disease, Robert Packer Hospital and the Guthrie Health Services, Sayre, PA USA; The Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Dan Sporn
- Division of Cardiovascular Disease, Robert Packer Hospital and the Guthrie Health Services, Sayre, PA USA; The Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Edo Kaluski
- Division of Cardiovascular Disease, Robert Packer Hospital and the Guthrie Health Services, Sayre, PA USA; The Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
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Murasato Y. How to use three-dimensional optical coherence tomography effectively in coronary bifurcation stenting. Front Cardiovasc Med 2022; 9:1023834. [DOI: 10.3389/fcvm.2022.1023834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Imaging-guided coronary bifurcation intervention has improved clinical outcomes due to the appropriate size selection of the devices and optimization of the procedure (sufficient stent expansion, reduction of stent malapposition, appropriate stent landing zone, and detection of vessel dissection). In particular, three-dimensional optical coherence tomography (3D OCT) facilitates clear visualization of stent configuration and guidewire position, which promotes optimal guidewire crossing to the side branch. Successive side branch dilation leads to wide ostial dilation with less strut malapposition. However, the link connection of the stent located on the bifurcated carina has been found to be an impediment to sufficient opening of the side branch, resulting in incomplete strut apposition. In such cases, the aggressive proximal optimization technique improves the jailing strut pattern, and 3D OCT navigates the guidewire crossing to the optimal cell that is most likely to be expanded sufficiently, which is not always a distal cell. In two-stent deployment, 3D OCT facilitates optimal guidewire crossing, which leads to less metallic carina, clustering, and overlapping. The present review describes a method of clear visualization and assessment with 3D OCT and discusses the efficacy of 3D OCT in coronary bifurcation stenting in clinical practice.
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Jang AY, Kim M, Oh PC, Suh SY, Lee K, Kang WC, Choi KH, Song YB, Gwon HC, Kim HS, Chun WJ, Hur SH, Rha SW, Chae IH, Jeong JO, Heo JH, Yoon J, Hong SJ, Park JS, Hong MK, Doh JH, Cha KS, Kim DI, Lee SY, Chang K, Hwang BH, Choi SY, Jeong MH, Nam CW, Koo BK, Han SH. Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions - A Baseline Clinical and Lesion Characteristic-Matched Analysis. Circ J 2022; 86:1365-1375. [PMID: 35896356 DOI: 10.1253/circj.cj-22-0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions.Methods and Results: We analyzed the data of patients with bifurcation lesions, obtained from a multicenter registry of 2,648 patients (median follow up, 53 months). The patients were treated by second generation drug-eluting stents (DESs). The primary outcome was target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR). PSM was performed to balance baseline clinical and angiographic discrepancies between 1 and 2 stents. After PSM (N=333 from each group), the 2-stent group had more TLRs (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.42-6.97, P=0.005) and fewer hard endpoints (composite of cardiac death and TVMI; HR 0.44, 95% CI 0.19-1.01, P=0.054), which resulted in a similar TLF rate (HR 1.40, 95% CI 0.83-2.37, P=0.209) compared to the 1-stent group. Compared with 1-stent, the 2-stent technique was more frequently associated with less TLF in the presence of main vessel (pinteraction=0.008) and side branch calcification (pinteraction=0.010). CONCLUSIONS The 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Minsu Kim
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Pyung Chun Oh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Soon Yong Suh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Kyounghoon Lee
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Woo Jung Chun
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Seung-Woon Rha
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Medicine, Chungnam National University Hospital
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine
| | - Soon Jun Hong
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center
| | - Myeong-Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Joon-Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea
| | - So-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
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A J, Malviya A, Thomas J, S V, Mandalay A, Joseph J, Mathew R. Rationale, Design, and Implications of Bifurcation Coronary Stenting: Insight from the Indian Bifurcation Stenting (IBIS) Registry. Cureus 2021; 13:e18027. [PMID: 34671518 PMCID: PMC8520440 DOI: 10.7759/cureus.18027] [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] [Accepted: 09/16/2021] [Indexed: 11/14/2022] Open
Abstract
Background Bifurcation coronary stenting (BCS) has unique therapeutic challenges. Several BCS strategies are prescribed for treatment, with conflicting data, and which is the best strategy for optimal short- and long-term outcomes remains a matter of debate. There is no systematic data from an Indian perspective in regard to patterns of BCS and its outcomes. Methods and analysis The Indian Bifurcation Stenting (IBIS) registry is a prospective, nationwide, endpoint-driven, investigator-initiated, multi-center, observational registry to compare the different bifurcation stent strategies, the effect of adjuvant techniques, and bifurcation anatomical differences in predicting short- and long-term clinical outcomes of bifurcation coronary interventions in India. A total of 1,000 patients from 20 clinical sites across the country will be enrolled in this study from September 2020 to August 2023. The primary endpoint will be the composite endpoint of major adverse cardiac events including cardiac death, target lesion myocardial infarction (MI), and ischemia-driven target lesion revascularization at the end of two years. The secondary endpoints include all causes of death, MI, target vessel revascularization, in-stent restenosis, stroke, and predefined procedural parameters. The safety endpoint is the occurrence of definite or probable stent thrombosis. Conclusion The aim of this prospective observational registry is to assess the practice patterns and clinical outcomes of patients undergoing coronary bifurcation lesion angioplasty in India. This will be extremely useful to provide an evidence-based insight as well as guidance to bifurcation angioplasty in India.
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Affiliation(s)
- Jabir A
- Cardiology, Lisie Hospital, Kochi, IND
| | - Amit Malviya
- Cardiology, North Eastern Indira Gandhi Regional Institute of Health And Medical Sciences, Shillong, IND
| | | | - Vijaykumar S
- Cardiology, Madras Medical Mission Hospital, Chennai, IND
| | | | - Jo Joseph
- Cardiology, Lisie Hospital, Kochi, IND
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