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Briguori C, Capodanno D, Contarini M, Donahue ME, Evola S, Garro N, Greco F, LA Manna A, Murè P, Nicosia A, Migliore G, Sacchetta G, Signore N, Tamburino C, Vizzari G, Biondi-Zoccai G. Acute and long-term results of percutaneous coronary intervention of bifurcation lesions with the dedicated Bioss Lim C stent: the Italian BIfurcation Observational Spontaneous Study (IBIOSS). Minerva Med 2024; 115:171-177. [PMID: 38536058 DOI: 10.23736/s0026-4806.23.08929-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) for bifurcation lesions still represents a clinical challenge. The Bioss Lim C is a dedicated device for bifurcation lesions, features a tapered shape and large cells, and thus appears as a promising adjunct to the current interventional cardiologists' armamentarium. We aimed at conducting a prospective multicenter study focusing on early and long-term results after Bioss Lim C implantation for true coronary bifurcation lesions. METHODS Patients with true bifurcation lesions in whom Bioss Lim C implantation was attempted were enrolled in four Italian centers. An explicit bifurcation management approach was recommended, leaving however the choice between one- vs. two-stent strategies at operator's discretion. Acute and long-term results were systematically appraised, focusing on an acute composite of complex side branch (SB) rewiring, SB pinching, or SB occlusion (primary efficacy endpoint), as well as major adverse events (MACE, i.e. death, myocardial infarction [MI], or target vessel revascularization [TVR]), individual components of MACE, and stent thrombosis. RESULTS A total of 207 patients were included, with age of 67.3±10.8 years, and 40 (19.3%) women. The target lesion was located in the left main in 48 (23.2%) patients, whereas proximal reference vessel diameter was 3.69±0.48 mm, and lesion length 20.3±3.4 mm. According to the Medina classification, most patients (60 [30.9%]) had 1-1-1 lesions. Drug-eluting stent implantation in the SB was carried out in 19 (9.3%) subjects, and kissing balloon inflation was used in 67 (32.5%). The primary efficacy endpoint occurred in 27 (13.0%), with side branch (SB) occlusion in two (1.0%), SB pinching in 23 (11.1%), and complex SB rewiring in six (2.9%), and was most frequent in patients with lower body mass index or dyslipidemia. After 24.1±19.5 months, MACE were adjudicated in 23 (11.1%) subjects, with death in 10 (4.8%), MI in six (2.9%), and TVR in seven (3.4%), as well as stent thrombosis in one (0.5%). CONCLUSIONS This study supports a wider adoption of the Bioss Lim C dedicated bifurcation device, thanks to the favorable acute results as well as long-term clinical outcomes, as well as its versatility for the stenting strategy provisionally or eventually adopted by operators.
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Affiliation(s)
- Carlo Briguori
- Department of Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Davide Capodanno
- Department of Cardiology, Policlinico G. Rodolico-San Marco University Hospital, University of Catania, Catania, Italy
| | - Marco Contarini
- Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa, Italy
| | | | - Salvatore Evola
- Catheterization Laboratory, Department of Medicine and Cardiology, Policlinico P. Giaccone University Hospital, Palermo, Italy
| | - Nadia Garro
- Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa, Italy
| | - Francesco Greco
- Cath Lab Unit, Santissima Annunziata Hospital, Cosenza, Italy
| | - Alessio LA Manna
- Department of Cardiology, Policlinico G. Rodolico-San Marco University Hospital, University of Catania, Catania, Italy
| | - Paola Murè
- Department of Cardiology, Policlinico G. Rodolico-San Marco University Hospital, University of Catania, Catania, Italy
| | - Antonino Nicosia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Nicola Signore
- Division of Hospital Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Corrado Tamburino
- Department of Cardiology, Policlinico G. Rodolico-San Marco University Hospital, University of Catania, Catania, Italy
| | - Giampiero Vizzari
- Interventional Cardiology Unit, G. Martino University Hospital, University of Messina, Messina, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy -
- Mediterranea Cardiocentro, Naples, Italy
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Onea HL, Spinu M, Homorodean C, Ober MC, Olinic M, Lazar FL, Achim A, Tataru DA, Olinic DM. Superficial Calcified Plates Associated to Plaque Erosions in Acute Coronary Syndromes. Life (Basel) 2023; 13:1732. [PMID: 37629589 PMCID: PMC10455434 DOI: 10.3390/life13081732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
This study investigates the clinical relevance and therapeutic implications of the OCT identification of intracoronary superficial calcified plates (SCPs) in acute coronary syndromes (ACSs). In 70 consecutive ACS patients (pts), we studied the three main underlying ACS mechanisms: plaque erosion (PE), plaque rupture and eruptive calcified nodule (CN). The PE lesions, occurring on an intact fibrous cap overlying a heterogeneous substrate, were identified in 12/70 pts (17.1%). PE on superficial calcified plates (PE-SCP) represented 58.3% of the PE lesions (7/12 pts) and had a 10% overall incidence in the culprit lesions (7/70 pts). PE-SCP lesions occurred mostly on the left anterior descending artery, correlated with white thrombi (85.7%) and had a proximal intraplaque site (71.4%). PE-SCP lesions were treated conservatively, as nonsignificant lesions, in 4/7 pts. Our study emphasizes that the coronary calcium-related ACS risk is not only associated with the spotty calcifications or CN but also with the PE-SCP lesions.
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Affiliation(s)
- Horea-Laurentiu Onea
- Medical Clinic Number 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (H.-L.O.); (C.H.); (M.O.); (F.-L.L.); (D.A.T.); (D.M.O.)
| | - Mihail Spinu
- Medical Clinic Number 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (H.-L.O.); (C.H.); (M.O.); (F.-L.L.); (D.A.T.); (D.M.O.)
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania;
| | - Calin Homorodean
- Medical Clinic Number 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (H.-L.O.); (C.H.); (M.O.); (F.-L.L.); (D.A.T.); (D.M.O.)
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania;
| | - Mihai Claudiu Ober
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania;
| | - Maria Olinic
- Medical Clinic Number 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (H.-L.O.); (C.H.); (M.O.); (F.-L.L.); (D.A.T.); (D.M.O.)
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania;
| | - Florin-Leontin Lazar
- Medical Clinic Number 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (H.-L.O.); (C.H.); (M.O.); (F.-L.L.); (D.A.T.); (D.M.O.)
| | - Alexandru Achim
- Cardiology Department, Kantonsspital Baselland, 4410 Liestal, Switzerland;
| | - Dan Alexandru Tataru
- Medical Clinic Number 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (H.-L.O.); (C.H.); (M.O.); (F.-L.L.); (D.A.T.); (D.M.O.)
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania;
| | - Dan Mircea Olinic
- Medical Clinic Number 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (H.-L.O.); (C.H.); (M.O.); (F.-L.L.); (D.A.T.); (D.M.O.)
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania;
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Onea HL, Spinu M, Homorodean C, Olinic M, Lazar FL, Ober MC, Stoian D, Itu LM, Olinic DM. Distinctive Morphological Patterns of Complicated Coronary Plaques in Acute Coronary Syndromes: Insights from an Optical Coherence Tomography Study. Diagnostics (Basel) 2022; 12:diagnostics12112837. [PMID: 36428897 PMCID: PMC9689106 DOI: 10.3390/diagnostics12112837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Optical coherence tomography (OCT) is an ideal imaging technique for assessing culprit coronary plaque anatomy. We investigated the morphological features and mechanisms leading to plaque complication in a single-center observational retrospective study on 70 consecutive patients with an established diagnosis of acute coronary syndrome (ACS) who underwent OCT imaging after coronary angiography. Three prominent morphological entities were identified. Type I or intimal discontinuity, which was found to be the most common mechanism leading to ACS and was seen in 35 patients (50%), was associated with thrombus (68.6%; p = 0.001), mostly affected the proximal plaque segment (60%; p = 0.009), and had no distinctive underlying plaque features. Type II, a significant stenosis with vulnerability features (inflammation in 16 patients, 84.2%; thin-cap fibroatheroma (TCFA) in 10 patients, 52.6%) and a strong association with lipid-rich plaques (94.7%; p = 0.002), was observed in 19 patients (27.1%). Type III, a protrusive calcified nodule, which was found to be the dominant morphological pattern in 16 patients (22.9%), was found in longer plaques (20.8 mm vs. 16.8 mm ID vs. 12.4 mm SS; p = 0.04) and correlated well with TCFA (93.8%; p = 0.02) and inflammation (81.3%). These results emphasize the existence of a wide spectrum of coronary morphological patterns related to ACS.
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Affiliation(s)
- Horea-Laurentiu Onea
- Medical Clinic Number 1, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Mihail Spinu
- Medical Clinic Number 1, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-746259047
| | - Calin Homorodean
- Medical Clinic Number 1, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
| | - Maria Olinic
- Medical Clinic Number 1, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
| | - Florin-Leontin Lazar
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
| | - Mihai Claudiu Ober
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
| | - Diana Stoian
- Advanta, Siemens SRL, 500097 Brasov, Romania
- Department of Automation and Information Technology, Transilvania University of Brașov, 500174 Brasov, Romania
| | - Lucian Mihai Itu
- Advanta, Siemens SRL, 500097 Brasov, Romania
- Department of Automation and Information Technology, Transilvania University of Brașov, 500174 Brasov, Romania
| | - Dan Mircea Olinic
- Medical Clinic Number 1, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Interventional Cardiology, Cluj County Emergency Hospital, 400006 Cluj-Napoca, Romania
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