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Suryawan IGR, Saputra PBT, Rurus MESE, Saputra ME, Widiarti W, Multazam CECZ, Alkaff FF. Comparison between provisional and dual systematic stenting approach for left main bifurcation disease: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102633. [PMID: 38744356 DOI: 10.1016/j.cpcardiol.2024.102633] [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: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
Despite recent advancements, challenges persist in determining the optimal stenting strategy for LM bifurcation disease. Hence, this systematic review aims to compare single provisional and systematic dual stenting for managing LM bifurcation disease. A systematic search was performed until January 14, 2024. For the effect measure, risk ratios (RRs) was calculated. This study included 22 studies with 10776 participants. The all-cause mortality and cardiovascular mortality revealed comparable outcomes between provisional and dual-systematic stenting (RR 1.13, CI95 %: 0.87-1.47, p 0.36, I2 59 %; RR 1.16, CI95 %: 0.73-1.84, p 0.63, I2 80 %). In addition, MACE, MI, TLR, TVR, and in stent thrombosis also showed similar findings. Subgroup analysis revealed that cohort studies was the source of heterogeneity in all-cause mortality, stent thrombosis, and TLR. This meta-analysis suggests comparable outcomes between provisional and dual-systematic stenting in managing LM bifurcation disease. Further study is needed to validate the outcomes of novel techniques.
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Affiliation(s)
- I Gde Rurus Suryawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Made Edgard Surya Erlangga Rurus
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Mahendra Eko Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Wynne Widiarti
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Firas Farisi Alkaff
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
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He L, Robb JF, Martinez-Camblor P, Andrus BW, Greene LJ, Gongal P, Reddy DS, DeVries JT. Longitudinal outcomes of final kissing balloon inflation in coronary bifurcation lesions treated with a single stent. Front Cardiovasc Med 2023; 10:1290024. [PMID: 38099223 PMCID: PMC10720711 DOI: 10.3389/fcvm.2023.1290024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Background Final kissing balloon inflation (FKBI) is a percutaneous coronary intervention (PCI) technique that is considered mandatory to improve outcomes in two-stent strategies, but its use in single-stent bifurcation PCI remains controversial. Methods In this retrospective cohort study, we identified patients with coronary bifurcation lesions treated with one stent from January 2012 to March 2021 at a single academic medical center. Incidence rates per 1,000 patient-years (IR1000) were calculated for the outcomes of all-cause mortality, myocardial infarction (MI), stent thrombosis (ST), target lesion revascularization (TLR), coronary artery bypass graft (CABG), and cardiac readmission between patients who received FKBI and those who did not over a median follow up of 2.3 years. Studied outcomes were adjusted for all baseline clinical and procedural characteristics. Results This study included 893 consecutive patients of which 256 received FKBI and 637 did not. The IR1000 for MI were 51.1 and 27.6 for patients who received FKBI and patients who did not, respectively (adjusted HR = 2.44, p = 0.001). The IR1000 for death were 31.2 and 52.3 for patients who received FKBI and patients who did not, respectively (adjusted HR = 0.68, p = 0.141). The incidence rates of ST, TLR, CABG, and cardiac readmissions were similar between patients who received FKBI and those who did not. Conclusions These results suggest that performing FKBI in a one-stent technique was associated with higher rates of myocardial infarction, particularly in the first 6 months, and no difference in death, ST, TLR, CABG, and cardiac readmission rates.
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Affiliation(s)
- Lefan He
- Department of Cardiology, University of Rochester Medical Center, Rochester, NY, United States
| | - John F. Robb
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Pablo Martinez-Camblor
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Bruce W. Andrus
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Lily J. Greene
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Prajesh Gongal
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Dhruthi S. Reddy
- Homer Stryker School of Medicine, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, MI, United States
| | - James T. DeVries
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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Dérimay F, Rioufol G, Aminian A, Maillard L, Finet G. Toward a sequential provisional coronary bifurcation stenting technique. From kissing balloon to re-POT sequence. Arch Cardiovasc Dis 2020; 113:199-208. [PMID: 32008946 DOI: 10.1016/j.acvd.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
The specific anatomy of coronary bifurcations makes them prime sites of atherogenesis and complicates revascularization. Account must be taken of the systematic difference in diameter between the 3 constituent vessels so as to minimize final side-branch ostium obstruction and maintain the law of conservation of flow, while respecting the bifurcation angles. Kissing balloon inflation (KBI) was long recommended, but never clearly demonstrated clinical benefit in single-stent provisional stenting. The detrimental proximal overstretch induced by simultaneous inflation of balloons, observed clinically and confirmed experimentally, probably explains this inefficacy. Advances in knowledge of bifurcation pathophysiology and experimental bench studies gradually led to the development of a new purely sequential technique, re-POT, without balloon juxtaposition, comprising 3 successive steps: (1) initial "proximal optimization technique" (POT), (2) side-branch opening, and (3) final POT. In contrast to KBI, re-POT has been progressively assessed from bench to first clinical study. The aim of the present review is to present the pathophysiological specificities of coronary bifurcations, and some explanations for the failure of KBI which led to the development of a new purely sequential coronary bifurcation provisional stenting strategy, based on re-POT.
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Affiliation(s)
- François Dérimay
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude-Bernard University, INSERM Unit 1060 CARMEN, Lyon, France.
| | - Gilles Rioufol
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude-Bernard University, INSERM Unit 1060 CARMEN, Lyon, France
| | - Adel Aminian
- Cardiology Department, CHU Charleroi, Charleroi, Belgium
| | | | - Gérard Finet
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude-Bernard University, INSERM Unit 1060 CARMEN, Lyon, France
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Nishida K, Toyofuku M, Morimoto T, Ohya M, Fuku Y, Higami H, Yamaji K, Muranishi H, Yamaji Y, Furukawa D, Tada T, Ko E, Kadota K, Ando K, Sakamoto H, Tamura T, Kawai K, Kimura T. Prognostic impact of final kissing balloon technique after crossover stenting for the left main coronary artery: from the AOI-LMCA registry. Cardiovasc Interv Ther 2018; 34:197-206. [PMID: 29691767 PMCID: PMC6561992 DOI: 10.1007/s12928-018-0522-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/02/2018] [Indexed: 01/17/2023]
Abstract
It is still uncertain whether the final kissing balloon technique (FKBT) is mandatory after crossover stenting for the left main coronary artery (LMCA). Assessing Optimal Percutaneous Coronary Intervention for LMCA (AOI-LMCA) registry, a 6-center retrospective registry, enrolled 1809 consecutive patients for LMCA stenting in Japan. In the present analysis, 5-year clinical outcomes were compared between non-FKBT (n = 160) and FKBT (n = 578) groups in patients treated with crossover stenting with drug-eluting stents from the LMCA to the left anterior descending artery. Propensity score-matched analysis was also performed in 160 patient pairs. In the entire study population as well as in the propensity-matched population, the cumulative 5-year incidence of the primary outcome measure (target lesion revascularization: TLR) was not significantly different between the FKBT and non-FKBT groups (10.7 versus 14.3%, P = 0.49, and 11.8 versus 14.3%, P = 0.53, respectively). In the sensitivity analysis by the multivariable Cox proportional hazard model, the effect of FKBT relative to non-FKBT for TLR remained insignificant (adjusted HR 0.89, 95% CI 0.47–1.69, P = 0.72). Regarding the TLR location, there were no significant differences in the cumulative incidences of TLR for LMCA-only, for the main branch, and for the side branch between the 2 groups (2.2 versus 1.3%, P = 0.93, 11.8 versus 9.1%, P = 0.71, and 8.2 versus 7.6%, P = 0.82, respectively). FKBT after a 1-stent strategy for LMCA crossover stenting did not affect TLR and other clinical outcomes during 5-year follow-up. Clinical Trial Registration: Assessing Optimal Percutaneous Coronary Intervention for Left Main Coronary Artery Stenting Registry (AOI LMCA Stenting Registry). http://www.umin.ac.jp/ctr/index/htm/. Unique Identifier: UMIN000014706.
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Affiliation(s)
- Koji Nishida
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hirooki Higami
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Hiromi Muranishi
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Yuhei Yamaji
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | | | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Euihong Ko
- Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Takashi Tamura
- Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
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Liu G, Ke X, Huang ZB, Wang LC, Huang ZN, Guo Y, Long M, Liao XX. Final kissing balloon inflation for coronary bifurcation lesions treated with single-stent technique : A meta-analysis. Herz 2017; 44:354-362. [PMID: 29181563 DOI: 10.1007/s00059-017-4647-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/02/2017] [Accepted: 10/26/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND The efficacy of final kissing balloon (FKB) inflation in one-stent techniques for bifurcation lesions is controversial. The goal of the present study was to investigate the impact of FKB on long-term clinical outcomes in one-stent strategies. METHODS A literature search of the PubMed, Embase, and Cochrane Library databases was undertaken through August 2017. The primary outcome was major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and target lesion revascularization. Overall hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the random-effects model. RESULTS Ten studies comprising 7364 patients treated with a one-stent technique were included in the analysis. Overall, FKB did not demonstrate a significant reduction in MACE compared with non-FKB in both randomized trials (HR: 1.13; 95% CI: 0.65-1.98) and observational studies (HR: 0.86; 95% CI: 0.61-1.20). The risk of cardiac death (HR: 0.89; 95% CI: 0.53-1.49), myocardial infarction (HR: 0.76; 95% CI: 0.53-1.09), and target lesion revascularization (HR: 0.96; 95% CI: 0.74-1.23) was also similar in both groups. CONCLUSION FKB may not be mandatory and a selective FKB strategy might be more justified in one-stent techniques for bifurcation lesions.
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Affiliation(s)
- G Liu
- Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - X Ke
- Department of Cardiology, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
| | - Z-B Huang
- Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - L-C Wang
- Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Z-N Huang
- Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Y Guo
- Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - M Long
- Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
- , 58 Zhongshan Rd II, 510080, Guangzhou, China.
| | - X-X Liao
- Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
- , 58 Zhongshan Rd II, 510080, Guangzhou, China.
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Ng AKY, Jim MH. Percutaneous Coronary Intervention for Bifurcation: How Can We Outperform the Provisional Strategy? Clin Cardiol 2016; 39:684-691. [PMID: 27556582 DOI: 10.1002/clc.22581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/03/2016] [Accepted: 07/06/2016] [Indexed: 01/29/2023] Open
Abstract
In the era of drug-eluting stents, the provisional stenting strategy has been established as the default strategy in percutaneous coronary intervention for bifurcation lesions. However, emerging evidence shows that, in selected situations, the complex strategy of stenting both vessels regardless could reduce side-branch restenosis without penalty. In particular, the double kissing crush technique has been proven to outperform the provisional strategy and other complex strategies in randomized trials. In this review, we present the evidence comparing the 2 strategies and individual stenting techniques and discuss the roles of other optimization techniques such as final kissing balloon inflation, proximal optimization technique, intravascular ultrasonography, and optical coherence tomography. Finally, we suggest a practical approach for choosing the optimal strategy for intervention with coronary bifurcation lesions.
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Affiliation(s)
| | - Man-Hong Jim
- Cardiac Medical Unit, Grantham Hospital, Hong Kong
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Cheng TO. Dilation or dilatation: to be or not to be? Int J Cardiol 2015; 199:373-4. [PMID: 26241644 DOI: 10.1016/j.ijcard.2015.06.178] [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: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Tsung O Cheng
- Department of Medicine, The George Washington University, Washington, DC, United States.
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