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Mrevlje B, McFadden E, de la Torre Hernández JM, Testa L, De Maria GL, Banning AP, Spitzer E. Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention in unprotected left main coronary artery disease: A systematic review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 59:99-108. [PMID: 37657950 DOI: 10.1016/j.carrev.2023.08.006] [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: 04/21/2023] [Revised: 08/13/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Significant unprotected left main coronary artery (ULMCA) disease is encountered in approximately 5 % of patients undergoing diagnostic coronary angiography. Intravascular ultrasound (IVUS) overcomes many of the known limitations of angiography and improves outcomes of patients undergoing percutaneous coronary interventions (PCI) in stable or complex coronary artery disease. The aim of this systematic review is to evaluate the evidence on IVUS-guidance versus angiography-guidance in ULMCA PCI, highlighting the chronological frequencies of event rates in line with the maturation of PCI technique and devices over time. METHODS A comprehensive systematic search in Medline was performed to identify all studies that had assessed the effect of IVUS-guided versus angiography-guided ULMCA PCI on various primary and secondary endpoints. RESULTS Seventeen studies (2 randomized, 10 non-randomized and 5 meta-analyses) were included in this systematic review. CONCLUSIONS This systematic review on IVUS-guided versus angiography-guided PCI in patients with significant ULMCA disease strongly supports the hypothesis that IVUS-guided PCI is associated with a significant reduction in major adverse cardiac events composites, all-cause death, cardiac death, myocardial infarction and stent thrombosis. Ongoing, adequately powered trials will contribute significantly to the level of evidence.
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Affiliation(s)
| | | | | | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy.
| | - Giovanni Luigi De Maria
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom.
| | - Adrian P Banning
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom.
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Bangalore S, Maehara A. Intravascular Ultrasound Optimization Criteria for Left Main Coronary Artery Stenting: In Pursuit of the Magic Numbers! Circ Cardiovasc Interv 2024; 17:e013691. [PMID: 38227696 DOI: 10.1161/circinterventions.123.013691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Sripal Bangalore
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine (S.B.)
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY (A.M.)
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital (A.M.)
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Kim JH, Kang DY, Ahn JM, Kweon J, Choi Y, Kim H, Lee J, Chae J, Kang SJ, Park DW, Park SJ. Optimal Minimal Stent Area and Impact of Stent Underexpansion in Left Main Up-Front 2-Stent Strategy. Circ Cardiovasc Interv 2024; 17:e013006. [PMID: 38227699 DOI: 10.1161/circinterventions.123.013006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 09/26/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND We previously reported the use of minimal stent area to predict angiographic in-stent restenosis after drug-eluting stent implantation for unprotected left main (LM) disease. We aimed to evaluate the optimal minimal stent area criteria for up-front LM 2-stenting based on long-term clinical outcomes. METHODS We identified 292 consecutive patients with LM bifurcation stenosis who were treated using the crush technique. The final minimal stent area was measured in the ostial left anterior descending artery (LAD), ostial left circumflex artery (LCX), and distal LM. The primary outcome was 5-year major adverse cardiac events, including all-cause death, myocardial infarction, and target lesion revascularization. RESULTS The minimal stent area cutoff values that best predicted the 5-year major adverse cardiac events were 11.8 mm2 for distal LM (area under the curve, 0.57; P=0.15), 8.3 mm2 for LAD ostium (area under the curve, 0.62; P=0.02), and 5.7 mm2 for LCX ostium (area under the curve, 0.64; P=0.01). Using these criteria, the risk of 5-year major adverse cardiac events was significantly associated with stent underexpansion in the LAD ostium (hazard ratio, 3.14; [95% CI, 1.23-8.06]; P=0.02) and LCX ostium (hazard ratio, 2.60 [95% CI, 1.11-6.07]; P=0.03) but not in the distal LM (hazard ratio, 0.81 [95% CI, 0.34-1.91]; P=0.63). Patients with stent underexpansion in both ostial LAD and LCX had a significantly higher rate of 5-year major adverse cardiac events than those with no or 1 underexpanded stent of either ostium (P<0.01). CONCLUSIONS Stent underexpansion in the LAD and LCX ostium was significantly associated with long-term outcomes in patients who underwent up-front 2-stenting for LM bifurcation stenosis.
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Affiliation(s)
- Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea (J.H.K.)
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Jihoon Kweon
- Department of Convergence Medicine, Asan Medical Center, Seoul, Republic of Korea (J.K., J.C.)
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Jihye Chae
- Department of Convergence Medicine, Asan Medical Center, Seoul, Republic of Korea (J.K., J.C.)
| | - Soo-Jin Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
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Kwon W, Lee JM, Yun KH, Choi KH, Lee SJ, Lee JY, Lee SY, Kim SM, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY, Song YB. Clinical Benefit of Intravascular Imaging Compared With Conventional Angiography in Left Main Coronary Artery Intervention. Circ Cardiovasc Interv 2023; 16:e013359. [PMID: 38018841 DOI: 10.1161/circinterventions.123.013359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/12/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) demonstrated that intravascular imaging-guided percutaneous coronary intervention (PCI) improved clinical outcome compared with angiography-guided PCI for patients with complex coronary artery lesions. This study aims to assess whether the prognostic benefit of intravascular imaging-guided procedural optimization persists in patients undergoing PCI for left main coronary artery disease. METHODS Of 1639 patients enrolled in the RENOVATE-COMPLEX-PCI, 192 patients with left main coronary artery disease were selected for the current prespecified substudy. Selected patients were randomly assigned to either the intravascular imaging-guided PCI group (n=138) or the angiography-guided PCI group (n=54). The primary end point was target vessel failure defined as a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization. RESULTS At a median follow-up of 2.1 years (interquartile range 1.1 to 3.0 years), intravascular imaging-guided PCI was associated with lower incidence of primary end point compared with angiography-guided PCI (6.8% versus 25.1%; hazard ratio, 0.31 [95% CI, 0.13-0.76]; P=0.010). This significant reduction in primary end point was mainly driven by a lower risk of cardiac death or spontaneous target vessel-related myocardial infarction (1.6% versus 12.7%; hazard ratio, 0.16 [95% CI, 0.03-0.82]; P=0.028). Intravascular imaging-guided PCI was independently associated with a lower risk of primary end point, even after adjusting for various clinical factors (hazard ratio, 0.29 [95% CI, 0.12-0.72]; P=0.007). CONCLUSIONS Intravascular imaging-guided PCI showed clinical benefit over angiography-guided PCI for left main coronary artery disease in reducing the risk of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.
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Affiliation(s)
- Woochan Kwon
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong Ho Yun
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Ki Hong Choi
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lee
- Kangbuk Samsung Hospital (S.-J.L., J.-Y.L.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Kangbuk Samsung Hospital (S.-J.L., J.-Y.L.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yeub Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L., S.M.K.)
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea (S.Y.L.)
| | - Sang Min Kim
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L., S.M.K.)
| | - Jae Young Cho
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul (C.J.K., H.-S.A.)
| | - Hyo-Suk Ahn
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul (C.J.K., H.-S.A.)
| | - Chang-Wook Nam
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Hyuck-Jun Yoon
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Yong Hwan Park
- Samsung Changwon Hospital (Y.H.P.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wang Soo Lee
- Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (W.S.L.)
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (J.-O.K., P.S.S.)
| | - Pil Sang Song
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (J.-O.K., P.S.S.)
| | - Joon-Hyung Doh
- Inje University Ilsan-Paik hospital, Goyang, Korea (J.-H.D.)
| | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea (S.-H.J.)
| | - Chang-Hwan Yoon
- Seoul National University Bundang Hospital, Seongnam, Korea (C.-H.Y.)
| | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.K.)
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.K.)
| | - Kwan Yong Lee
- The Catholic University of Korea, Incheon St Mary's Hospital, Seoul (K.Y.L.)
| | - Young-Hyo Lim
- Hanyang University Seoul Hospital, College of Medicine, Hanyang University, Seoul, Korea (Y.-H.L.)
| | - Yun-Hyeong Cho
- Hanyang University Myongji Hospital, Goyang, Korea (Y.-H.C.)
| | - Jin-Man Cho
- Kyung Hee University Hospital at Gangdong, Seoul, Korea (J.-M.C.)
| | - Woo Jin Jang
- Ewha Womans University College of Medicine, Seoul, Korea (W.J.J.)
| | - Kook-Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, Korea (K.-J.C.)
| | - David Hong
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
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Intravascular Imaging During Percutaneous Coronary Intervention: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:590-605. [PMID: 36754518 DOI: 10.1016/j.jacc.2022.11.045] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 02/09/2023]
Abstract
Coronary angiography has historically served as the gold standard for diagnosis of coronary artery disease and guidance of percutaneous coronary intervention (PCI). Adjunctive use of contemporary intravascular imaging (IVI) technologies has emerged as a complement to conventional angiography-to further characterize plaque morphology and optimize the performance of PCI. IVI has utility for preintervention lesion and vessel assessment, periprocedural guidance of lesion preparation and stent deployment, and postintervention assessment of optimal endpoints and exclusion of complications. The role of IVI in reducing major adverse cardiac events in complex lesion subsets is emerging, and further studies evaluating broader use are underway or in development. This paper provides an overview of currently available IVI technologies, reviews data supporting their utilization for PCI guidance and optimization across a variety of lesion subsets, proposes best practices, and advocates for broader use of these technologies as a part of contemporary practice.
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Ruiz-Nodar JM. Antiplatelet therapy after complex percutaneous coronary intervention and in left main coronary disease. Not all lesions are the same. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:223-226. [PMID: 36623687 DOI: 10.1016/j.rec.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Juan M Ruiz-Nodar
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
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Cortese B, Piraino D, Gentile D, Onea HL, Lazar L. Intravascular imaging for left main stem assessment: An update on the most recent clinical data. Catheter Cardiovasc Interv 2022; 100:1220-1228. [PMID: 36273435 DOI: 10.1002/ccd.30440] [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] [Received: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 01/04/2023]
Abstract
Left main (LM) stem has different structural and anatomical characteristics compared to all of the other segments of the coronary tree, thus its management through percutaneous coronary intervention (PCI) is a challenge and is associated with worse clinical outcome and higher need for revascularization as compared to other lesion settings. Intravascular imaging, by means of intravascular ultrasound (IVUS) or optical coherence tomography (OCT), is an important tool for LM PCI guidance, aiming at improving the immediate performance and the long term outcome of this procedure. Following current guidelines and recent scientific findings, IVUS becomes important to firstly assess, and finally evaluate the result of LM stenting, according to the experience and preferences of the operator. The role of OCT still remains to be defined, but recent data is shedding light also on this imaging technique. The aim of this review is to highlight the latest scientific advancements regarding intravascular imaging in LM coronary artery disease.
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Affiliation(s)
- Bernardo Cortese
- Cardiovascular Research Group, Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Davide Piraino
- Interventional Cardiology Laboratory, Maria Eleonora Hospital, Palermo, Italy
| | - Domitilla Gentile
- Cardiovascular Research Group, Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Horea-Laurentiu Onea
- Interventional Cardiology Department no 2, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Leontin Lazar
- Cardiovascular Research Group, Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy.,Interventional Cardiology Department no 2, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania
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Ruiz-Nodar JM. Antiagregación en la intervención coronaria compleja y en la enfermedad del tronco. No todas las lesiones son iguales. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Albiero R, Burzotta F, Lassen JF, Lefèvre T, Banning AP, Chatzizisis YS, Johnson TW, Ferenc M, Pan M, Daremont O, Hildick-Smith D, Chieffo A, Louvard Y, Stankovic G. Treatment of coronary bifurcation lesions, part I: implanting the first stent in the provisional pathway. The 16th expert consensus document of the European Bifurcation Club. EUROINTERVENTION 2022; 18:e362-e376. [PMID: 35570748 PMCID: PMC10259243 DOI: 10.4244/eij-d-22-00165] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Stepwise layered provisional stenting (PS) is the most commonly used strategy to treat coronary bifurcation lesions (CBL). The term 'stepwise layered' emphasises the versatility of this approach that allows the adjustment of the procedure plan according to the CBL complexity, starting with stent implantation in one branch and implantation of a second stent in the other branch only when required. A series of refinements have been implemented over the years to facilitate the achievement of predictable procedural results using this approach. However, despite its simplicity and versatility, operators using this technique require full knowledge of the pitfalls of each procedural step. Part I of this 16th European Bifurcation Club consensus paper provides a detailed step-by-step overview of the pitfalls and technical troubleshooting during the implantation of the first stent using the PS strategy for the treatment of CBL.
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Affiliation(s)
- Remo Albiero
- Interventional Cardiology Unit, Ospedale Civile di Sondrio, Sondrio, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jens Flensted Lassen
- Department of Cardiology B, Odense Universitates Hospital & University of Southern Denmark, Odense C, Denmark
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Adrian P Banning
- Cardiovascular Medicine Division, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol and Weston NHSFT & University of Bristol, Bristol, United Kingdom
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital. University of Cordoba (IMIBIC), Cordoba, Spain
| | | | - David Hildick-Smith
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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De Maria GL, Testa L, de la Torre Hernandez JM, Terentes-Printzios D, Emfietzoglou M, Scarsini R, Bedogni F, Spitzer E, Banning A. A multi-center, international, randomized, 2-year, parallel-group study to assess the superiority of IVUS-guided PCI versus qualitative angio-guided PCI in unprotected left main coronary artery (ULMCA) disease: Study protocol for OPTIMAL trial. PLoS One 2022; 17:e0260770. [PMID: 34995276 PMCID: PMC8740965 DOI: 10.1371/journal.pone.0260770] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/02/2021] [Indexed: 12/28/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) is used increasingly for revascularization of unprotected left main coronary artery (LMCA) disease. Observational studies and subgroup analyses from clinical trials, have suggested a possible benefit from the use of intravascular ultrasound (IVUS) guidance when performing unprotected LMCA PCI. However, the value of imaging with IVUS has never been proven in an appropriately powered randomized clinical trial. The OPtimizaTIon of Left MAin PCI With IntravascuLar Ultrasound (OPTIMAL) trial has been designed to establish whether IVUS-guided PCI optimization on LMCA is associated with superior clinical outcomes when compared with standard qualitative angiography-guided PCI. Methods The OPTIMAL trial is a randomized, multicenter, international study designed to enroll a total of 800 patients undergoing PCI for unprotected LMCA disease. Patients will be randomized in a 1:1 fashion to IVUS-guided PCI versus angiogram-guided PCI. In patients allocated to the angiogram-guided arm, use of IVUS is discouraged, unless there are safety concerns. In patients allocated to the IVUS guidance arm, pre-procedural IVUS assessment is highly recommended, whilst post-procedural IVUS assessment is mandatory to confirm appropriate stenting result and/or to guide stent result optimization, according to predefined criteria. Patients will be followed up to 2 years after the index procedure. The primary outcome measure is the Academic Research Consortium (ARC) patient-oriented composite endpoint (PoCE) which includes all-cause death, any stroke, any myocardial infarction and any repeat revascularization at 2 years follow-up. Discussion The OPTIMAL trial aims to provide definitive evidence about the clinical impact of IVUS-guidance during PCI to an unprotected LMCA. It is anticipated by the investigators, that an IVUS-guided strategy will be associated with less clinical events compared to a strategy guided by angiogram alone. Trial registration ClinicalTrials.gov: NCT04111770. Registered on October 1, 2019.
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Affiliation(s)
- Giovanni Luigi De Maria
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy
| | | | - Dimitrios Terentes-Printzios
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Maria Emfietzoglou
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Roberto Scarsini
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Francesco Bedogni
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy
| | - Ernest Spitzer
- European Cardiovascular Research Institute, Rotterdam, The Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Adrian Banning
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
- * E-mail:
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11
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Calcagno S, Massaro G, Romagnoli E. "Crushing" the minimum: Nano-Crush approach, a novel approach for coronary bifurcation stenting. Minerva Cardiol Angiol 2022; 70:455-458. [PMID: 35212514 DOI: 10.23736/s2724-5683.22.05979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Simone Calcagno
- Division of Cardiology, San Paolo Hospital, Civitavecchia, Rome, ITaly -
| | - Gianluca Massaro
- Division of Cardiology, Tor Vergata University Hospital, Rome, Italy
| | - Enrico Romagnoli
- Division of Cardiology, Tor Vergata University Hospital, Rome, Italy.,Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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12
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Mailey JA, Spence MS. The Contemporary Management of Left Main Coronary Artery Disease. Curr Cardiol Rev 2022; 18:e170621194128. [PMID: 34139985 PMCID: PMC9241110 DOI: 10.2174/1573403x17666210617094735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/23/2020] [Accepted: 03/16/2021] [Indexed: 11/22/2022] Open
Abstract
The 'gold standard' in the management of left main coronary artery disease has historically been coronary artery bypass surgery. Recent innovations in drug-eluting stent technology coupled with the increasing utility of physiology and imaging guidance for procedures have led to an evolving role of percutaneous coronary intervention in left main disease of low and intermediate anatomical complexity. This revascularization modality carries the clear advantage of being less invasive and significantly reduced recovery times. This practice is currently supported by international guidelines, however, it remains a controversial topic in the field of interventional cardiology, and the long-term outcomes of a percutaneous strategy have been questioned. This review describes the current evidence base for the assessment and choice of intervention in left main coronary artery disease. The percutaneous revascularization techniques and use of imaging to optimize procedures and improve clinical outcomes have been discussed.
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Affiliation(s)
- Jonathan A Mailey
- Cardiology Department, Royal Victoria Hospital, Belfast, United Kingdom
| | - Mark S Spence
- Cardiology Department, Royal Victoria Hospital, Belfast, United Kingdom
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13
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Milasinovic D, Stankovic G. Towards a common pathway for the treatment of left main disease: contemporary evidence and future directions: Left main disease treatment. ASIAINTERVENTION 2021; 7:85-95. [PMID: 34913011 PMCID: PMC8670569 DOI: 10.4244/aij-d-21-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 06/14/2023]
Abstract
There is increasing evidence to support percutaneous treatment of left main (LM) disease. Due to its major clinical impact, any procedure in the left main should be meticulously planned and performed. In this review, we aim to integrate the available evidence into a common treatment pathway, starting with understanding the distinct anatomical features of the left main. A three-level decision-making process is presented. First, in instances of angiographic ambiguity, intravascular ultrasound and fractional flow reserve can be used to decide if revascularisation could be deferred. Second, if revascularisation is indicated, the risks and benefits of percutaneous versus surgical procedures should be evaluated. Third, if percutaneous coronary intervention (PCI) is chosen, the operator should decide between the provisional single-stent versus upfront two-stent strategies. Regardless of the PCI technique selected, it should be performed according to the recommendations of a stepwise procedure utilising proximal optimisation (POT) after each instance of crossover stenting and kissing balloon inflation (KBI) where necessary. In addition to the recognised quality markers such as POT and KBI, we discuss the clinical relevance of the operator's LM PCI experience and the intracoronary imaging guidance when treating patients with left main disease.
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Affiliation(s)
- Dejan Milasinovic
- University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia, Pasterova 2, Belgrade 11000, Serbia. E-mail:
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14
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Saleem S, Ullah W, Mukhtar M, Sarvepalli D, Younas S, Arab SA, Al Hemyari B, Zahid S, Nazir S, Cheema T, Mir T, Abdul-Waheed M. Angiographic-only or intravascular ultrasound-guided approach for left-main coronary artery intervention: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2021; 19:1029-1035. [PMID: 34747315 DOI: 10.1080/14779072.2021.2004122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The use of intravascular ultrasound (IVUS) in percutaneous revascularization of left-main coronary artery disease (LMCAD) warrants further exploration. We aimed to collate all available data on the merits of IVUS in LMCAD to help decision-making. METHODS The MEDLINE, Embase, and Cochrane databases were queried for relevant randomized controlled trials (RCTs) and observational cohort studies (OCS). The data were analyzed using random-effects model to calculate unadjusted odds ratio (OR) between IVUS-guided and angiography-only LMCA revascularization. RESULTS A total of 14 studies (2 RCTs and 12 OCS), comprising 18944 patients, were included. The pooled odds of all-cause mortality (OR 0.57, 95%CI 0.46-0.70, p = <0.00001), cardiovascular mortality (OR 0.37, 95%CI 0.26-0.54, p = <0.00001), left-main revascularization (OR 0.63, 95%CI 0.45-0.89, p = 0.009) and myocardial infarction (OR 0.80, 95% CI 0.66-0.97, p = 0.02) were significantly lower with IVUS-guidance. There was no difference observed in the odds of the stent thrombosis (OR 0.57, 95% CI 0.31-1.05, p = 0.07) and stroke (OR 1.7, 95%CI 0.56-5.14, p = 0.35) between the two groups. A subgroup analysis based on the study design and follow-up duration mirrored the pooled estimates. CONCLUSION IVUS-guided LMCA intervention is associated with overall improved cardiovascular outcomes than the angiography-only approach. This needs to be tested in a large randomized controlled trial.
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Affiliation(s)
- Sameer Saleem
- Cardiovascular Medicine, University of Kentucky, Lexington, USA
| | - Waqas Ullah
- Cardiovascular Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maryam Mukhtar
- Cardiovascular Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Sundas Younas
- Cardiovascular Medicine, Western Kentucky Heart and Lung, Bowling Green, KY
| | - Shuaib Ahmed Arab
- Cardiovascular Medicine, Western Kentucky Heart and Lung, Bowling Green, KY
| | | | - Salman Zahid
- Cardiovascular Medicine Rochester General Hospital, Rochester, USA
| | - Salik Nazir
- Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Tayyab Cheema
- Cardiovascular Medicine, West Suburban Medical Center, Oak Park, IL, USA
| | - Tanveer Mir
- Cardiovascular Medicine, Detroit Medical Center, Detroit, MI, USA
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15
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Cortese B, de la Torre Hernandez JM, Lanocha M, Ielasi A, Giannini F, Campo G, D'Ascenzo F, Latini RA, Krestianinov O, Alfonso F, Trani C, Prati F, Linares JA, Sardella G, Wlodarczak A, Viganò E, Camarero TG, Stella P, Sozykin A, Fineschi M, Burzotta F. Optical coherence tomography, intravascular ultrasound or angiography guidance for distal left main coronary stenting. The ROCK cohort II study. Catheter Cardiovasc Interv 2021; 99:664-673. [PMID: 34582631 DOI: 10.1002/ccd.29959] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 08/07/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES to test the safety and efficacy of intravascular imaging and specifically optical coherence tomography (OCT) as a diagnostic tool for left main angioplasty and analyze the mid-term outcome accordingly. BACKGROUND Clinical data and international guidelines recommend the use of intravascular imaging ultrasound (IVUS) to guide left main (LM) angioplasty. Despite early experience using OCT in this setting is encouraging, the evidence supporting its use is still limited. METHODS ROCK II is a multicenter, investigator-driven, retrospective European study to compare the performance of IVUS and OCT versus angiography in patients undergoing distal-LM stenting. The primary study endpoint was target-lesion failure (TLF) including cardiac death, target-vessel myocardial infarction and target-lesion revascularization. We designed this study hypothesizing the superiority of intravascular imaging over angiographic guidance alone, and the non-inferiority of OCT versus IVUS. RESULTS A total of 730 patients, 377 with intravascular-imaging guidance (162 OCT, 215 IVUS) and 353 with angiographic guidance, were analyzed. The one-year rate of TLF was 21.2% with angiography and 12.7% with intravascular-imaging (p = 0.039), with no difference between OCT and IVUS (p = 0.26). Intravascular-imaging was predictor of freedom from TLF (HR 0.46; 95% CI 0.23-0.93: p = 0.03). Propensity-score matching identified three groups of 100 patients each with no significant differences in baseline characteristics. The one-year rate of TLF was 16% in the angiographic, 7% in the OCT and 6% in the IVUS group, respectively (p = 0.03 for IVUS or OCT vs. angiography). No between-group significant differences in the rate of individual components of TLF were found. CONCLUSIONS Intravascular imaging was superior to angiography for distal LM stenting, with no difference between OCT and IVUS.
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Affiliation(s)
- Bernardo Cortese
- Cardiovascular Department, Clinica Polispecialistica San Carlo, Paderno Dugnano, Milano, Italy.,Cardiovascular Department, Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy.,Cardiovascular Department, San Carlo Clinic, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | | | - Magdalena Lanocha
- Cardiovascular Department, Poznań University of Medical Sciences, Poznan, Poland
| | - Alfonso Ielasi
- Cardiovascular Department, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Francesco Giannini
- Cardiovascular Department, Interventional Cardiology, GVM, Cotignola, Italy
| | - Gianluca Campo
- Cardiovascular Department, Interventional Cardiology, University of Ferrara, Ferrara, Italy
| | - Fabrizio D'Ascenzo
- Cardiovascular Department, Division of Cardiology, University of Turin, Città della Salute e Della Scienza, Torino, Italy
| | - Roberto A Latini
- Cardiovascular Department, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Oleg Krestianinov
- Cardiovascular Department, Interventional Cardiology, NRTCP Novosibirisk, Russia
| | - Fernando Alfonso
- Cardiovascular Department, Hospital Universitario del la Princesa, Madrid, Spain
| | - Carlo Trani
- Cardiovascular Department, Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Prati
- Cardiovascular Department, Cardiology Unit, Ospedale San Giovanni, Rome, Italy
| | - Jose A Linares
- Cardiovascular Department, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | - Gennaro Sardella
- Cardiovascular Department, Interventional Cardiology, Policlinico Umberto I, Rome, Italy
| | - Adrian Wlodarczak
- Cardiovascular Department, Poznań University of Medical Sciences, Poznan, Poland
| | - Elena Viganò
- Cardiovascular Department, San Carlo Clinic, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | - Tamara Garcia Camarero
- Cardiovascular Department, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Pieter Stella
- Cardiovascular Department, Interventional Cardiology, UMC Utrecht, The Netherlands
| | - Alexander Sozykin
- Cardiovascular Department, Russian Academy of Science, Moscow, Russia
| | - Massimo Fineschi
- Cardiovascular Department, Interventional Cardiology, Policlinico Le Scotte, Siena, Italy
| | - Francesco Burzotta
- Cardiovascular Department, Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
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16
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Abstract
Intravascular imaging using both intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have become important tools in the Interventional Cardiologists armamentarium. However, in some centers, intravascular imaging is not widely employed. A number of reasons for this may exist, including lack of training in the use of intravascular imaging. Co-registration with angiography may be a helpful tool for those beginning to use both IVUS and OCT in the cath lab, and may reduce the learning curve associated with its use. For experienced operators, co-registration can shorten procedure time and lessen contrast use which may be particularly important when performing complex or multivessel PCI. As a research tool, co-registration can allow for accurate comparison of interval intravascular images. In this review, we will discuss how to acquire co-registered images using both IVUS and OCT systems, and the potential advantages of this technology over non-co-registered images, and indeed angiography alone.
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Affiliation(s)
- Angela McINERNEY
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Javier Escaned
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Nieves Gonzalo
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain -
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17
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Amabile N, Rangé G, Souteyrand G, Godin M, Boussaada M, Meneveau N, Cayla G, Casassus F, Lefèvre T, Hakim R, Bagdadi I, Motreff P, Caussin C. Optical coherence tomography to guide percutaneous coronary intervention of the left main coronary artery: the LEMON study. EUROINTERVENTION 2021; 17:e124-e131. [PMID: 33226003 PMCID: PMC9724912 DOI: 10.4244/eij-d-20-01121] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Intravascular ultrasound (IVUS)-guided PCI improves the prognosis of left main stem (LMS) PCI and is currently recommended by international guidelines. Although OCT resolution is greater than that of IVUS, this tool is not yet recommended in LMS angioplasty due to the absence of data. AIMS This pilot study aimed to analyse the feasibility, safety and impact of OCT-guided LMS PCI. METHODS This prospective, multicentre trial investigated whether patients might benefit from OCT-guided PCI for mid/distal LMS according to a pre-specified protocol. The primary endpoint was procedural success defined as follows: residual angiographic stenosis <50% + TIMI 3 flow in all branches + adequate OCT stent expansion (LEMON criteria). RESULTS Seventy patients were included in the final analysis (median age: 72 [64-81] years, 73% male). The OCT pre-specified protocol was applied in all patients. The primary endpoint was achieved in 86% of subjects. Adequate stent expansion was observed in 86%, significant edge dissection in 30% and residual significant strut malapposition in 24% of the cases. OCT guidance modified the operators' strategy in 26% of the patients. The rate of one-year survival free from major adverse clinical events was 98.6% (97.2-100). CONCLUSIONS This pilot study is the first to report the feasibility and performance of OCT-guided LMS PCI according to a pre-specified protocol.
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Affiliation(s)
- Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France
| | - Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | - Geraud Souteyrand
- Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne, Clermont Ferrand, France
| | - Matthieu Godin
- Cardiology Department, Clinique St Hilaire, Rouen, France
| | - Mohamed Boussaada
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Meneveau
- Department of Cardiology, EA3920, University Hospital Jean Minjoz, Besançon, France
| | - Guillaume Cayla
- Cardiology Department, CHU Nimes, University of Montpellier, Nimes, France
| | | | - Thierry Lefèvre
- Institut Cardio-Vasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Radwane Hakim
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | - Imane Bagdadi
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Pascal Motreff
- Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne, Clermont Ferrand, France
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18
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Radu Juul Jensen M, Räber L. Fruitful new data on left main PCI: the LEMON study. EUROINTERVENTION 2021; 17:e97-e99. [PMID: 34110285 PMCID: PMC9725080 DOI: 10.4244/eijv17i2a17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Maria Radu Juul Jensen
- Department of Cardiology, Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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19
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Debate: The role of percutaneous coronary intervention for left main disease after EXCEL and NOBEL trials. ACTA ACUST UNITED AC 2021; 74:651-654. [PMID: 33653671 DOI: 10.1016/j.rec.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/18/2020] [Indexed: 11/21/2022]
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20
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de la Torre Hernández JM. Debate: Papel de la revascularización percutánea del tronco coronario izquierdo tras los ensayos EXCEL y NOBLE. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Lazkani M, Tripathi B, Dattilo P. Impact of intracoronary imaging on in‐hospital mortality and 30‐day readmission rates following percutaneous coronary intervention: A nationwide readmissions database analysis. Catheter Cardiovasc Interv 2020; 98:1082-1094. [DOI: 10.1002/ccd.29394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Mohamad Lazkani
- Internal medicine, Cardiovascular disease UCHealth, Medical Center of the Rockies Loveland Colorado USA
| | - Byomesh Tripathi
- Internal medicine, Cardiovascular disease Banner University Medical Center Phoenix Arizona USA
| | - Philip Dattilo
- Internal medicine, Cardiovascular disease UCHealth, Medical Center of the Rockies Loveland Colorado USA
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22
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Case BC, Yerasi C, Forrestal BJ, Shlofmitz E, Garcia-Garcia HM, Mintz GS, Waksman R. Intravascular ultrasound guidance in the evaluation and treatment of left main coronary artery disease. Int J Cardiol 2020; 325:168-175. [PMID: 33039578 DOI: 10.1016/j.ijcard.2020.10.008] [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: 08/26/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 01/17/2023]
Abstract
Percutaneous coronary intervention (PCI) of left main coronary artery (LMCA) disease has become an acceptable revascularization strategy. Evaluating the extent and characteristics of obstructive disease of the LMCA by angiography is challenging and limited in its accuracy. In contrast, intravascular ultrasound (IVUS) provides accurate imaging of the coronary lumen as well as quantitative measurements and quantitative assessment of the vessel wall components. IVUS for LMCA PCI should be performed before, during, and after intervention; IVUS enhances every step in the procedure and is associated with a mortality advantage in comparison with angiographic guidance alone. In this review, we provide an update on LMCA PCI and the role of IVUS for lesion assessment and stent optimization. In addition, the latest clinical evidence of the benefits of IVUS-guided LMCA PCI as compared to angiography is reviewed.
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Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Gary S Mintz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America.
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23
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de la Torre Hernandez JM. Intravascular ultrasound in percutaneous coronary intervention for in-stent chronic total occlusion: guidance for long-term success. EUROINTERVENTION 2020; 16:e445-e447. [PMID: 32763863 DOI: 10.4244/eijv16i6a80] [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: 11/23/2022]
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24
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Maehara A, Mintz GS, Stone GW. IVUS guidance during left main PCI: not if, but when and how. EUROINTERVENTION 2020; 16:189-191. [PMID: 32597762 DOI: 10.4244/eijv16i3a32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Akiko Maehara
- Columbia University Medical Center, New York, NY, USA
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25
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Stankovic G, Milasinovic D, Mehmedbegovic Z. Left main PCI: are we giving the kiss the attention it deserves? EUROINTERVENTION 2020; 16:192-194. [PMID: 32597763 DOI: 10.4244/eijv16i3a33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
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