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Güner A, Güner EG, Uzun F. Letter: Cardiovascular outcomes after 2-stent or stepwise provisional techniques for coronary bifurcation lesions. EUROINTERVENTION 2024; 20:e457. [PMID: 38562071 PMCID: PMC10979379 DOI: 10.4244/eij-d-24-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Ahmet Güner
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ezgi Gültekin Güner
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatih Uzun
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Dérimay F, Aminian A, Lattuca B, Souteyrand G, Maillard L, Alvain S, Cayla G, Motreff P, Bochaton T, Hayek A, Rioufol G, Finet G. One year results of coronary bifurcation revascularization with the re-POT provisional sequential technique. The CABRIOLET registry. Int J Cardiol 2024; 397:131632. [PMID: 38048882 DOI: 10.1016/j.ijcard.2023.131632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/18/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Re-POT (proximal optimization technique (POT)) is a simple provisional sequential technique for percutaneous coronary bifurcation revascularization with better arterial geometry respect compared to classical techniques. Re-POT has demonstrated excellent mechanical and short-term clinical results. The multicenter CABRIOLET registry (NCT03550196) evaluate the long-term clinical benefit of the re-POT sequence in non-selected patients. METHODS All consecutive patients presenting a coronary bifurcation lesion for which provisional stenting was indicated were included in 5 european centers. Re-POT strategy was systematically attempted. The primary endpoint was target lesion failure (TLF), comprising cardiac death, myocardial infarction, stent thrombosis and target lesion revascularization (TLR) at 12 months' follow-up. The secondary endpoints were the individual components of the primary endpoint, all-cause death, target vessel failure (TVF) and target vessel revascularization (TVR). Complex bifurcation was defined as Medina 0.1.1 or 1.1.1. RESULTS A total of 500 patients aged 67.7 ± 11.7 years, 78.4% male, were included from 2015 to 2019, 174 of whom (34.8%) were considered having complex bifurcation lesions. Bifurcations involved the left main in 35.2% of cases. The full re-POT sequence was systematically performed in all cases. At 1 year, TLF was 2.0% (1.7% in complex vs. 2.1% in non-complex bifurcation; p = NS), and TLR was 1.6%, (1.1% vs. 1.8% respectively; p = NS). TVF and TVR rates were 3.2% and 2.8%. On multivariate analysis, only multivessel disease was predictive of TLF at 1 year (OR = 1.66 (1.09-2.53), p = 0.02). CONCLUSIONS In this large prospective all-comer registry, provisional stenting with re-POT technique appeared safe and effective at 1 year, without anatomical bifurcation restriction.
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Affiliation(s)
- François Dérimay
- Department of Interventional Cardiology, Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France.
| | - Adel Aminian
- Cardiology Department, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Benoit Lattuca
- ACTION Study Group, Cardiology Department, Centre Hospitalier Universitaire de Nimes, Nimes, France
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Sean Alvain
- Department of Interventional Cardiology, Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
| | - Guillaume Cayla
- ACTION Study Group, Cardiology Department, Centre Hospitalier Universitaire de Nimes, Nimes, France
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Bochaton
- INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France; Department of Intensive Cardiac Care, Cardiovascular Hospital, Hospices Civils de Lyon, Bron, France
| | - Ahmad Hayek
- INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France; Department of Intensive Cardiac Care, Cardiovascular Hospital, Hospices Civils de Lyon, Bron, France
| | - Gilles Rioufol
- Department of Interventional Cardiology, Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France
| | - Gérard Finet
- Department of Interventional Cardiology, Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France
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Volet C, Puricel S, Cook ST, di Cicco P, Faucherre Y, Arroyo D, Togni M, Cook S. Proximal optimization technique and percutaneous coronary intervention for left main disease: POTENTIAL-LM. Catheter Cardiovasc Interv 2024; 103:417-424. [PMID: 38297989 DOI: 10.1002/ccd.30961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/27/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Optimal stent deployment in left main (LM) bifurcation is paramount, and incomplete stent apposition may cause major adverse cardiac events (MACE). Bench studies show that the proximal optimization technique (POT) provides the best stent apposition. AIMS We aimed to investigate the impact of POT on clinical outcomes in patients treated for unprotected LM (ULM) disease at our institution. METHODS We identified 162 patients who underwent percutaneous coronary intervention (PCI) for ULM coronary disease in the Cardio-FR database. Out of these, 99 (61%) had undergone POT, while 63 patients were treated without POT. The primary outcome was the bifurcation-oriented composite endpoint (BOCE) of cardiac death, target-bifurcation myocardial infarction and target-bifurcation revascularization at maximal follow-up. RESULTS Mean age was 76 years, and 69% presented with acute coronary syndrome. Mean follow-up was 2.25 years (822 days). The BOCE occurred in 43 (27%) of which 20 (20%) in the POT group and 23 (37%) in the no-POT group (p = 0.009). Cardiac death occurred in 15 (15%) patients in the POT- and 17 (27%) in no-POT group (p = 0.26). Target bifurcation revascularization occurred in 4 (4%) patients in the POT- and 6 (10%) patients in the no-POT group (p = 0.19). POT In the multivariate analysis, POT was the strongest parameter and was associated with BOCE, cardiac death, occurrence of any revascularization and all-cause mortality. CONCLUSION The POT improves clinical outcomes. These findings strongly support the systematic use of POT in patients undergoing ULM-PCI.
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Affiliation(s)
- Corentin Volet
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | - Serban Puricel
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | - Selma T Cook
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | | | | | - Diego Arroyo
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | - Mario Togni
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
| | - Stéphane Cook
- Cardiology, University & Hospital Fribourg, Fribourg, Switzerland
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4
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Gao C, Li D, Dai H, Liu H, Liu P, Cheng M, Zhang M, Guo W. Review of Progress in Interventional Therapy for Coronary Bifurcation Lesions. Rev Cardiovasc Med 2024; 25:2. [PMID: 39077661 PMCID: PMC11262401 DOI: 10.31083/j.rcm2501002] [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: 06/28/2023] [Revised: 10/10/2023] [Accepted: 10/24/2023] [Indexed: 07/31/2024] Open
Abstract
Despite a decade of extensive research and clinical insights, percutaneous coronary intervention strategies for coronary bifurcation lesions have remained a challenging and highly debated area. This article presents a review of the latest findings and advances in defining and classifying coronary bifurcation lesions, in vitro studies, intracoronary imaging, stenting strategies, and the deployment of drug-coated balloons. Based on current evidence, this review provides recommendations for interventional cardiologists to develop individualized interventional strategies and enhance the efficiency of stenting procedures.
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Affiliation(s)
- Chuncheng Gao
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, 710038 Xi’an, Shaanxi, China
| | - Dongdong Li
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, 710038 Xi’an, Shaanxi, China
| | - Huimiao Dai
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, 710038 Xi’an, Shaanxi, China
| | - Hao Liu
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, 710038 Xi’an, Shaanxi, China
| | - Pengyun Liu
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, 710038 Xi’an, Shaanxi, China
| | - Miaomiao Cheng
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, 710038 Xi’an, Shaanxi, China
| | - Mingming Zhang
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, 710038 Xi’an, Shaanxi, China
| | - Wangang Guo
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, 710038 Xi’an, Shaanxi, China
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Li D, Dai H, Gao C, Liu H, Yang A, Guo W. Review of Techniques for Protecting Side Branch from Occlusion during Provisional Stenting in Coronary Bifurcation Lesions. Rev Cardiovasc Med 2023; 24:323. [PMID: 39076435 PMCID: PMC11272884 DOI: 10.31083/j.rcm2411323] [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: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 07/31/2024] Open
Abstract
Coronary bifurcation lesions remain one of the most challenging lesions for cardiology interventionists. The provisional stenting strategy has been regarded as the first option for most of these lesions. However, the main complication of this technique is side branch (SB) occlusion, which could lead to a peri-procedural myocardial infarction or even death. Various studies have focused on addressing this issue, but there are no definitive guidelines in the literature to treat these lesions. There isn't enough clinical evidence from randomized controlled trial or two-arm cohort studies to illustrate which techniques provide the best outcomes. In this review, we summarize the mechanisms, independent predictors and predictive models of SB occlusion, and review seventeen techniques involving SB protection and occlusion rescue. Every technique was evaluated according to related bench tests, clinical studies and our own clinical experiences. The aim of this review is to provide interventionists with new insights for the treatment of coronary bifurcation lesions.
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Affiliation(s)
- Dongdong Li
- Department of Cardiology, Tangdu Hospital, Air Force Medical
University, 710038 Xi'an, Shaanxi, China
| | - Huimiao Dai
- Department of Cardiology, Tangdu Hospital, Air Force Medical
University, 710038 Xi'an, Shaanxi, China
| | - Chuncheng Gao
- Department of Cardiology, Tangdu Hospital, Air Force Medical
University, 710038 Xi'an, Shaanxi, China
| | - Hao Liu
- Department of Cardiology, Tangdu Hospital, Air Force Medical
University, 710038 Xi'an, Shaanxi, China
| | - Aili Yang
- Department of Endocrinology, Tangdu Hospital, Air Force Medical
University, 710038 Xi'an, Shaanxi, China
| | - Wangang Guo
- Department of Cardiology, Tangdu Hospital, Air Force Medical
University, 710038 Xi'an, Shaanxi, China
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Yamawaki M, Murasato Y, Watanabe Y, Kinoshita Y, Okubo M, Yumoto K, Masuda N, Otake H, Aoki J, Nakazawa G, Numasawa Y, Ito T, Shite J, Okamura T, Takagi K, Kozuma K, Lefèvre T, Chevalier B, Louvard Y, Suzuki N, Kozuma K. Impact of coronary bifurcation angle on stent malapposition in a randomized comparison between proximal optimization technique followed by side branch dilatation and kissing balloon inflation. IJC HEART & VASCULATURE 2023; 48:101265. [PMID: 37680550 PMCID: PMC10480620 DOI: 10.1016/j.ijcha.2023.101265] [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: 04/12/2023] [Revised: 07/12/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
Background The impact of coronary bifurcation angle (BA) on incomplete stent apposition (ISA) after crossover stenting followed by side branch (SB) intervention has not been established. Methods A total of 100 crossover stentings randomly treated with proximal optimization technique followed by short balloon dilation in the SB (POT-SBD group, 48 patients) and final kissing balloon technique (KBT group, 52 patients) were analyzed in the PROPOT trial. Major ISA with maximum distance > 400 μm and its location was determined using optical coherence tomography before SB intervention and at the final procedure. The BA was defined as the angle between the distal main vessel and SB. Optimal POT was determined when the difference in stent volume index between the proximal and distal bifurcation was greater than the median value (0.86 mm3/mm) before SB intervention. Result Major ISA was more frequently observed in the POT-SBD than in the KBT group (35% versus 17%, p < 0.05). In the POT-SBD group, worsening ISA after SBD was prominent at the distal bifurcation. The BA was an independent predictor of major ISA (odds ratio 1.04, 95% confidence interval 1.00-1.07, p < 0.05) with a cut-off value of 59.5° (p < 0.05). However, the cases treated with optimal POT in the short BA (<60°) indicated the lowest incidence of major ISA. In the KBT group, BA had no significant impact. Conclusion A wide BA has a potential risk for the occurrence of major ISA after POT followed by SBD in coronary bifurcation stenting.
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Affiliation(s)
- Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yusuke Watanabe
- Department of Medicine, Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | | | - Munenori Okubo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Kazuhiko Yumoto
- Department of Cardiology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Naoki Masuda
- Department of Cardiology, Ageo Central General Hospital, Ageo, Japan
| | - Hiromasa Otake
- Department of Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jiro Aoki
- Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Tatsuya Ito
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Takayuki Okamura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kayoko Kozuma
- Department of Biostatistics, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Thierry Lefèvre
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Bernard Chevalier
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Yves Louvard
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Nobuaki Suzuki
- Division of Cardiology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Ken Kozuma
- Department of Medicine, Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
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Khelimskii D, Bessonov I, Kashtanov M, Sapozhnikov S, Badoian A, Baranov A, Manukyan S, Utegenov R, Krestyaninov O. Long-term clinical outcomes after kissing balloon inflation in patients with coronary bifurcation lesions treated with provisional stenting technique. Results from the real-world multicenter registry. Indian Heart J 2023; 75:313-320. [PMID: 37178866 PMCID: PMC10568054 DOI: 10.1016/j.ihj.2023.05.003] [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: 03/29/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE There is a lack of data regarding the long-term clinical efficacy of the kissing balloon inflation (KBI) after provisional stenting of coronary bifurcation lesions. The aim of this study was to analyze the impact of KBI on long-term clinical outcomes in patients undergoing provisional stenting for the coronary bifurcation lesions in a large real-world population. METHODS A total of 873 patients who underwent percutaneous coronary interventions (PCI) with provisional stenting and had clinical follow up were analyzed. Patients treated with 2-stent strategy were excluded. To reduce the effect of potential confounding factors in this observational study, propensity score matching was conducted. RESULTS KBI was performed in 325 patients (37.2%). The median follow-up duration was 37.3 months. Patients treated with KBI more often had a previous PCI (48.6% vs. 42.5% SMD = 0.123). Patients in non-kissing group had more complex coronary disease with higher prevalence of calcification (14.8% vs. 21.4% SMD = 0.172), thrombosis (2.8% vs. 5.8% SMD = 0.152) and longer side branch lesions (8.3% vs. 11.7% SMD = 0.113). There were no significant differences in the major adverse cardiac events including death, myocardial infarction, target lesion revascularization after KBI versus no KBI (15.4% vs. 15.7%, p = 0.28), in total cohort or in matched patients (17.1% vs. 15.8%, adjusted HR 1.01, 95% CI: 0.65-1.65, p = 0.95). The lack of effect of KBI on clinical outcomes was consistent across various subgroups including left main disease. CONCLUSION In this multicenter real-world registry, KBI did not improve long-term clinical outcomes in patients with coronary bifurcation lesions treated with provisional stenting technique.
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Affiliation(s)
- Dmitrii Khelimskii
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation.
| | - Ivan Bessonov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 625026, Russian Federation
| | - Maksim Kashtanov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 625026, Russian Federation; Ural Federal University, Ekaterinburg, Russian Federation
| | - Stanislav Sapozhnikov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 625026, Russian Federation
| | - Aram Badoian
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Aleksey Baranov
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Serezha Manukyan
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Ruslan Utegenov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 625026, Russian Federation
| | - Oleg Krestyaninov
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
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Gautier A, Roffi M, Laanmets P, Munir S, Malik FTN, Romo AI, Maluenda G, Kuramitsu S, Angioi M, Wijns W, Saito S, Chevalier B. Complementary evidence on the performance of coronary stents generated by a randomized controlled trial and a worldwide registry. Am Heart J 2023; 261:35-44. [PMID: 36931370 DOI: 10.1016/j.ahj.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Large-scale registries can provide valuable complementary data to randomized controlled trials (RCT) for the postmarketing evaluation of coronary stents, but their scientific relevance remains debated. METHODS We sought to compare the evidence on the performance of a single coronary stent platform generated by the RCT for its regulatory approval and a well-conducted international registry. Patients treated with the Ultimaster coronary stent in the CENTURY II (CII-UM) trial (n = 551) were compared to patients in the real-world e-ULTIMASTER (e-UM) registry (n = 35,389). All major events were adjudicated by an independent clinical event committee in both studies. Propensity weighted analysis was used to balance baseline and procedural differences between the 2 populations. RESULTS Coronary artery disease was more complex in e-UM compared to CII-UM, including more acute coronary syndromes, multivessel disease, left main, arterial, or venous grafts, and chronic total occlusions (P < .005 for all). At one-year follow-up and after excluding periprocedural myocardial infarction (MI) there was no statistically significant difference between CII-UM and e-UM regarding all-cause death (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.26-1.20, P = .14), cardiac death (HR 0.71, 95% CI 0.29-1.72, P = .45), target lesion failure (HR 1.18, 95% CI 0.78-1.78, P = .44), and target vessel MI (HR 0.76, 95% CI 0.24-2.38, P = .63). However, target vessel revascularization rate was significantly higher in CII-UM than in e-UM, HR 1.78, 95% CI 1.23-2.56, P = .002. CONCLUSIONS A well-conducted large-scale registry can provide valuable complementary evidence to RCTs on the postmarket performance of new coronary stents, across a wider range of uses and various geographic areas.
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Affiliation(s)
- Alexandre Gautier
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Marco Roffi
- Division of Cardiology, University Hospitals, Geneva, Switzerland
| | - Peep Laanmets
- North Estonia Medical Center Foundation, Tallinn, Estonia
| | - Shahzad Munir
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | | | | | - Gabriel Maluenda
- San Borja Arriaran Hospital and University of Chile, Santiago de Chile, Chile
| | - Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | - William Wijns
- Department of Cardiology, National University of Ireland Galway, Galway Ireland
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Bernard Chevalier
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France.
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Li D, Gao C, Dai H, Liu H, Li J, Guo W. Must absolutely accurate balloon position be achieved during POT? More in vitro tests, but less clinical evidence. Front Cardiovasc Med 2023; 10:1166020. [PMID: 37265569 PMCID: PMC10229867 DOI: 10.3389/fcvm.2023.1166020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/28/2023] [Indexed: 06/03/2023] Open
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10
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Arunothayaraj S, Behan MW, Lefèvre T, Lassen JF, Chieffo A, Stankovic G, Burzotta F, Pan M, Ferenc M, Hovasse T, Spence MS, Brunel P, Cotton JM, Cockburn J, Carrié D, Baumbach A, Maeng M, Louvard Y, Hildick-Smith D. Stepwise provisional versus systematic culotte for stenting of true coronary bifurcation lesions: five-year follow-up of the multicentre randomised EBC TWO Trial. EUROINTERVENTION 2023; 19:EIJ-D-23-00211. [PMID: 37946522 PMCID: PMC10333921 DOI: 10.4244/eij-d-23-00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The multicentre European Bifurcation Club Trial (EBC TWO) showed no significant differences in 12-month clinical outcomes between patients randomised to a provisional stenting strategy or systematic culotte stenting in non-left main true bifurcations. AIMS This study aimed to investigate the 5-year clinical results of the EBC TWO Trial. METHODS A total of 200 patients undergoing stent implantation for non-left main bifurcation lesions were recruited into EBC TWO. Inclusion criteria required a side branch diameter ≥2.5 mm and side branch lesion length >5 mm. Five-year follow-up was completed for 197 patients. The primary endpoint was the composite of all-cause mortality, myocardial infarction, or target vessel revascularisation. RESULTS The mean side branch stent diameter was 2.7±0.3 mm and mean side branch lesion length was 10.3±7.2 mm. At 5-year follow-up, the primary endpoint occurred in 18.4% of provisional and 23.7% of systematic culotte patients (hazard ratio [HR] 0.75, 95% confidence interval [CI]: 0.41-1.38). No significant differences were identified individually for all-cause mortality (7.8% vs 7.2%, HR 1.11, 95% CI: 0.40-3.05), myocardial infarction (8.7% vs 13.4%, HR 0.64, 95% CI: 0.27-1.50) or target vessel revascularisation (6.8% vs 9.3%, HR 1.12, 95% CI: 0.37-3.34). Stent thrombosis rates were also similar (1.9% vs 3.1%, HR 0.63, 95% CI: 0.11-3.75). There was no significant interaction between the extent of side branch disease and the primary outcome (p=0.34). CONCLUSIONS In large non-left main true bifurcation lesions, the use of a systematic culotte strategy showed no benefit over provisional stenting for the composite outcome of all-cause mortality, myocardial infarction, or target vessel revascularisation at 5 years. The stepwise provisional approach may be considered preferable for the majority of true coronary bifurcation lesions. CLINICALTRIALS gov: NCT01560455.
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Affiliation(s)
| | | | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Jens F Lassen
- Department of Cardiology B, Odense University Hospital, Odense, Denmark and University of Southern Denmark, Odense, Denmark
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Goran Stankovic
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Francesco Burzotta
- Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba, (IMIBIC), Cordoba, Spain
| | - Miroslaw Ferenc
- University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Philippe Brunel
- Hôpital privé Dijon Bourgogne, Clinique Valmy, Dijon, France
| | - James M Cotton
- Royal Wolverhampton University Hospital NHS Trust, Wolverhampton, UK
| | - James Cockburn
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Didier Carrié
- Department of Cardiology, Toulouse University, Rangueil Hospital, Toulouse, France
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital & Aarhus University, Aarhus, Denmark
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Hôpital privé Jacques Cartier, Ramsay Santé, Massy, France
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11
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Moț ȘDC, Șerban AM, Achim A, Dădârlat-Pop A, Tomoaia R, Pop D. Clinical Characteristics and Outcomes following Percutaneous Coronary Intervention in Unprotected Left Main Disease: A Single-Center Study. Diagnostics (Basel) 2023; 13:diagnostics13071333. [PMID: 37046550 PMCID: PMC10093002 DOI: 10.3390/diagnostics13071333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Background: Hemodynamically significant unprotected left main (LM) coronary artery disease is a high-risk clinical condition because of the large area of myocardium at risk, and it requires prompt revascularization. Percutaneous coronary intervention (PCI) is an appropriate alternative to coronary artery bypass grafting (CABG) for revascularization of unprotected LM disease in patients with low-to-intermediate anatomic complexity or when the patient refuses CABG after adequate counseling by the heart team. Methods: We retrospectively evaluated 201 patients receiving left main (LM) provisional one-stent or two-stent procedures, and we assessed the clinical characteristics and outcomes of patients undergoing unprotected LM PCI. Results: The mean age was 66.5 ± 9.9 years, and 72% were male. The majority of the subjects presented several cardiovascular risk factors, among which arterial hypertension (179 patients, 89.5%) and dyslipidemia (173 patients, 86.5%) were the most frequent. Out of all patients, 162 (81.8%) underwent revascularization by using the one-stent technique, while the two-stent technique was used in 36 patients (18.2%). The median value of fractional flow reserve (FFR) of the side branch was 0.9 [0.85–0.95], and 135 patients (67.1%) showed a value of FFR > 0.8. One hundred nine patients (54.2%) had a stent enhancement side branch length (SESBL) > 2, with median values of 2.5 mm2 [2.1–3]. Regarding angiographic parameters, the LM area as assessed by intravascular ultrasound (IVUS) or optical coherence tomography (OCT) and the grade of stenosis as assessed by quantitative coronary angiography (QCA) were similar between groups. However, patients who required revascularization by using the two-stent technique presented more frequently with intermediate rather than low SYNTAX scores (69.4% vs. 28.4%, p < 0.0001). Also, the same group required kissing balloon inflation (KBI) more frequently (69.4% vs. 30%, p < 0.001). There were no differences regarding the success of revascularization between the use of the one-stent or two-stent technique. FFR was able to predict a SESBL > 2 mm. The cut-off value for FFR to afford the highest degree of sensitivity (74.5%) and specificity (47%) for a SESBL > 2 was >0.86, indicating a moderate accuracy (AUC = 0.61, 95% CI 0.525–0.690, p = 0.036). Conclusions: Unprotected left main PCI is a safe and effective revascularization option amongst a complex and morbid population. There were no differences regarding the success of revascularization between the use of the one-stent or two-stent technique, and there was no significant impact of KBI on side branch FFR measurements but lower side branch FFR values were correlated with angiographic side branch compromise.
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Affiliation(s)
- Ștefan Dan Cezar Moț
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Adela Mihaela Șerban
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alexandru Achim
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- Cardiology Department, Kantonsspital Baselland, 4410 Liestal, Switzerland
| | - Alexandra Dădârlat-Pop
- Cardiology Department, Heart Institute Niculae Stăncioiu, 19-21 Motilor Street, 400001 Cluj-Napoca, Romania
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Raluca Tomoaia
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Cardiology, Clinical Rehabilitation Hospital, 400347 Cluj-Napoca, Romania
| | - Dana Pop
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Cardiology, Clinical Rehabilitation Hospital, 400347 Cluj-Napoca, Romania
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12
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Musumeci G, Annibali G. Keep it simple. Catheter Cardiovasc Interv 2023; 101:947-948. [PMID: 36906803 DOI: 10.1002/ccd.30609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/13/2023]
Affiliation(s)
- Giuseppe Musumeci
- Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano Umberto I, Turin, Italy
| | - Gianmarco Annibali
- Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano Umberto I, Turin, Italy
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13
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Arunothayaraj S, Lassen JF, Clesham GJ, Spence MS, Koning R, Banning AP, Lindsay M, Christiansen EH, Egred M, Cockburn J, Mylotte D, Brunel P, Ferenc M, Hovasse T, Wlodarczak A, Pan M, Silvestri M, Erglis A, Kretov E, Chieffo A, Lefèvre T, Burzotta F, Darremont O, Stankovic G, Morice MC, Louvard Y, Hildick-Smith D. Impact of technique on bifurcation stent outcomes in the European Bifurcation Club Left Main Coronary Trial. Catheter Cardiovasc Interv 2023; 101:553-562. [PMID: 36709485 DOI: 10.1002/ccd.30575] [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: 07/08/2022] [Revised: 08/18/2022] [Accepted: 01/15/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Techniques for provisional and dual-stent left main bifurcation stenting require optimization. AIM To identify technical variables influencing procedural outcomes and periprocedural myocardial infarction following left main bifurcation intervention. METHODS Procedural and outcome data were analyzed in 438 patients from the per-protocol cohort of the European Bifurcation Club Left Main Trial (EBC MAIN). These patients were randomized to the provisional strategy or a compatible dual-stent extension (T, T-and-protrude, or culotte). RESULTS Mean age was 71 years and 37.4% presented with an acute coronary syndrome. Transient reduction of side vessel thrombolysis in myocardial infarction flow occurred after initial stent placement in 5% of procedures but was not associated with periprocedural myocardial infarction. Failure to rewire a jailed vessel during any strategy was more common when jailed wires were not used (9.5% vs. 2.5%, odds ratio [OR]: 6.4, p = 0.002). In the provisional cohort, the use of the proximal optimization technique was associated with less subsequent side vessel intervention (23.3% vs. 41.9%, OR: 0.4, p = 0.048). Side vessel stenting was predominantly required for dissection, which occurred more often following side vessel preparation (15.3% vs. 4.4%, OR: 3.1, p = 0.040). Exclusive use of noncompliant balloons for kissing balloon inflation was associated with reduced need for side vessel intervention in provisional cases (20.5% vs. 38.5%, OR: 0.4, p = 0.013), and a reduced risk of periprocedural myocardial infarction across all strategies (2.9% vs. 7.7%, OR: 0.2, p = 0.020). CONCLUSION When performing provisional or compatible dual-stent left main bifurcation intervention, jailed wire use is associated with successful jailed vessel rewiring. Side vessel preparation in provisional patients is linked to increased side vessel dissection requiring stenting. Use of the proximal optimization technique may reduce the need for additional side vessel intervention, and noncompliant balloon use for kissing balloon inflation is associated with a reduction in both side vessel stenting and periprocedural myocardial infarction. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02497014.
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Affiliation(s)
- Sandeep Arunothayaraj
- Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
| | | | - Gerald J Clesham
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK.,Cardiovascular System Block, MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex, UK
| | - Mark S Spence
- Department of Cardiology, Belfast Health and Social Care Trust, Belfast, UK
| | - René Koning
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
| | - Adrian P Banning
- Department of Cardiology, Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mitchell Lindsay
- Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | | | - Mohaned Egred
- Department of Cardiology, Freeman Hospital & Newcastle University, Newcastle upon Tyne, UK
| | - James Cockburn
- Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Darren Mylotte
- Department of Cardiology, University Hospital and National University of Ireland, Galway, Ireland
| | - Philippe Brunel
- Interventional Cardiology Unit, Clinique de Fontaine, Dijon, France
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II, Universitäts-Herzzentrum Bad Krozingem, Bad Krozingen, Germany
| | - Thomas Hovasse
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Adrian Wlodarczak
- Department of Cardiology, Poland Miedziowe Centrum Zdrowia Lubin, Lubin, Poland
| | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba (IMIBIC), Cordoba, Spain
| | - Marc Silvestri
- Department of Cardiology, GCS Axium, Rambot, Aix en Provence, France
| | - Andrejs Erglis
- Department of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia
| | - Evgeny Kretov
- Interventional Cardiology Unit, Sibirskiy Fеdеrаl Biomedical Research Center Novosibirsk, Novosibirsk, Russia
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Thierry Lefèvre
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Olivier Darremont
- Department of Cardiology, Clinique Saint-Augustin-Elsan, Bordeaux, France
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marie-Claude Morice
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Yves Louvard
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - David Hildick-Smith
- Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
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14
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Jin X, Niu K, Shen C. Recent Evidence on Advances in PCI Treatment for Left Main Coronary Artery Disease. Rev Cardiovasc Med 2022; 23:370. [PMID: 39076197 PMCID: PMC11269061 DOI: 10.31083/j.rcm2311370] [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: 03/29/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 07/31/2024] Open
Abstract
Revascularization therapy significantly improves the outcomes of patients with left main coronary artery disease (LMCAD), compared with medical therapy alone. For many years, coronary artery bypass grafting (CABG) has been the primary and standard treatment strategy. However, with advances in percutaneous coronary intervention (PCI) techniques and improvements in patients' outcomes, there is growing evidence supporting PCI for LMCAD. In this review, we aim to integrate the available evidences on advances in PCI treatment for LMCAD and provide guidance for further clinical practice.
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Affiliation(s)
- Xian Jin
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200235 Shanghai, China
| | - Kaifan Niu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200235 Shanghai, China
| | - Chengxing Shen
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200235 Shanghai, China
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15
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Hildick-Smith D, Arunothayaraj S, Stankovic G, Chen SL. Percutaneous coronary intervention of bifurcation lesions. EUROINTERVENTION 2022; 18:e273-e291. [PMID: 35866256 PMCID: PMC9912967 DOI: 10.4244/eij-d-21-01065] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bifurcation coronary artery disease is common as the development of atherosclerosis is facilitated by altered endothelial shear stress. Multiple anatomical and physiological factors need to be considered when treating bifurcation lesions. To achieve optimal results, various stenting techniques have been developed, each with benefits and limitations. In this state-of-the-art review we describe technically important characteristics of bifurcation lesions and summarise the evidence supporting contemporary bifurcation techniques.
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Affiliation(s)
- David Hildick-Smith
- Sussex Cardiac Centre, Royal Sussex County Hospital, Eastern Road, BN2 5BE Brighton, United Kingdom
| | - Sandeep Arunothayaraj
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, United Kingdom
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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16
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Alasnag M, Mamas MA. A Frequentist Opting for the Road Less Traveled. J Am Heart Assoc 2022; 11:e026446. [PMID: 35722997 PMCID: PMC9238654 DOI: 10.1161/jaha.122.026446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mirvat Alasnag
- Cardiac CenterKing Fahd Armed Forces CenterJeddahSaudi Arabia
| | - Mamas A. Mamas
- Keele Cardiovascular Research GroupKeele UniversityStoke on TrentUnited Kingdom
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17
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Park DY, An S, Jolly N, Attanasio S, Yadav N, Rao S, Vij A. Systematic Review and Network Meta-Analysis Comparing Bifurcation Techniques for Percutaneous Coronary Intervention. J Am Heart Assoc 2022; 11:e025394. [PMID: 35723005 PMCID: PMC9238651 DOI: 10.1161/jaha.122.025394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/07/2022] [Indexed: 12/14/2022]
Abstract
Background Bifurcation lesions account for 20% of all percutaneous coronary interventions and represent a complex subset which are associated with lower procedural success and higher rates of restenosis. The ideal bifurcation technique, however, remains elusive. Methods and Results Extensive search of the literature was performed to pull data from randomized clinical trials that met predetermined inclusion criteria. Conventional meta-analysis produced pooled relative risk (RR) and 95% CI of 2-stent technique versus provisional stent on prespecified outcomes. Both frequentist and Bayesian network meta-analyses were performed to compare bifurcation techniques. A total of 8318 patients were included from 29 randomized clinical trials. Conventional meta-analysis showed no significant differences in all-cause mortality, cardiac death, major adverse cardiac events, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization between 2-stent techniques and provisional stenting. Frequentist network meta-analysis revealed that double kissing crush was associated with lower cardiac death (RR, 0.57; 95% CI, 0.38-0.84), major adverse cardiac events (RR, 0.50; 95% CI, 0.39-0.64), myocardial infarction (RR, 0.60; 95% CI, 0.39-0.90), stent thrombosis (RR, 0.50; 95% CI, 0.28-0.88), target lesion revascularization, and target vessel revascularization when compared with provisional stenting. Double kissing crush was also superior to other 2-stent techniques, including T-stent or T and protrusion, dedicated bifurcation stent, and culotte. Conclusions Double kissing crush was associated with lower risk of cardiac death, major adverse cardiac events, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization compared with provisional stenting and was superior to other 2-stent techniques. Superiority of 2-stent strategy over provisional stenting was observed in subgroup meta-analysis stratified to side branch lesion length ≥10 mm.
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Affiliation(s)
- Dae Yong Park
- Department of MedicineJohn H. Stroger Jr Hospital of Cook CountyChicagoIL
| | - Seokyung An
- Department of Biomedical ScienceSeoul National University Graduate SchoolSeoulKorea
| | - Neeraj Jolly
- Division of CardiologyRush University Medical CenterChicagoIL
| | - Steve Attanasio
- Division of CardiologyRush University Medical CenterChicagoIL
| | - Neha Yadav
- Division of CardiologyCook County HealthChicagoIL
- Division of CardiologyRush Medical CollegeChicagoIL
| | - Sunil Rao
- Duke Clinical Research Institute and Duke University Health SystemDurhamNC
| | - Aviral Vij
- Division of CardiologyCook County HealthChicagoIL
- Division of CardiologyRush Medical CollegeChicagoIL
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18
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Murasato Y, Watanabe Y, Yamawaki M, Kinoshita Y, Okubo M, Yumoto K, Masuda N, Otake H, Aoki J, Nakazawa G, Numasawa Y, Ito T, Shite J, Okamura T, Takagi K, Kozuma K, Lefèvre T, Chevalier B, Louvard Y, Suzuki N, Kozuma K. Effect of proximal optimization technique on coronary bifurcation stent failure: Insights from the multicenter randomized PROPOT trial. Catheter Cardiovasc Interv 2022; 99:1047-1058. [PMID: 35170843 DOI: 10.1002/ccd.30120] [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: 11/02/2021] [Revised: 12/24/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We investigated the effect of proximal optimization technique (POT) on coronary bifurcation stent failure (BSF) in cross-over stenting by comparing with the kissing balloon technique (KBT) in a multicenter randomized PROPOT trial. BACKGROUND POT is recommended due to increased certainty for optimal stent expansion and side branch (SB) wiring. METHODS We randomized 120 patients treated with crossover stenting into the POT group, which was followed by SB dilation (SBD), and the KBT group. Finally, 52 and 57 patients were analyzed by optical coherence tomography before SBD and at the final procedure, respectively. Composite BSF was defined as a maximal malapposition distance of >400 μm, or malapposed and SB-jailed strut rates of >5.95% and >21.4%, respectively. RESULTS Composite BSF before SBD in the POT and KBT groups was observed in 29% and 26% of patients, respectively. In the POT group, differences in stent volumetric index between the proximal and distal bifurcation (odds ratio [OR] 60.35, 95% confidential interval [CI] 0.13-0.93, p = 0.036) and between the proximal bifurcation and bifurcation core (OR: 3.68, 95% CI: 1.01-13.40, p = 0.048) were identified as independent risk factors. Composite BSF at final in 27% and 32%, and unplanned additional procedures in 38% and 25% were observed, respectively. Composite BSF before SBD was a risk factor for the former (OR: 6.33, 95% CI: 1.10-36.50, p = 0.039) and the latter (OR: 6.43, 95% CI: 1.25-33.10, p = 0.026) in the POT group. CONCLUSION POT did not result in a favorable trend in BSF. Insufficient expansion of the bifurcation core after POT was associated with BSF.
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Affiliation(s)
- Yoshinobu Murasato
- Department of Cardiology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | | | - Munenori Okubo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Kazuhiko Yumoto
- Department of Cardiology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Naoki Masuda
- Department of Cardiology, Ageo Central General Hospital, Ageo, Japan
| | - Hiromasa Otake
- Department of Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jiro Aoki
- Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Tatsuya Ito
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Takayuki Okamura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kayoko Kozuma
- Department of Biostatistics, The University of Tokyo, Tokyo, Japan
| | - Thierry Lefèvre
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Bernard Chevalier
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Yves Louvard
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Nobuaki Suzuki
- Division of Cardiology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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19
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Minha S, Pereg D. Stent Fractures: New Insights into an Old Issue. J Clin Med 2022; 11:jcm11020424. [PMID: 35054117 PMCID: PMC8779805 DOI: 10.3390/jcm11020424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/12/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sa’ar Minha
- Interventional Cardiology, Shamir Medical Center, Be’er-Yaakov 6093000, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 6997807, Israel;
- Correspondence: or ; Tel.: +972-505-191-939 or +972-8-977-9738
| | - David Pereg
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv 6997807, Israel;
- Cardiology Department, Meir Medical Center, Kfar Saba 4428164, Israel
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20
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Chieffo A, Beneduce A. Post-stenting optimisation techniques in bifurcation percutaneous coronary interventions: much remains to be explored. EUROINTERVENTION 2021; 17:e869-e871. [PMID: 34870598 PMCID: PMC9707482 DOI: 10.4244/eijv17i11a146] [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)
- Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
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21
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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
- University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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22
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Stankovic G, Milasinovic D. Standardisation of techniques for bifurcation stenting optimisation: the journey continues. EUROINTERVENTION 2021; 17:701-702. [PMID: 34665137 PMCID: PMC9707443 DOI: 10.4244/eijv17i9a122] [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)
- Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, 26 Visegradska, 11000 Belgrade, Serbia
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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