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Çizgici AY, Güner A, Alizade E, Çetin İ, Serin E, Doğan A, Gökçe K, Serter B, Çiloğlu K, Kahraman S, Uysal H, Çörekçioğlu B, Demirci G, Tanık VO, Aktürk F, Keskin K, Püşüroğlu H, Akman C, Yıldız M, Ertürk M, Uzun F. Cardiovascular outcomes of complex bifurcation lesions following double kissing crush or nano-crush techniques: The multicenter EVOLUTE-CRUSH V study. Catheter Cardiovasc Interv 2024. [PMID: 38923152 DOI: 10.1002/ccd.31137] [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: 04/13/2024] [Revised: 05/30/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Double kissing crush (DKC) and nano-crush (NC) techniques are frequently used, but the comparison for both techniques is still lacking. The goal of this multicenter study was to retrospectively assess the midterm clinical results of DKC and NC stenting in patients with complex bifurcation lesions (CBLs). METHODS A total of 324 consecutive patients [male: 245 (75.6%), mean age: 60.73 ± 10.21 years] who underwent bifurcation percutaneous coronary intervention between January 2019 and May 2023 were included. The primary endpoint defined as the major cardiovascular events (MACE) included cardiac death, target vessel myocardial infarction (TVMI), or clinically driven target lesion revascularization (TLR). Inverse probability weighting (IPW) was performed to reduce treatment selection bias. This is the first report comparing the clinical outcomes of DKC and NC stenting in patients with CBL. RESULTS The initial revascularization strategy was DKC in 216 (66.7%) cases and NC in 108 (33.3%) patients. SYNTAX scores [25.5 ± 6.73 vs. 23.32 ± 6.22, p = 0.005] were notably higher in the NC group than the DKC group. The procedure time (76.98 ± 25.1 vs. 57.5 ± 22.99 min, p = 0.001) was notably higher in the DKC group. The incidence of MACE (18.5 vs. 9.7%, p = 0.025), clinically driven TLR (14.8 vs. 6%, p = 0.009), and TVMI (10.2 vs. 4.2%, p = 0.048) were notably higher in the NC group than in the DKC group. The midterm MACE rate in the overall population notably differed between the NC group and the DKC group (adjusted HR (IPW): 2.712, [95% CI: 1.407-5.228], p = 0.003). CONCLUSION In patients with CBLs, applying the DKC technique for bifurcation treatment had better ischemia-driven outcomes than the NC technique.
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Affiliation(s)
- Ahmet Yaşar Çizgici
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Elnur Alizade
- Department of Cardiology, Koşuyolu Kartal Heart Training & Research Hospital, Istanbul, Turkey
| | - İlyas Çetin
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Ebru Serin
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Doğan
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kaan Gökçe
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Berkay Serter
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Koray Çiloğlu
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Serkan Kahraman
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hande Uysal
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Büşra Çörekçioğlu
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gökhan Demirci
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Veysel Ozan Tanık
- Department of Cardiology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Faruk Aktürk
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hamdi Püşüroğlu
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Cemalettin Akman
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Yıldız
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ertürk
- 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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Zhang S, Hu G, Zhang B, Li Y, Li B, Liu Z, Ma P, Qiu Y, Xu Q. Successful true cavity pathfinding with balloon assisted CTO with bifurcation lesions: Two case reports. Medicine (Baltimore) 2024; 103:e37404. [PMID: 38552077 PMCID: PMC10977579 DOI: 10.1097/md.0000000000037404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/07/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Coronary artery disease is a prevalent global cardiovascular ailment, with percutaneous coronary intervention (PCI) standing out as a crucial method for relieving symptoms and enhancing the quality of life in patients with coronary heart disease. However, the presence of concurrent chronic total occlusion (CTO) and bifurcation lesions within coronary arteries elevates the complexity and treatment risks, especially when the entry point of the CTO is ambiguous. OBJECTIVE This study aims to present an innovative approach for treating CTO complicated with bifurcation lesions, focusing on true cavity pathfinding assisted by a balloon. METHODS Two cases of CTO patients with concomitant bifurcation lesions are described. One case involves CTO of the left anterior descending artery) combined with anterior non-angle trigeminal lesions, while the other entails CTO of the posterior left artery combined with posterior angle trigeminal lesions. True lumen identification using a balloon and subsequent opening of the CTO blood vessel were performed in both cases. RESULTS In both cases, the true lumen was successfully located with the assistance of a balloon, leading to the successful opening of the CTO blood vessel. This approach not only simplified the procedure but also reduced procedural difficulty and associated risks of complications compared to traditional guide wire operations. CONCLUSION The application of true cavity pathfinding assisted by a balloon offers a novel and effective strategy for managing CTO complicated with bifurcation lesions. The method simplifies the procedure, decreases procedural difficulty, and lowers the risk of complications associated with guide wire operations. However, further studies and long-term follow-up data are warranted to validate the reliability and long-term efficacy of this innovative approach.
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Affiliation(s)
- Shichang Zhang
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Guangxin Hu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Botao Zhang
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yinping Li
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ben Li
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhijun Liu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ping Ma
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yumin Qiu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qingbin Xu
- Department of Cardiology, Cardiovascular and Cerebrovascular Disease Hospital of General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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