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Digne F, Darmon A, Nejjari M. Optimizing Stent Placement in Aorto-Ostial Lesions: Introducing the New Floating Balloon Technique. JACC Cardiovasc Interv 2024:S1936-8798(24)00950-6. [PMID: 39177558 DOI: 10.1016/j.jcin.2024.06.025] [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: 06/13/2024] [Accepted: 06/25/2024] [Indexed: 08/24/2024]
Affiliation(s)
- Franck Digne
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
| | - Arthur Darmon
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Mohammed Nejjari
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
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De Silva K, Li Kam Wa ME, Wells T, Mozid A, Ladwiniec A, Hynes BG, Kotecha A, Ratib K, Biswas S, Amabile N, Deharo P, McEntagart M, Spratt JC, Digne F, Hogg M, Mailey JA, Walsh SJ, Kalra SS. The everolimus eluting Synergy Megatron TM drug-eluting stent platform: Early outcomes from the European Synergy Megatron TM Implanters' Registry. Catheter Cardiovasc Interv 2023; 102:1222-1228. [PMID: 37948428 PMCID: PMC10903108 DOI: 10.1002/ccd.30902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The Synergy MegatronTM is an everolimus-drug eluting stent that may offer advantages in the treatment of aorto-ostial disease and large proximal vessels. AIMS To report the short- to medium-term clinical outcomes from the European Synergy MegatronTM Implanters' Registry. METHODS This registry was an investigator-initiated study conducted at 14 European centers. The primary outcome was target lesion failure (TLF), defined as the composite of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularisation. RESULTS Five hundred seventy-five patients underwent PCI with MegatronTM between 2019 and 2021. Patients were 69 ± 12 years old, 26% had diabetes mellitus, 24% had moderate-severe left ventricular impairment and 59% presented with an acute coronary syndrome. 15% were deemed prohibitively high risk for surgical revascularisation. The target vessel involved the left main stem in 55%, the ostium of the RCA in 13% and was a true bifurcation (Medina 1,1,1) in 50%. At 1 year, TLF was observed in 40 patients, with 26 (65%) occurring within the first 30 days. The cumulative incidence of TLF was 4.5% at 30 days and 8.6% (95% CI 6.3-11.7) at 1 year. The incidence of stent thrombosis was 0.5% with no late stent thromboses. By multivariate analysis, the strongest independent predictors of TLF were severe left ventricular impairment (HR 3.43, 95% CI: 1.67-6.76, p < 0.001) and a target vessel involving the left main (HR 4.00 95% CI 1.81-10.15 p = 0.001). CONCLUSIONS Use of the Synergy MegatronTM everolimus eluting stent in a 'real-world' setting shows favorable outcomes at 30 days and 1 year.
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Affiliation(s)
- Kalpa De Silva
- Cardiovascular Division, St Thomas' HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Coronary Research Group, British Heart Foundation Centre of Research ExcellenceKing's College LondonLondonUK
| | - Matthew E. Li Kam Wa
- Cardiovascular Division, St Thomas' HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Coronary Research Group, British Heart Foundation Centre of Research ExcellenceKing's College LondonLondonUK
| | - Tim Wells
- Cardiology Department, Salisbury District HospitalSalisbury NHS Foundation TrustSalisburyUK
| | - Abdul Mozid
- Cardio Respiratory Clinical Services Unit, Leeds General InfirmaryThe Leeds Teaching Hospitals NHS TrustLeedsUK
| | - Andrew Ladwiniec
- Department of Cardiology, Glenfield HospitalUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Brian G. Hynes
- Cardiology DepartmentUniversity Hospital GalwayGalwayIreland
| | - Ashish Kotecha
- Department of Cardiology, Royal Devon and Exeter HospitalRoyal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Karim Ratib
- Cardiology Department, Royal Stoke University HospitalUniversity Hospitals of North Midlands NHS TrustStokeUK
| | - Sinjini Biswas
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Nicolas Amabile
- Cardiology DepartmentL'Institut Mutualiste MontsourisParisFrance
| | - Pierre Deharo
- Cardiology DepartmentAssistance Publique Hôpitaux de MarseilleMarseilleFrance
| | | | - James C. Spratt
- Cardiology Clinical Academic Group, St George's University HospitalSt George's University Hospitals NHS Foundation TrustLondonUK
| | - Franck Digne
- Cardiology DepartmentCentre Cardiologique du NordSaint DenisFrance
| | - Meadhbh Hogg
- Department of CardiologyBelfast Health and Social Care TrustBelfastUK
| | | | - Simon J. Walsh
- Department of CardiologyBelfast Health and Social Care TrustBelfastUK
| | - Sundeep S. Kalra
- Cardiology Department, Royal Free HospitalRoyal Free London NHS Foundation TrustLondonUK
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Yamamoto K, Sato T, Salem H, Matsumura M, Fall KN, Prasad M, Ng VG, Sethi SS, Nazif TM, Parikh SA, Vahl TP, Ali ZA, Karmpaliotis D, Rabbani LE, Collins MB, Leon MB, McEntegart MB, Moses JW, Kirtane AJ, Mintz GS, Maehara A. Mechanisms and treatment outcomes of ostial right coronary artery in-stent restenosis. EUROINTERVENTION 2023; 19:e383-e393. [PMID: 37283548 PMCID: PMC10397676 DOI: 10.4244/eij-d-23-00107] [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: 02/11/2023] [Accepted: 04/28/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Despite a high rate of in-stent restenosis (ISR) after stenting the right coronary artery (RCA) ostium, the mechanism of ostial RCA ISR is not well understood. AIMS We aimed to clarify the cause of ostial RCA ISR using intravascular ultrasound (IVUS). METHODS Overall, 139 ostial RCA ISR lesions were identified with IVUS, pre-revascularisation. Primary ISR mechanisms were classified as follows: 1) neointimal hyperplasia (NIH); 2) neoatherosclerosis; 3) ostium not covered by the stent; 4) stent fracture or deformation; 5) stent underexpansion (old minimum stent area <4.0 mm2 or stent expansion <50%); or 6) a protruding calcified nodule. RESULTS The median duration from prior stenting was 1.2 (first quartile 0.6, third quartile 3.1) years. The primary mechanisms of ISR were NIH in 25% (n=35) of lesions, neoatherosclerosis in 22% (n=30), uncovered ostium in 6% (n=9) (biological cause 53%, n=74), stent fracture or deformation in 25% (n=35), underexpansion in 11% (n=15), and protruding calcified nodules in 11% (n=15) (mechanical cause 47%, n=65). Including secondary mechanisms, 51% (n=71) of ostial RCA ISRs had stent fractures that were associated with greater hinge motion of the ostial-aorta angle during the cardiac cycle. The Kaplan-Meier rate of target lesion failure at 1 year was 11.5%. When the mechanically caused ISRs were treated without new stents, they suffered a higher subsequent event rate (41.4%) compared with non-mechanical causes or mechanical causes treated without restenting (7.8%, unadjusted hazard ratio 6.44, 95% confidence interval: 2.33-17.78; p<0.0001). CONCLUSIONS Half of the ostial RCA ISRs were due to mechanical causes. Subsequent event rates were high, especially in mechanically caused ISRs treated without the implantation of a new stent.
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Affiliation(s)
- Kei Yamamoto
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Takao Sato
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Hanan Salem
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Cardiovascular Medicine Department, Faculty of Medicine - Tanta University, Tanta, Egypt
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Khady N Fall
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Megha Prasad
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Vivian G Ng
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Sanjum S Sethi
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Tamim M Nazif
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Sahil A Parikh
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Torsten P Vahl
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
| | - Dimitri Karmpaliotis
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - LeRoy E Rabbani
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Michael B Collins
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Martin B Leon
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Margaret B McEntegart
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Jeffery W Moses
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Ajay J Kirtane
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Akiko Maehara
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
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Sliman H, Aker A, Jaffe R. Snaring an Aorto-Ostial Stent. JACC Cardiovasc Interv 2022; 15:e215-e216. [DOI: 10.1016/j.jcin.2022.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 10/14/2022]
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Reddy PKV, Daibes J, Skaf M, Ochoa R, Fujisaki T, Lin P, Patel A, Kwan T. The Use of Bumper Wire Technique and Intravascular Ultrasound for Precise Aorto-Ostial Stenting. Front Cardiovasc Med 2022; 9:929472. [PMID: 35911530 PMCID: PMC9329583 DOI: 10.3389/fcvm.2022.929472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAorto-ostial interventions are challenging due to the limitations of contemporary equipment, imprecise ostial demarcation, and problematic ostial lesion characteristics. Suboptimal stent placement is common and portends worse clinical outcomes. Procedural and long-term outcomes of the bumper wire technique with intravascular ultrasound (IVUS) assessment have not been investigated.MethodsA single-center retrospective study was conducted. Patients who underwent ostial lesion percutaneous coronary intervention (PCI) with the bumper wire technique between January 2019 and September 2020 were identified. The primary endpoint was to determine the geographic miss rate defined by inadequate ostial coverage or excess stent protrusion of > 2 mm by IVUS or angiography. The secondary endpoint was target lesion failure (TLF) at 6 months after PCI, defined as the composite of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularization.ResultsIn total, 45 patients were identified. The average age was 71.7 years old, and 85.4% were men. Indication for PCI was acute coronary syndrome in about a third of patients. Twenty-six patients had left main ostial lesions and 19 patients had right coronary artery ostial lesions. Geographic miss was detected in two patients (4.4%): one patient (2.2%) had excess proximal stent protrusion and one patient (2.2%) had an ostial miss. Six patients were lost to follow-up. TLF, stroke, or major bleeding were not observed in any of the patients.ConclusionThe bumper wire technique is safe and efficient with low rates of geographic miss or adverse clinical outcomes. This is the first study to confirm precise aorto-ostial stent implantation with the bumper wire technique using IVUS confirmation.
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Affiliation(s)
- Pavan K. V. Reddy
- Division of Cardiovascular Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York, NY, United States
| | - Joseph Daibes
- Division of Cardiovascular Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York, NY, United States
| | - Michel Skaf
- Department of Medicine, Icahn School of Medicine, Mount Sinai Morningside and West, New York, NY, United States
| | - Roberto Ochoa
- Department of Medicine, Icahn School of Medicine, Mount Sinai Morningside and West, New York, NY, United States
| | - Tomohiro Fujisaki
- Department of Medicine, Icahn School of Medicine, Mount Sinai Morningside and West, New York, NY, United States
| | - Patricia Lin
- Chinatown Cardiology, New York, NY, United States
| | - Apurva Patel
- Division of Cardiovascular Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York, NY, United States
- Chinatown Cardiology, New York, NY, United States
| | - Tak Kwan
- Division of Cardiovascular Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York, NY, United States
- Chinatown Cardiology, New York, NY, United States
- *Correspondence: Tak Kwan,
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Agostoni P, Kortsmit J, Colombo A. Accurate stent placement in challenging percutaneous coronary interventions using the stent positioning assist system. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:123-129. [DOI: 10.1016/j.carrev.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Abdulrahman B, Mashayekhi K, Tajti P, Ferenc M, Valina CM, Hochholzer W, Neumann FJ, Nührenberg TG. Clinical Outcomes after Additional Dynamic Renal® Stent Implantation for Stent Recoil in Ostial Coronary Lesions. J Clin Med 2020; 9:jcm9123964. [PMID: 33297448 PMCID: PMC7762371 DOI: 10.3390/jcm9123964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Interventional treatment of aorto-ostial coronary stenoses is limited by stent recoil and suboptimal angiographic results, leading to restenosis and frequent re-interventions. As a potential bail-out strategy for stent recoil, implantation of an additional stent to increase radial force has been reported. Thus, we sought to investigate clinical outcomes after additional implantation of a Dynamic Renal® stent (DRS), a non-coronary; bare-metal stent with very high radial force, in aorto-ostial coronary stenoses. Methods: Patients treated by implantation of DRSs for stent recoil in the ostial right coronary artery or the left main stem were identified from the hospital database. Baseline clinical and procedural characteristics were compared to patients who underwent re-intervention for in-stent-restenosis in similar segments by either implantation of conventional drug-eluting stents (DES) or paclitaxel-coated balloons (PCB). Clinical follow-ups were performed up to three years following re-intervention with the assessment of death, target lesion reintervention (TLR), and major adverse cardiac events (MACE) as a combination death, myocardial infarction and target vessel revascularization. Kaplan–Meier analyses were performed for event-free survival between the three groups. Results: Between 05/2013 and 07/2019, 28 patients underwent DRS implantation of aorto-ostial coronary lesions. In comparison with 49 patients with DES implantation and 29 patients undergoing PCB treatment, no relevant differences in baseline parameters were identified. Median follow-up was 714 days, with an available follow-up of >1 year after intervention in 82.1% of patients. In the entire study cohort at two years after re-intervention, the TLR rate was 16% (17 patients), the MACE rate 37% (39 patients), and all-cause mortality 9% (10 patients), with no significant differences between the three groups. Conclusions: DRS implantation for treating stent recoil of aorto-ostial coronary lesions resulted in a high rate of TLR, and was associated with similar risk for death and MACE compared to treatment of in-stent-restenosis with DES or PCB. Randomized, larger comparisons of contemporary DES in patients exclusively presenting with stent recoil are necessary to further define the efficacy and safety of this approach.
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Kočka V, Thériault-Lauzier P, Xiong TY, Ben-Shoshan J, Petr R, Laboš M, Buithieu J, Mousavi N, Pilgrim T, Praz F, Overtchouk P, Beaudry JP, Spaziano M, Pelletier JP, Martucci G, Dandona S, Rinfret S, Windecker S, Leipsic J, Piazza N. Optimal Fluoroscopic Projections of Coronary Ostia and Bifurcations Defined by Computed Tomographic Coronary Angiography. JACC Cardiovasc Interv 2020; 13:2560-2570. [PMID: 33153569 DOI: 10.1016/j.jcin.2020.06.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to define the optimal fluoroscopic viewing angles of both coronary ostia and important coronary bifurcations by using 3-dimensional multislice computed tomographic data. BACKGROUND Optimal fluoroscopic projections are crucial for coronary imaging and interventions. Historically, coronary fluoroscopic viewing angles were derived empirically from experienced operators. METHODS In this analysis, 100 consecutive patients who underwent computed tomographic coronary angiography (CTCA) for suspected coronary artery disease were studied. A CTCA-based method is described to define optimal viewing angles of both coronary ostia and important coronary bifurcations to guide percutaneous coronary interventions. RESULTS The average optimal viewing angle for ostial left main stenting was left anterior oblique (LAO) 37°, cranial (CRA) 22° (95% confidence interval [CI]: LAO 33° to 40°, CRA 19° to 25°) and for ostial right coronary stenting was LAO 79°, CRA 41° (95% CI: LAO 74° to 84°, CRA 37° to 45°). Estimated mean optimal viewing angles for bifurcation stenting were as follows: left main: LAO 0°, caudal (CAU) 49° (95% CI: right anterior oblique [RAO] 8° to LAO 8°, CAU 43° to 54°); left anterior descending with first diagonal branch: LAO 11°, CRA 71° (95% CI: RAO 6° to LAO 27°, CRA 66° to 77°); left circumflex bifurcation with first marginal branch: LAO 24°, CAU 33° (95% CI: LAO 15° to 33°, CAU 25° to 41°); and posterior descending artery and posterolateral branch: LAO 44°, CRA 34° (95% CI: LAO 35° to 52°, CRA 27° to 41°). CONCLUSIONS CTCA can suggest optimal fluoroscopic viewing angles of coronary artery ostia and bifurcations. As the frequency of use of diagnostic CTCA increases in the future, it has the potential to provide additional information for planning and guiding percutaneous coronary intervention procedures.
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Affiliation(s)
- Viktor Kočka
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Third Faculty of Medicine, Charles University, Prague, Czech Republic; Cardiocenter, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Pascal Thériault-Lauzier
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tian-Yuan Xiong
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jeremy Ben-Shoshan
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Tel-Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Róbert Petr
- Third Faculty of Medicine, Charles University, Prague, Czech Republic; Cardiocenter, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Marek Laboš
- Cardiocenter, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Jean Buithieu
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Negareh Mousavi
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Swiss Cardiovascular Center, Bern, Switzerland
| | - Pavel Overtchouk
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Pierre Beaudry
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marco Spaziano
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Philippe Pelletier
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Giuseppe Martucci
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sonny Dandona
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stéphane Rinfret
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Bern, Switzerland
| | - Jonathon Leipsic
- Department of Radiology, St. Paul Hospital, Vancouver, British Columbia, Canada
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
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10
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Wintzer-Wehekind J, Larose E, Rodés-Cabau J, Barbeau G. Coronary Stent Protruding in the Ascending Aorta. JACC Cardiovasc Interv 2020; 13:263-264. [DOI: 10.1016/j.jcin.2019.07.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
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11
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Ohashi K, Abe D, Kuroki N, Yuba T, Suzuki K. Clinical impact of the gap-angle ratio in patients with ostial lesions of the right coronary artery undergoing percutaneous coronary intervention. Heart Vessels 2019; 34:1717-1727. [PMID: 31028408 DOI: 10.1007/s00380-019-01417-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 04/19/2019] [Indexed: 11/24/2022]
Abstract
The aim of this study was to investigate the incidence of binary restenosis and its predictors in patients with ostial lesions of the right coronary artery (RCAos) who underwent percutaneous coronary intervention (PCI). RCAos are associated with a high incidence of restenosis, and the implantations of drug-eluting stents for RCAos have not been fully elucidated. The study participants included 75 patients (72.3 ± 9.5 years, 72% men) who underwent PCI for RCAos at our institution between November 2001 and May 2017. The angle between the greater curvature of the aortic wall and the right coronary artery take-off in the diastolic and systolic phases in the left anterior oblique position view was investigated. Clinical outcome was defined as binary restenosis at follow-up coronary angiography. We also evaluated target lesion failure (TLF) defined as a composite of cardiac mortality, target vessel myocardial infarction, and target lesion revascularization (TLR). The incidence of binary restenosis was 48.0% (n = 36) of the entire cohort. The incidence of TLF was 49.3% (n = 37) of the entire cohort, which was mainly driven by TLR (36.0%, n = 27). The area under the curve of the gap-angle ratio [(difference between the maximum and minimum angles)/(minimum angle); GAR] for binary restenosis was 0.73, and the cutoff value was 0.306 (sensitivity 67%, specificity 82%). The patients were divided into two groups: a low-GAR (< 0.306; n = 30) and high-GAR group (> 0.306; n = 45). Binary restenosis was more frequent in the high-GAR group than in the low-GAR group (76.7% vs. 28.9%, p = 0.007). The cumulative rate of TLF was significantly higher in the high-GAR group when compared with the low-GAR group (53.3% vs. 40.0%, p = 0.01), which was mainly driven by TLR (56.7% vs. 22.2%, p = 0.01). High-GAR (> 0.306) [OR 2.66 (1.34-5.31), p = 0.005] and stent under expansion [OR 2.37 (1.10-5.11), p = 0.03] were found to be independent predictors of binary restenosis after adjustment for multiple confounders. Multivariable analysis also revealed that high-GAR (> 0.306) [OR 2.06 (1.02-4.14), p = 0.03] and stent under expansion [OR 2.82 (1.28-6.19), p = 0.01] were independent predictors of TLF. We suggest that GAR (> 0.306) predicts binary restenosis and TLF in patients undergoing PCI for RCAos.
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Affiliation(s)
- Koichi Ohashi
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-0022, Japan.
| | - Daisuke Abe
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-0022, Japan
| | - Norihiro Kuroki
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-0022, Japan
| | - Takao Yuba
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-0022, Japan
| | - Kou Suzuki
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-0022, Japan
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12
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Chen GC, Lu XM, Song YM, Gyawail L, Geng ZH, Song MB, Qian DH, Zhang YP, Ni DC, He Y. A 3-year experience of a simple, novel technique for accurate ostial/non-ostial coronary stenting: The buddy balloon anchor stent technique. Catheter Cardiovasc Interv 2018; 92:1147-1152. [PMID: 30019847 DOI: 10.1002/ccd.27667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/26/2018] [Accepted: 04/19/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of a new technique for accurate ostial/non-ostial coronary stenting in percutaneous coronary intervention (PCI). BACKGROUND Accurate stent localization is a key factor impacting the postoperative success of patients undergoing PCI. However, the accurate localization of some lesions, especially ostial lesions, is very difficult to achieve, because they are often complicated by bobbing or to-and-fro movement of the stent during cardiac contractions. METHODS We report a novel technique of precise ostial/non-ostial stenting based on the buddy balloon anchor stent (BBAS) technique. Between May 2014 and July 2017, 47 patients with significant ostial/non-ostial coronary stenosis that required accurate stenting were included in this study. Of them, 23 patients were treated using the conventional method and the remaining 24 patients were treated using (BBAS) technique. Evaluation was then performed using intravascular ultrasound (IVUS) in the procedural, or coronary computed tomography angiography (CCTA) in the follow up. RESULTS Using the BBAS technique, the procedural success was achieved in all 24 (100%) cases. IVUS was performed in seven patients (29.17%) and no procedural complications occurred. All six failed cases that occurred among patients with right coronary artery and left anterior descending artery ostial stenosis treated using the conventional method, the lesions were subsequently successfully re-stented using the BBAS technique. After a follow-up of 3-36 months, CCTA was performed in 11 patients (45.83%), all the stents were in the accurate position. There were no major cardiovascular events of death, myocardial infarction, or target lesion revascularization. CONCLUSION BBAS is a simple, highly successful and safe technique for accurate stenting of difficult ostial/nonostial coronary stenosis lesions.
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Affiliation(s)
- G C Chen
- Department Of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital, Chong Qing, China
| | - X M Lu
- Department Of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital, Chong Qing, China
| | - Y M Song
- Department Of Cardiology, Institute of Cardiovascular Disease of People's Liberation Army, Xinqiao Hospital, Army Medical University, Chong Qing, China
| | - Laxman Gyawail
- Department Of Cardiology, Second Affiliated Hospital of Chongqing Medical University, Chong Qing, China
| | - Z H Geng
- Department Of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital, Chong Qing, China
| | - M B Song
- Department Of Cardiology, Institute of Cardiovascular Disease of People's Liberation Army, Xinqiao Hospital, Army Medical University, Chong Qing, China
| | - D H Qian
- Department Of Cardiology, Institute of Cardiovascular Disease of People's Liberation Army, Xinqiao Hospital, Army Medical University, Chong Qing, China
| | - Y P Zhang
- Department Of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital, Chong Qing, China
| | - D C Ni
- Department Of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital, Chong Qing, China
| | - Yun He
- Department Of Cardiology, Chongqing Kanghua Zhonglian Cardiovascular Hospital, Chong Qing, China
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13
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Comparison of mid-term clinical outcomes after treatment of ostial right coronary artery lesions with early and new generation drug-eluting stents: Insights from an international multicenter registry. Int J Cardiol 2018; 254:53-58. [DOI: 10.1016/j.ijcard.2017.10.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 11/21/2022]
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14
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Kassimis G, Raina T. GuideLiner extension catheter-facilitated side strut stenting technique for the treatment of right coronary artery ostial in-stent restenosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:133-136. [PMID: 29117919 DOI: 10.1016/j.carrev.2017.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 12/24/2022]
Abstract
Percutaneous coronary intervention (PCI) for the treatment of right coronary artery (RCA) ostial in-stent restenosis (ISR) can be challenging. The technical difficulties are compounded by excessive stent protrusion into the aorta, preventing coaxial engagement of the guiding catheter and wiring through the central stent lumen. Through this review, we aim to highlight the practical challenges encountered during the treatment of ostial RCA ISR through PCI and evaluate the various interventional techniques that have been used. We describe the first reported case of a GuideLiner extension catheter-facilitated side-strut stenting for the treatment of ostial RCA ISR and demonstrate the safety and feasibility of this novel technique.
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Affiliation(s)
- George Kassimis
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom.
| | - Tushar Raina
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
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