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Elsheikh AN, Elsaeid A, Sharafeldin S, Elshedoudy S, ElGendy E. Early effect of different bifurcation techniques on left ventricular mechanics in elective percutaneous coronary intervention. Egypt Heart J 2024; 76:81. [PMID: 38955907 PMCID: PMC11219646 DOI: 10.1186/s43044-024-00502-5] [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: 04/29/2024] [Accepted: 05/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Bifurcation lesions are prevalent amongst patients with symptomatic coronary artery disease subjected to percutaneous coronary intervention (PCI). Recent consensus commends a conservative (provisional) approach when managing the side branch. Here, the aim was to explore the immediate impact of different bifurcation techniques (one stent and two stent strategies) on left ventricular LV) myocardial functions using speckle tracking echocardiography in patients subjected to elective PCI. Sixty two consecutive patients diagnosed with coronary bifurcation lesion (CBL) were enrolled. Patients were categorized into: one-stent strategy (Provisional group, n = 44) and a two-stent strategy (TAP, DK crush, or Culotte technique, n = 18), based on the coronary bifurcation site, angle, side branch diameter and Medina classification. LVEF%, regional and global longitudinal strain (GLS), and E/E' were measured before and within 24 h post PCI. RESULTS In both provisional and 2- stent technique, the mitral inflow velocities and mitral annular velocities showed improvement with significant reduction in E/e' (P < 0.03 and P < 0.001) respectively while LVEF% did not change. There were no significant changes in any other echo parameters post PCI. In provisional group, there were significant improvements in LAD (P < 0.001), RCA (P < 0.01) territories and GLS (P < 0.01). Δ LAD was expressively higher (34.5%) compared with Δ LCX (9.6%) and ΔRCA (25.4%), P < 0.001, P < 0.01 respectively. In the 2-stent technique group, there were significant improvements in peak longitudinal strain of LAD territory (P < 0.01), RCA territory (P < 0.01) and GLS (P < 0.01) respectively. Δ LAD territory was significantly higher in provisional group in comparison with the 2- stent technique group. Δ GLS was correlated inversely to Gensini score in provisional group and to the number of vessel diseased in 2-stent technique group. CONCLUSION PCI of the bifurcation lesion positively impact myocardial function. Both bifurcation techniques improve LV mechanical properties using 2D strain imaging while LV EF% remains unchanged.
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Affiliation(s)
- Amr Nasser Elsheikh
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt.
| | - Ayman Elsaeid
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
| | - Samia Sharafeldin
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
| | - Sahar Elshedoudy
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
| | - Ehab ElGendy
- Cardiology Department, Tanta University, 55-ElGish Street, Tanta, Gharbia, Egypt
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2
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Wang J, Li C, Ding D, Zhang M, Wu Y, Xu R, Lu H, Chen Z, Chang S, Dai Y, Qian J, Zhang F, Tu S, Ge J. Functional comparison of different jailed balloon techniques in treating non-left main coronary bifurcation lesions. Int J Cardiol 2022; 364:20-26. [PMID: 35597490 DOI: 10.1016/j.ijcard.2022.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a paucity of data comparing functional difference between active jailed balloon technique (A-JBT) and conventional jailed balloon technique (C-JBT) in treating non-left main coronary bifurcation lesions (CBLs). METHODS In this retrospective cohort study, we consecutively enrolled 232 patients with non-left main CBLs who underwent percutaneous coronary intervention (PCI) using JBTs between January 2018 and March 2019. Among them, 191 patients entered the final analysis with 12-months angiographic follow-up. We stratified patients into A-JBT group (130 patients) and C-JBT group (61 patients). The functional analysis by Murray law-based quantitative flow ratio (μQFR) and Seattleanginaquestionnaire (SAQ) were performed to compare the two techniques. RESULTS Compared with C-JBT group, A-JBT group observed a lower abrupt (0.8% vs. 11.1%, p = 0.002) and final SB occlusion (0 vs. 7.9%, p = 0.005). Meanwhile, A-JBT group had a significantly higher μQFR of side branch (SB) both post-PCI and 12-months follow-up (median [interquartile range (IQR)]: 0.91 (0.86-0.96) vs. 0.82 (0.69-0.92), p < 0.001; median [IQR]: 0.95 (0.89-0.98) vs. 0.85 (0.74-0.93), p < 0.001) than C-JBT group. Besides, A-JBT group gained a μQFR improvement at follow-up period compared with post-PCI data (median [IQR]: 0.95 [0.89-0.98] vs. 0.91[0.86-0.96] of SB, p < 0.001) and a higher SAQ scores at 12-months follow-up compared with C-JBT group (p < 0.001). CONCLUSIONS Compared with C-JBT, A-JBT provided excellent SB protection during MV stenting and improved the SB functional blood flow as well as the angina relief even after 12 months.
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Affiliation(s)
- Jingpu Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chenguang Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Daixin Ding
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
| | - Mingyou Zhang
- Department of Cardiology, The first hospital of Jilin university, Changchun, China
| | - Yizhe Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Rende Xu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hao Lu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhangwei Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shufu Chang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuxiang Dai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China..
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
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3
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Dangas G, Garg A. Double kissing crush stenting: No pain, no gain? Catheter Cardiovasc Interv 2022; 99:1045-1046. [PMID: 35441815 DOI: 10.1002/ccd.30183] [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: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/10/2022]
Affiliation(s)
- George Dangas
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York City, New York, US
| | - Aakash Garg
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York City, New York, US
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Scanning Electron Microscopic Assessment of Stent Coating Integrity in Jailed Wire Technique for Bifurcation Treatment. J Interv Cardiol 2021; 2021:2629393. [PMID: 34113221 PMCID: PMC8166474 DOI: 10.1155/2021/2629393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/20/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives To assess the impact of different guidewires on stent coating integrity in jailed wire technique (JWT) for bifurcation treatment. Background JWT is commonly adopted to protect side branch in provisional one-stent strategy for coronary bifurcation lesions. However, this technique may cause defects in stent coatings. The degree of coating damage caused by different types of jailed wires remains unknown. Methods A fluid model with a bifurcation was established to mimic the condition in vivo. One-stent strategy was performed with three types of guidewire (nonpolymer-jacketed wire, intermediate polymer-jacketed wire, and full polymer-jacketed wire) tested for JWT. Scanning electron microscopy (SEM) was used to evaluate stent coating integrity and wire structure. The degrees of coating defects were recorded as no, slight, moderate, and severe defects. Results A total of 27 samples were tested. Analyses of SEM images showed a significant difference in the degree of coating damage among the three types of wire after the procedure of JWT (P < 0.001). Nonpolymer-jacketed wire could inevitably cause a severe defect in stent coatings, while full polymer-jacketed wire caused the least coating damages. Besides, there were varying degrees of coil deformation in nonpolymer-jacketed wires, while no surface damage or jacket shearing was observed in full polymer-jacketed wires. Conclusions Although nonpolymer-jacketed wire has long been recommended for JWT, our bench-side study suggests that full polymer-jacketed wire may be a better choice. Further clinical studies are needed to confirm our findings.
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Kuropiĭ TS, Utegenov RB, Khelimskiĭ DA, Badoian AG, Éraliev TK, Krest'ianinov OV. [Use of drug-coated balloons for interventions on bifurcation lesions of coronary arteries]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:46-52. [PMID: 34528588 DOI: 10.33529/angio2021319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Interventions on bifurcation lesions of the coronary bed are one of the most complicated tasks of interventional cardiology. Recent trends are toward active study of using drug-eluting balloons for interventions in this type of lesions. Using such technique makes it possible to minimize the risks associated with implantation of stents in sites of coronary artery bifurcations with good angiographic results. This article is a review of the literature data concerning the use of drug-coated balloons in interventions on bifurcation lesions of the coronary bed, discussing peculiarities of the balloon catheter design, dynamics of delivery of an antiproliferative drug to the vascular wall. This is followed by considering the experience with using innovative sirolimus-coated balloon catheters, as well as future perspectives of these devices for interventions in coronary artery bifurcation lesions.
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Affiliation(s)
- T S Kuropiĭ
- Department of Endovascular Diagnosis and Treatment, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - R B Utegenov
- Department of Endovascular Diagnosis and Treatment, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - D A Khelimskiĭ
- Department of Endovascular Diagnosis and Treatment, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - A G Badoian
- Department of Endovascular Diagnosis and Treatment, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - T K Éraliev
- Department of Endovascular Diagnosis and Treatment, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - O V Krest'ianinov
- Department of Endovascular Diagnosis and Treatment, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
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Mohamed MO, Polad J, Hildick-Smith D, Bizeau O, Baisebenov RK, Roffi M, Íñiguez-Romo A, Chevalier B, von Birgelen C, Roguin A, Aminian A, Angioi M, Mamas MA. Impact of coronary lesion complexity in percutaneous coronary intervention: one-year outcomes from the large, multicentre e-Ultimaster registry. EUROINTERVENTION 2020; 16:603-612. [DOI: 10.4244/eij-d-20-00361] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
PURPOSE OF REVIEW Coronary artery disease affecting bifurcations poses a challenge for percutaneous intervention. Several techniques and strategies for percutaneous management of bifurcation lesions have been described in the literature with variable data available for outcomes. In this review, we provide an overview of the strategies and techniques used for percutaneous intervention of bifurcation lesions with an update of recent technical developments and clinical evidence. RECENT FINDINGS The coronary bifurcation lesions of both left main and other coronary segments are best treated with a provisional stenting strategy where main branch is treated with a stent placement and side branch intervention reserved for angiographically or physiologically determined hemodynamically significant residual stenosis despite application of a proximal stent optimization technique. When a provisional stent strategy is not likely to be successful due to anatomic or morphologic lesion characteristics and a large side branch or distal left main bifurcation is involved, an upfront bifurcation stenting strategy with double kissing crush technique may provide the optimum results. Coronary imaging and fractional flow determination may guide lesion specific management, facilitate device selection and improve clinical outcomes for percutaneous therapy for bifurcation lesions. SUMMARY Despite advances in technology and procedural techniques, percutaneous intervention of coronary bifurcation lesions remains challenging and associated with higher adverse outcomes compared to non bifurcation lesions. Among the several bifurcation strategies, a provisional stenting approach is preferred for technical simplicity and better long term outcomes. Double kissing crush technique provides superior clinical results and should be preferred when a two stent strategy is indicated. Use of coronary imaging and physiology assessment should be incorporated in the algorithm of bifurcation interventions for greater technical and clinical success.
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Kogame N, Chichareon P, De Wilder K, Takahashi K, Modolo R, Chang CC, Tomaniak M, Komiyama H, Chieffo A, Colombo A, Garg S, Louvard Y, Jüni P, G. Steg P, Hamm C, Vranckx P, Valgimigli M, Windecker S, Stoll H, Onuma Y, Janssens L, Serruys PW. Clinical relevance of ticagrelor monotherapy following 1‐month dual antiplatelet therapy after bifurcation percutaneous coronary intervention: Insight from GLOBAL LEADERS trial. Catheter Cardiovasc Interv 2019; 96:100-111. [DOI: 10.1002/ccd.28428] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/10/2019] [Accepted: 07/27/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Norihiro Kogame
- Department of CardiologyAmsterdam University Medical Center Amsterdam The Netherlands
- Department of CardiologyToho University medical center Ohashi hospital Tokyo Japan
| | - Ply Chichareon
- Department of CardiologyAmsterdam University Medical Center Amsterdam The Netherlands
- Faculty of Medicine, Division of Cardiology, Department of Internal MedicinePrince of Songkla University Songkhla Thailand
| | | | - Kuniaki Takahashi
- Department of CardiologyAmsterdam University Medical Center Amsterdam The Netherlands
| | - Rodrigo Modolo
- Department of CardiologyAmsterdam University Medical Center Amsterdam The Netherlands
- Cardiology Division, Department of Internal MedicineUniversity of Campinas (UNICAMP) Campinas Brazil
| | - Chun Chin Chang
- Department of Interventional CardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Mariusz Tomaniak
- Department of Interventional CardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Hidenori Komiyama
- Department of CardiologyAmsterdam University Medical Center Amsterdam The Netherlands
| | - Alaide Chieffo
- Interventional Cardiology UnitIRCCS San Raffaele Scientific Institute Milan Italy
| | - Antonio Colombo
- Interventional Cardiology UnitVilla Maria Cecila Hospital GVM Cotignola (RA) Italy
| | - Scot Garg
- Department of CardiologyRoyal Blackburn Hospital Blackburn UK
| | - Yves Louvard
- Department of CardiologyRamsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier Massy France
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital Toronto Ontario Canada
- Department of Medicine and Institute of Health Policy, Management and EvaluationUniversity of Toronto Toronto Ontario Canada
| | - Philippe G. Steg
- French Alliance for Cardiovascular Trials (FACT), Université Paris‐Diderot Paris France
| | - Christian Hamm
- Kerckhoff Heart and Thorax Center, University of Giessen Giessen Germany
| | - Pascal Vranckx
- Faculty of Medicine and Life Sciences, Jessa Ziekenhuis, the Hasselt University Hasselt Belgium
| | - Marco Valgimigli
- Department of CardiologyInselspital, University of Bern Bern Switzerland
| | - Stephan Windecker
- Department of CardiologyInselspital, University of Bern Bern Switzerland
| | | | - Yoshinobu Onuma
- Department of Interventional CardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Luc Janssens
- Heart CentreImelda Hospital Bonheiden Bonheiden Belgium
| | - Patrick W. Serruys
- International Centre for Circulatory Health, Imperial College London London UK
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9
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(Tryton - an alternative to established bifurcation techniques?). COR ET VASA 2019. [DOI: 10.33678/cor.2019.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Zhang W, Ji F, Yu X, Wang X. Long-term treatment effect and adverse events of a modified jailed-balloon technique for side branch protection in patients with coronary bifurcation lesions. BMC Cardiovasc Disord 2019; 19:12. [PMID: 30630420 PMCID: PMC6327459 DOI: 10.1186/s12872-018-0995-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/27/2018] [Indexed: 01/10/2023] Open
Abstract
Background Percutaneous coronary interventions (PCI) of bifurcation lesions is technically challenging and associated with lower success rates and higher frequency of adverse outcomes. In the present study, we aimed to evaluate the immediate and long-term treatment effect and adverse events of a new modified jailed-balloon technique on side branch (SB) during PCI on coronary bifurcation lesions. Methods This was a prospective study of 60 patients (49 males, 11 females, mean age 66 ± 10 years) with coronary bifurcation lesions treated at the Beijing Hospital between September 2014 and October 2015. They underwent main vessel (MV) stenting and modified jailed-balloon technique on the SB. All patients were followed with hospital visits at 9 months. Angiographic success, major adverse cardiac events (MACE), SB occlusion, and angina were evaluated. Results The majority of the patients had acute coronary syndrome (91.7%) and Medina 1.1.1. bifurcation lesions (71.7%). After MV stenting, thrombolysis in myocardial infarction (TIMI) 3 flow was established 100% of MV and 93.3% of SB. No SB occlusion occurred. The jailed SB balloon and wire could be successfully removed in all patients without damage or entrapment. The majority (91.7%) of patients achieved Canadian Cardiovascular Society I stage. There was no MACE during in-hospital stay and 9-month follow-up. Conclusion The modified JBT provided high rate of procedural success, excellent SB protection during MV stenting, and excellent immediate and long-term clinical outcomes.
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Affiliation(s)
- Wenduo Zhang
- Department of Cardiology, National Center of Gerontology, China, Beijing Hospital, NO.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Fusui Ji
- Department of Cardiology, National Center of Gerontology, China, Beijing Hospital, NO.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
| | - Xue Yu
- Department of Cardiology, National Center of Gerontology, China, Beijing Hospital, NO.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Xinyue Wang
- Department of Cardiology, National Center of Gerontology, China, Beijing Hospital, NO.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
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Rampat R, Mayo T, Hildick-Smith D, Cockburn J. A randomized trial comparing two stent sizing strategies in coronary bifurcation treatment with bioresorbable vascular scaffolds - The Absorb Bifurcation Coronary (ABC) trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:43-49. [PMID: 30170828 DOI: 10.1016/j.carrev.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/23/2018] [Accepted: 08/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Limited information is available on the use of Bioresorbable Vascular Scaffold (BVS) in bifurcations involving significant side branches. When treating bifurcation disease with metal stents, the recommendation is to choose a stent diameter based on the distal main vessel diameter. Whether this sizing strategy is applicable to BVS is currently unknown. METHODS We randomised 37 patients undergoing elective PCI for 'false' bifurcation disease (Medina 0,1,0; 1,0,0; 1,1,0) to receive BVS based either on proximal or distal reference diameters. Optical Frequency Domain Imaging (OFDI) measurements were performed pre BVS insertion to obtain proximal and distal reference diameters and post implantation. BVS size was chosen according to the proximal or distal reference diameter as per randomisation. Implantation was performed using the PSP technique tailored to bifurcation stenting. OFDI was repeated post implantation to confirm satisfactory expansion and apposition. RESULTS Baseline demographics between the two groups were similar. Patients were aged 62.8 ± 3.3 years; 76% were male. Mean side branch diameter was 2.24 ± 0.13 mm. TIMI III flow in the main vessel was achieved in all cases. Side branch occlusion occurred in 1 case (2.7%). In the distal-sizing arm, there was a greater incidence of significant malapposition (>300 μm) at the proximal end of the scaffold on OCT (2.3% versus 0.8%, p 0.023). The incidence of distal edge dissections was numerically greater in the proximal-sizing group but this was not statistically significant (31.3% vs 11.8%, p 0.17). CONCLUSION Both proximal and distal sizing strategies have similar procedural complication rates when using the ABSORB BVS to treat coronary bifurcations. However a proximal sizing strategy is associated with less malapposition and may be preferable.
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Affiliation(s)
- Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, BN2 5BE, UK; Brighton and Sussex Medical School, BN1 9PX, UK.
| | - Thomas Mayo
- Brighton and Sussex Medical School, BN1 9PX, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, BN2 5BE, UK
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, BN2 5BE, UK
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12
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A randomized trial of bifurcation stenting technique in chronic total occlusions percutaneous coronary intervention. Coron Artery Dis 2018; 29:30-38. [PMID: 29220345 DOI: 10.1097/mca.0000000000000551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal strategy to treat bifurcation lesions (BFLs) in a percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) remains unknown. AIMS We sought to assess whether T-provisional or mini-crush is appropriate for BFLs within CTO vessels. PATIENTS AND METHODS From January 2011 to December 2013, patients who underwent successful CTO guidewire crossing and with a BFL within the CTO target vessel were enrolled prospectively and assigned randomly to either T-provisional stenting or the mini-crush technique for BFL treatment. One-year clinical follow-up was performed. Major adverse cardiac and cerebrovascular events (MACCE) were defined as the composite of cardiovascular death, myocardial infarction, target vessel revascularization, and stroke. RESULTS The prevalence of BFLs was 54.3%. A total of 146 patients with BFLs within CTO vessel were enrolled prospectively and assigned randomly to either T-provisional stenting (N=73) or the mini-crush technique (N=73). Angiographic and clinical success rates were similar in the two groups: 91.8 versus 97.2% (P=0.27) and 91.8 versus 94.5% (P=0.67), respectively.Although T-provisional stenting was associated with a nonsignificantly lower incidence of MACCE in case of BFLs located far from the CTO (9.3 vs. 22.2%; P=0.426), the mini-crush technique resulted in higher MACCE-free survival at 1 year in the presence of BFLs within the CTO body or close to the proximal or the distal cap (89.1 vs. 64.9%; P=0.007). CONCLUSION The mini-crush technique appeared to be associated with improved 1-year clinical and angiographic outcomes, particularly when used to treat BFLs located within the CTO body or close to the proximal or the distal cap.
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Ford TJ, McCartney P, Corcoran D, Collison D, Hennigan B, McEntegart M, Hildick-Smith D, Oldroyd KG, Berry C. Single- Versus 2-Stent Strategies for Coronary Bifurcation Lesions: A Systematic Review and Meta-Analysis of Randomized Trials With Long-Term Follow-up. J Am Heart Assoc 2018; 7:JAHA.118.008730. [PMID: 29802145 PMCID: PMC6015365 DOI: 10.1161/jaha.118.008730] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background The majority of coronary bifurcation lesions are treated with a provisional single‐stent strategy rather than an up‐front 2‐stent strategy. This approach is supported by multiple randomized controlled clinical trials with short‐ to medium‐term follow‐up; however, long‐term follow‐up data is evolving from many data sets. Methods and Results Meta‐analysis of randomized controlled trials evaluating long‐term outcomes (≥1 year) according to treatment strategy for coronary bifurcation lesions. Nine randomized controlled trials with 3265 patients reported long‐term clinical outcomes at mean weighted follow‐up of 3.1±1.8 years. Provisional single stenting was associated with lower all‐cause mortality (2.94% versus 4.23%; risk ratio: 0.69; 95% confidence interval, 0.48–1.00; P=0.049; I2=0). There was no difference in major adverse cardiac events (15.8% versus 15.4%; P=0.79), myocardial infarction (4.8% versus 5.5%; P=0.51), target lesion revascularization (9.3% versus 7.6%; P=0.19), or stent thrombosis (1.8% versus 1.6%; P=0.28) between the groups. Prespecified sensitivity analysis of long‐term mortality at a mean of 4.7 years of follow‐up showed that the provisional single‐stent strategy was associated with reduced all‐cause mortality (3.9% versus 6.2%; risk ratio: 0.63; 95% confidence interval, 0.42–0.97; P=0.036; I2=0). Conclusions Coronary bifurcation percutaneous coronary intervention using a provisional single‐stent strategy is associated with a reduction in all‐cause mortality at long‐term follow‐up.
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Affiliation(s)
- Thomas J Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom.,University of New South Wales, Sydney, Australia
| | - Peter McCartney
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - David Corcoran
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Damien Collison
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Barry Hennigan
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - David Hildick-Smith
- Division of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom.,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom .,British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
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14
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Borgia F, Niglio T, De Luca N, Di Serafino L, Esposito G, Trimarco B, Cirillo P. True double bifurcation lesions: new application of the self-expandable Axxess stent and review of literature with dedicated bifurcation devices. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:254-260. [PMID: 29735349 DOI: 10.1016/j.carrev.2018.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 11/17/2022]
Abstract
Complex coronary artery bifurcation lesions occurred in hard clinical scenarios, such as acute coronary syndromes, may represent a challenge for interventional cardiologists, with not-defined general consensus on treatment. Even if provisional stenting is the most common option used to restore rapidly the coronary branches flow, improvements in industrial technologies and design of new dedicated bifurcation devices might open new modalities of treatment in these complex cases. The Axxess stent (Biosensors Europe SA, Morges, Switzerland) is a self-expanding biolimus-eluting conical V-shape stent, specifically designed to treat "easily" coronary artery bifurcation lesions, with reported favorable long-term clinical results in stable patients compared to a provisional technique. We report for the first time the feasibility to use this device in a case of "true double coronary bifurcation lesion" occurred in the context of acute coronary syndrome. Moreover, we reviewed studies with bifurcation dedicated devices and available cases of "true double bifurcation lesions", underlying advantages/disadvantages of using one device over the others during acute coronary syndrome.
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Affiliation(s)
- Francesco Borgia
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy.
| | - Tullio Niglio
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Divisions of Cardiology and Cardiothoracic Surgery, Federico II University, Naples, Italy
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15
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Lassen J, Burzotta F, Banning A, Lefèvre T, Darremont O, Hildick-Smith D, Chieffo A, Pan M, Holm N, Louvard Y, Stankovic G. Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. EUROINTERVENTION 2018; 13:1540-1553. [DOI: 10.4244/eij-d-17-00622] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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16
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Zhou Y, Chen S, Huang L, Hildick-Smith D, Ferenc M, Jabbour RJ, Azzalini L, Colombo A, Chieffo A, Zhao X. Definite stent thrombosis after drug-eluting stent implantation in coronary bifurcation lesions: A meta-analysis of 3,107 patients from 14 randomized trials. Catheter Cardiovasc Interv 2017; 92:680-691. [PMID: 29214736 DOI: 10.1002/ccd.27443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/06/2017] [Accepted: 11/11/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Yu Zhou
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
| | - Shengda Chen
- State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University; China
- IBiTech, bioMMeda, Department of Electronics and Information Systems, iMinds Medical IT Department; Ghent University; De Pintelaan Ghent Belgium
| | - Lan Huang
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
| | - David Hildick-Smith
- Sussex Cardiac Centre; Brighton and Sussex University Hospitals; Brighton United Kingdom
| | - Miroslaw Ferenc
- The Division of Cardiology and Angiology II; University Heart Center Freiburg - Bad Krozingen, Suedring 15, Bad Krozingen; Germany
| | | | | | | | - Alaide Chieffo
- Cardiology Department; San Raffaele Hospital; Milan Italy
| | - Xiaohui Zhao
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University; Chongqing China
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17
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Hildick-Smith D, Behan MW, Lassen JF, Chieffo A, Lefèvre T, Stankovic G, Burzotta F, Pan M, Ferenc M, Bennett L, Hovasse T, Spence MJ, Oldroyd K, Brunel P, Carrie D, Baumbach A, Maeng M, Skipper N, Louvard Y. The EBC TWO Study (European Bifurcation Coronary TWO): A Randomized Comparison of Provisional T-Stenting Versus a Systematic 2 Stent Culotte Strategy in Large Caliber True Bifurcations. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003643. [PMID: 27578839 DOI: 10.1161/circinterventions.115.003643] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 07/15/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND For the treatment of coronary bifurcation lesions, a provisional strategy is superior to systematic 2-stent techniques for the most bifurcation lesions. However, complex anatomies with large side branches (SBs) with significant ostial disease length are considered by expert consensus to warrant a 2-stent technique upfront. This consensus view has not been scientifically assessed. METHODS AND RESULTS Symptomatic patients with large caliber true bifurcation lesions (SB diameter ≥2.5 mm) and significant ostial disease length (≥5 mm) were randomized to either a provisional T-stent strategy or a dual stent culotte technique. Two hundred patients aged 64±10 years, 82% male, were randomized in 20 European centers. The clinical presentations were stable coronary disease (69%) and acute coronary syndromes (31%). SB stent diameter (2.67±0.27 mm) and length (20.30±5.89 mm) confirmed the extent of SB disease. Procedural success (provisional 97%, culotte 94%) and kissing balloon inflation (provisional 95%, culotte 98%) were high. Sixteen percent of patients in the provisional group underwent T-stenting. The primary end point (a composite of death, myocardial infarction, and target vessel revascularization at 12 months) occurred in 7.7% of the provisional T-stent group versus 10.3% of the culotte group (hazard ratio, 1.02; 95% confidence interval, 0.78-1.34; P=0.53). Procedure time, x-ray dose, and cost all favored the simpler procedure. CONCLUSIONS When treating complex coronary bifurcation lesions with large stenosed SBs, there is no difference between a provisional T-stent strategy and a systematic 2-stent culotte strategy in a composite end point of death, myocardial infarction, and target vessel revascularization at 12 months. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT 01560455.
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Affiliation(s)
- David Hildick-Smith
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Miles W Behan
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.).
| | - Jens F Lassen
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Alaide Chieffo
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Thierry Lefèvre
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Goran Stankovic
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Francesco Burzotta
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Manuel Pan
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Miroslaw Ferenc
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Lorraine Bennett
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Thomas Hovasse
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Mark J Spence
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Keith Oldroyd
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Philippe Brunel
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Didier Carrie
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Andreas Baumbach
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Michael Maeng
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Nicola Skipper
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
| | - Yves Louvard
- From the Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (D.H.-S., L.B., N.S.); Edinburgh Heart Centre, United Kingdom (M.W.B.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.F.L., M.M.); Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy (A.C.); Institute Cardiovasculaire Paris Sud, Hospital Privé Jacques Cartier, Massy, France (T.L., T.H., Y.L.); Department of Cardiology, Clinical Centre of Serbia, Belgrade (G.S.); Medical Faculty, University of Belgrade, Serbia (G.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (F.B.); Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.); University Heart Center Freiburg, Bad Krozingen, Germany (M.F.); Department of Cardiology, Royal Victoria Hospital, Belfast, United Kingdom (M.J.S.); Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Department of Cardiology, Clinique de Fontaine-les-Djon, France (P.B.); Department of Cardiology, Rangueil Hospital, Toulouse, France (D.C.); and Bristol Heart Institute, United Kingdom (A.B.)
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Percutaneous coronary intervention of bifurcation lesions and platelet reactivity. Int J Cardiol 2017; 250:92-97. [PMID: 29074039 DOI: 10.1016/j.ijcard.2017.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/15/2017] [Accepted: 10/05/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although bifurcation percutaneous coronary intervention (PCI) is associated with lower procedural success rates and higher risk of complications, there are little data regarding outcomes after successful bifurcation PCI with contemporary stents and techniques. Whether residual platelet reactivity (PR) affects outcomes differently after bifurcation versus non-bifurcation PCI is also unknown. We studied the association between bifurcation PCI, PR, and clinical outcomes among patients undergoing successful PCI with drug-eluting stents. METHODS Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they underwent bifurcation PCI. Two-year outcomes were compared between groups using Cox proportional hazards models. Target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, and ischemia-driven target vessel revascularization. RESULTS Among the 8582 patients included in ADAPT-DES, 1276 (15%) had bifurcation PCI. Bifurcation PCI was independently associated with increased risk of TVF (adjusted hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.08-1.46, p=0.003), driven by higher risk of myocardial infarction (5.9% vs. 4.6%, p=0.033) and ischemia-driven target vessel revascularization (13.0% vs. 9.2%, p<0.0001). There was no statistical interaction between PR and bifurcation PCI regarding TVF risk (adjusted pinteraction=0.87). Stenting of both bifurcation branches was associated with the highest risk of TVF (adjusted HR 1.91, 95% CI 1.48-2.46 versus non-bifurcation PCI; ptrend<0.001). CONCLUSIONS Bifurcation PCI is associated with a higher risk of 2-year adverse ischemic events than non-bifurcation PCI, a risk that is particularly high when both bifurcation branches are stented, and with HPR conferring similar risk for bifurcation and non-bifurcation PCI.
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19
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Sawaya FJ, Lefèvre T, Chevalier B, Garot P, Hovasse T, Morice MC, Rab T, Louvard Y. Contemporary Approach to Coronary Bifurcation Lesion Treatment. JACC Cardiovasc Interv 2017; 9:1861-78. [PMID: 27659563 DOI: 10.1016/j.jcin.2016.06.056] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/15/2016] [Accepted: 06/23/2016] [Indexed: 12/22/2022]
Abstract
Coronary bifurcations are frequent and account for approximately 20% of all percutaneous coronary interventions. Nonetheless, they remain one of the most challenging lesion subsets in interventional cardiology in terms of a lower procedural success rate and increased rates of long-term adverse cardiac events. Provisional side branch stenting should be the default approach in the majority of cases and we propose easily applicable and reproducible stepwise techniques associated with low risk of failure and complications.
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Affiliation(s)
- Fadi J Sawaya
- Ramsay-Générale de Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy and Hôpital Privé Claude Galien, Quincy, France
| | - Thierry Lefèvre
- Ramsay-Générale de Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy and Hôpital Privé Claude Galien, Quincy, France
| | - Bernard Chevalier
- Ramsay-Générale de Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy and Hôpital Privé Claude Galien, Quincy, France
| | - Phillipe Garot
- Ramsay-Générale de Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy and Hôpital Privé Claude Galien, Quincy, France
| | - Thomas Hovasse
- Ramsay-Générale de Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy and Hôpital Privé Claude Galien, Quincy, France
| | - Marie-Claude Morice
- Ramsay-Générale de Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy and Hôpital Privé Claude Galien, Quincy, France
| | - Tanveer Rab
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Yves Louvard
- Ramsay-Générale de Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy and Hôpital Privé Claude Galien, Quincy, France.
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20
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Stefanini G, Byrne R, Windecker S, Kastrati A. State of the art: coronary artery stents – past, present and future. EUROINTERVENTION 2017; 13:706-716. [DOI: 10.4244/eij-d-17-00557] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Nairooz R, Saad M, Elgendy IY, Mahmoud AN, Habash F, Sardar P, Anderson D, Shavelle DM, Abbott JD. Long-term outcomes of provisional stenting compared with a two-stent strategy for bifurcation lesions: a meta-analysis of randomised trials. Heart 2017; 103:1427-1434. [PMID: 28314731 DOI: 10.1136/heartjnl-2016-310929] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 01/17/2023] Open
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22
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Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, Interventional Cardiology Unit, San Giovanni Evangelista Hospital, Via A. Parrozzani 3, 00019 Tivoli, Rome, Italy
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23
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Ng AKY, Jim MH. Percutaneous Coronary Intervention for Bifurcation: How Can We Outperform the Provisional Strategy? Clin Cardiol 2016; 39:684-691. [PMID: 27556582 DOI: 10.1002/clc.22581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/03/2016] [Accepted: 07/06/2016] [Indexed: 01/29/2023] Open
Abstract
In the era of drug-eluting stents, the provisional stenting strategy has been established as the default strategy in percutaneous coronary intervention for bifurcation lesions. However, emerging evidence shows that, in selected situations, the complex strategy of stenting both vessels regardless could reduce side-branch restenosis without penalty. In particular, the double kissing crush technique has been proven to outperform the provisional strategy and other complex strategies in randomized trials. In this review, we present the evidence comparing the 2 strategies and individual stenting techniques and discuss the roles of other optimization techniques such as final kissing balloon inflation, proximal optimization technique, intravascular ultrasonography, and optical coherence tomography. Finally, we suggest a practical approach for choosing the optimal strategy for intervention with coronary bifurcation lesions.
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Affiliation(s)
| | - Man-Hong Jim
- Cardiac Medical Unit, Grantham Hospital, Hong Kong
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24
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Bennett J, Vanhaverbeke M, Vanden Driessche N, Adriaenssens T, Hiltrop N, Desmet W, Sinnaeve P, Dubois C. Absorb Bioresorbable Vascular Scaffold in Complex Coronary Bifurcation Interventions: Insights From an In Vivo Multimodality Imaging Study. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.003849. [PMID: 27512090 DOI: 10.1161/circinterventions.116.003849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/15/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although bioresorbable scaffolds offer potential advantages compared with metallic drug-eluting stents in the treatment of complex coronary bifurcation lesions, there are concerns that the polymeric scaffold integrity may be compromised. This in vivo study sought to provide insights about the feasibility of performing complex bifurcation stenting with Absorb bioresorbable vascular scaffolds (Abbott Vascular, Santa Clara, CA). METHODS AND RESULTS Twenty New Zealand white rabbits underwent stenting of the nondiseased aortoiliac bifurcation with bioresorbable vascular scaffolds using provisional (PS, n=5), culotte (n=5), modified-T (n=5), or T-and protrusion (n=5) stenting techniques. Angiography, optical coherence tomography, and microcomputed tomography were performed. Angiographic results were excellent without evidence of dissection or side branch (SB) compromise. PS optimally opened the SB ostium without deforming the main vessel (MV) bioresorbable vascular scaffolds, avoiding malapposition, and revealing a single connector fracture in 1 of 5 cases on microcomputed tomography. Culotte stenting resulted in complete bifurcation coverage with extensive segments of double-layered struts and inappropriately apposed struts at the bifurcation level in 3 of 5 cases. On microcomputed tomography, there was MV and SB scaffold distortion at the bifurcation with single strut fractures in 4 of 5 and double fractures in 1 of 5. Modified-T and T-and protrusion resulted in complete bifurcation coverage and in minimal double-strut layers at the neocarina. On microcomputed tomography, no strut fractures were present after modified-T, whereas in 3 of 5 T-and protrusion procedures single strut fractures were noted. CONCLUSIONS Bifurcation stenting using bioresorbable vascular scaffolds is feasible with excellent angiographic results. PS with additional T-and protrusion whenever needed seems a reasonable approach. Whenever a 2-stent technique is planned, modified T-stenting appears the most promising.
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Affiliation(s)
- Johan Bennett
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.).
| | - Maarten Vanhaverbeke
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Nina Vanden Driessche
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Tom Adriaenssens
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Nick Hiltrop
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Walter Desmet
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Peter Sinnaeve
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
| | - Christophe Dubois
- From the Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium (J.B., T.A., N.H., W.D., P.S., C.D.); and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Belgium (J.B., M.V., N.V.D., T.A., W.D., P.S., C.D.)
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Chan PH, Alegria-Barrero E, Foin N, Paulo M, Lindsay AC, Viceconte N, Di Mario C. Extended use of the GuideLiner in complex coronary interventions. EUROINTERVENTION 2016; 11:325-35. [PMID: 24930135 DOI: 10.4244/eijy14m06_02] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS Challenging coronary anatomies including chronic total occlusions (CTO), extreme vessel tortuosity, diseased bypass grafts, and anomalous coronary arteries pose difficulties in coronary interventions. The GuideLiner is a monorail catheter originally developed to facilitate delivery of stents to target lesions in tortuous vessels. We conducted a study on the feasibility and safety of utilising this catheter in a wider array of complex coronary interventions. METHODS AND RESULTS Consecutive patients undergoing coronary or peripheral interventions where a GuideLiner was used were recruited into this study. Patient demographics, lesion and vessel characteristics, procedural details and outcomes were prospectively entered into our database and analysed. From September 2009 to October 2011, 54 consecutive patients underwent coronary intervention in our institution using a GuideLiner; 21 out of 54 coronary applications were motivated by the need to increase support to cross CTOs, predominantly of the RCA. Anomalous or angulated take-off of the treatment vessels (31%), previously deployed proximal stents (15%), heavy proximal calcification (9%) and tortuosity (7%) accounted for the remaining reasons. One patient had successful renal denervation with the aid of a GuideLiner catheter. Procedural success was 98% in our series with no device-related periprocedural complications such as ostial dissection or myocardial necrosis. CONCLUSIONS The use of a GuideLiner facilitates the approach to complex coronary interventions including chronic total occlusion and saphenous vein graft intervention by providing greater back-up support and easier engagement of coronary ostia.
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Affiliation(s)
- Pak Hei Chan
- International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom
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26
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Grundeken MJ, Hassell ME, Kraak RP, de Bruin DM, Koch KT, Henriques JP, van Leeuwen TG, Tijssen JG, Piek JJ, de Winter RJ, Wykrzykowska JJ. Treatment of coronary bifurcation lesions with the Absorb bioresorbable vascular scaffold in combination with the Tryton dedicated coronary bifurcation stent: evaluation using two- and three-dimensional optical coherence tomography. EUROINTERVENTION 2015; 11:877-84. [DOI: 10.4244/eijy14m08_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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27
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Çaylı M, Şeker T, Gür M, Elbasan Z, Şahin DY, Elbey MA, Çil H. A Novel-Modified Provisional Bifurcation Stenting Technique: Jailed Semi-Inflated Balloon Technique. J Interv Cardiol 2015; 28:420-9. [PMID: 26346292 DOI: 10.1111/joic.12225] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We proposed a new technique for the treatment of coronary bifurcation lesions, called jailed semi-inflated balloon technique (JSBT). BACKGROUND Currently, provisional approach is recommended to treat most of coronary bifurcation lesions. However, it is associated with the risk of side branch (SB) occlusion after main vessel (MV) stenting due to plaque or carina shift into the SB. The SB occlusion may cause peri-procedural myonecrosis or hemodynamic compromise. Therefore, strategies are needed to reduce the SB occlusion during provisional approach. METHODS Between September 2014 and April 2015, we selected 137 patients (104 male, 33 female; mean age 63.6 ± 11.7 years) with 148 distinct coronary bifurcation lesions underwent percutaneous coronary intervention using JSBT. All patients were followed with hospital visits or telephone contact up to 1 month. RESULTS The majority of the patients had acute coronary syndrome (64.2%) and Medina 1.1.1. bifurcation lesions (62.8%). The lesion localization was distal left main (LM) coronary artery in 28 patients. After the MV stenting, thrombolysis in myocardial infarction (TIMI) 3 flow was established in 100% of both MV and SB. There was no SB occlusion in any patient. There was no major adverse cardiac event during in-hospital stay and 1 month follow-up. CONCLUSIONS The JSBT technique can be successfully performed in both LM and non-LM bifurcation lesion. This technique provides high rate of procedural success, excellent SB protection during MV stenting and excellent immediate clinical outcome.
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Affiliation(s)
- Murat Çaylı
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Taner Şeker
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mustafa Gür
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Zafer Elbasan
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Durmus Yildiray Şahin
- Department of Cardiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | | | - Habib Çil
- Department of Cardiology, Dicle University, Turkey
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Okamura T, Onuma Y, Yamada J, Iqbal J, Tateishi H, Nao T, Oda T, Maeda T, Nakamura T, Miura T, Yano M, Serruys PW. 3D optical coherence tomography: new insights into the process of optimal rewiring of side branches during bifurcational stenting. EUROINTERVENTION 2015; 10:907-15. [PMID: 24531393 DOI: 10.4244/eijv10i8a157] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We describe three-dimensional optical coherence tomography (3D-OCT) guided bifurcation stenting and the clinical utility of 3D-OCT. METHODS AND RESULTS Twenty-two consecutive patients who underwent OCT examination to confirm the recrossing position after stent implantation in a bifurcation lesion were enrolled. Frequency domain OCT images were obtained to check the recrossing position and 3D reconstructions were performed off-line. The recrossing position was clearly visualised in 18/22 (81.8%) cases. In 13 cases, serial 3D-OCT could be assessed both before and after final kissing balloon post-dilation (FKBD). We divided these cases into two groups according to the presence of the link between hoops at the carina: free carina type (n=7) and connecting to carina type (n=6). All free carina types complied with the distal rewiring. The percentage of incomplete stent apposition (%ISA) of free carina type at the bifurcation segment after FKBD was significantly smaller than that of the connecting to carina type (0.7±0.9% vs. 12.2±6.5%, p=0.0074). CONCLUSIONS 3D-OCT confirmation of the recrossing into the jailed side branch is feasible during PCI and may help to achieve distal rewiring and favourable stent positioning against the side branch ostium, leading to reduction in ISA and potentially better clinical outcomes.
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Affiliation(s)
- Takayuki Okamura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Mennuni MG, Pagnotta PA, Stefanini GG. Coronary Stents: The Impact of Technological Advances on Clinical Outcomes. Ann Biomed Eng 2015; 44:488-96. [DOI: 10.1007/s10439-015-1399-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/17/2015] [Indexed: 12/29/2022]
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Darremont O, Leymarie JL, Lefèvre T, Albiero R, Mortier P, Louvard Y. Technical aspects of the provisional side branch stenting strategy. EUROINTERVENTION 2015; 11 Suppl V:V86-90. [DOI: 10.4244/eijv11sva19] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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31
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Sakata K, Koo BK, Waseda K, Nakatani D, Yock PG, Whitbourn R, Worthley SG, Ormiston J, Webster M, Wilkins GT, Honda Y, Meredith IT, Fitzgerald PJ. A Y-shaped bifurcation-dedicated stent for the treatment of de novo coronary bifurcation lesions: an IVUS analysis from the BRANCH trial. EUROINTERVENTION 2015; 10:e1-8. [PMID: 25169593 DOI: 10.4244/eijy14m08_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this IVUS substudy was to assess the efficacy of the Y-shaped Medtronic bifurcation-dedicated stent (BDS) for the treatment of de novo coronary bifurcated lesions. METHODS AND RESULTS In the BRANCH trial, post-procedure IVUS was performed in 45 patients. IVUS was available in both branches in 19 lesions and only the main branch (MB) in 26 lesions. IVUS analysis included four distinct locations: proximal MB, bifurcation site, distal MB, and side branch (SB). Lumen symmetry was calculated as minimum/maximum lumen diameters. The quantity of isolated stent struts across the SB ostium was used to assess inadequate strut apposition to the carina resulting in partial jailing of the SB orifice. A minimum stent area (MSA) <4 mm2 was found in 0% of proximal and distal MB, and in 15.4% of SB. In SB, MSA was located mainly at mid or distal segments (84.6%), rather than at the SB ostium. Eccentric stent expansion and edge dissection were seen primarily at proximal MB. Isolated struts were seen in only 20.9% of SB ostia with a minimum length of 0.7±0.4 mm. CONCLUSIONS Implantation of BDS resulted in adequate stent dimensions and strut apposition at the carina and SB ostium. ClinicalTrials.gov Identifier: NCT00607321.
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Affiliation(s)
- Kenji Sakata
- Stanford University Medical Center, Stanford, CA, USA
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Généreux P, Kumsars I, Lesiak M, Kini A, Fontos G, Slagboom T, Ungi I, Metzger DC, Wykrzykowska JJ, Stella PR, Bartorelli AL, Fearon WF, Lefèvre T, Feldman RL, LaSalle L, Francese DP, Onuma Y, Grundeken MJ, Garcia-Garcia HM, Laak LL, Cutlip DE, Kaplan AV, Serruys PW, Leon MB. A Randomized Trial of a Dedicated Bifurcation Stent Versus Provisional Stenting in the Treatment of Coronary Bifurcation Lesions. J Am Coll Cardiol 2015; 65:533-43. [DOI: 10.1016/j.jacc.2014.11.031] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 10/22/2014] [Accepted: 11/19/2014] [Indexed: 11/29/2022]
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Silva JD, Carrillo X, Salvatella N, Fernandez-Nofrerias E, Rodriguez-Leor O, Mauri J, Bayes-Genis A. The utility of stent enhancement to guide percutaneous coronary intervention for bifurcation lesions. EUROINTERVENTION 2014; 9:968-74. [PMID: 23774612 DOI: 10.4244/eijv9i8a162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS Percutaneous coronary intervention (PCI) of bifurcation lesions is complex and is technically very demanding. Coronary angiography is considered the gold standard method to guide PCI but has several limitations. The purpose of this study was to determine the utility of stent enhancement with StentBoost® (StB), a novel fluoroscopic imaging technique, and its potential role during bifurcation PCI. METHODS AND RESULTS This prospective study included 97 patients who underwent bifurcation PCI (98 bifurcations), using StB. Bifurcation lesions were classified according to the modified Medina classification. StB was performed in all patients to obtain improved stent visualisation and to detect optimal release and deployment. Therefore, three groups were formed, according to the quality of image: optimal visualisation, suboptimal visualisation and poor visualisation. Most of the bifurcation disease involved the main vessel (99%) and in 80 patients (81.6%) there was side branch involvement. Most bifurcations had both main vessel and side branch lesions (Medina 1,1,1) (70 patients, 71.4%). StB image quality was good in 79.6% of the cases (optimal visualisation of the stent and guidewire), was suboptimal in 19.4%, and poor in 1% (overlapping of structures or devices). In three cases, StB enabled the identification of the guidewire and angioplasty balloon passing outside stent borders during rewiring of the side branch. CONCLUSIONS Imaging techniques have a primary role during bifurcation PCI. StentBoost is a simple and quick method that offers several advantages, enabling improved stent visualisation, appropriate rewiring of the side branch, adequate stent expansion and optimal apposition of the struts to the wall.
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Affiliation(s)
- Joana D Silva
- Cardiovascular Intervention Unit, Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Pan M, Medina A, Romero M, Ojeda S, Martin P, Suarez de Lezo J, Segura J, Mazuelos F, Novoa J, Suarez de Lezo J. Assessment of side branch predilation before a provisional T-stent strategy for bifurcation lesions. A randomized trial. Am Heart J 2014; 168:374-80. [PMID: 25173550 DOI: 10.1016/j.ahj.2014.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/19/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND A simple approach is the predominant strategy for the percutaneous coronary intervention of bifurcation lesions. Performing side branch (SB) predilation in this context is currently a matter of controversy. In this study, we assess the efficacy of SB predilatation before a provisional T-stent strategy for bifurcation lesions. METHODS Between February 2009 and November 2012, 372 patients with true bifurcation lesions were randomized to either predilation of the SB (n = 187) or no predilatation (n = 185) before main branch (MB) stent implantation and a subsequent SB provisional stent strategy. RESULTS There were no significant differences between the patient groups regarding the baseline characteristics. After MB stent implantation, the TIMI flow of the SB was higher in the patients with SB predilation: TIMI flow 0 to 1; 2 (1%) versus 18 (10%), P < .001; and TIMI flow III; 179 (96%) versus 152 (82%), P < .001. Side branch stenting rates were 4% versus 3%, P = not significant. In addition, 60 patients (32%) from the SB predilation group presented SB residual stenosis by visual inspection <50%, and TIMI flow ≥III did not require any additional treatment. The failure rate of SB rewiring, the time of rewiring, the number of wires used, and the incidence of major events were similar in both groups of patients. CONCLUSIONS Predilation of the SB resulted in improved TIMI flow after MB stenting and less indication to subsequently treat the SB. If rewiring of the SB is required, predilation did not hinder this maneuver.
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Affiliation(s)
- Manuel Pan
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain.
| | - Alfonso Medina
- Dr Negrin Hospital, Department of Cardiology, University of Las Palmas, Las Palmas de Gran Canaria, Spain
| | - Miguel Romero
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
| | - Soledad Ojeda
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
| | - Pedro Martin
- Dr Negrin Hospital, Department of Cardiology, University of Las Palmas, Las Palmas de Gran Canaria, Spain
| | - Javier Suarez de Lezo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
| | - Jose Segura
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
| | - Francisco Mazuelos
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
| | - Jose Novoa
- Dr Negrin Hospital, Department of Cardiology, University of Las Palmas, Las Palmas de Gran Canaria, Spain
| | - Jose Suarez de Lezo
- Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain
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Maehara A, van Geuns RJ, Louvard Y, Müller R, Grube E, Morice MC, Davis HR, Kaplan AV, Onuma Y, Serruys PW, Mintz GS. Serial intravascular ultrasound observations from the Tryton first-in-man study. EUROINTERVENTION 2014; 10:475-83. [PMID: 25138185 DOI: 10.4244/eijv10i4a81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To report serial intravascular ultrasound (IVUS) findings of bifurcation lesions treated with the dedicated Tryton Side Branch Stent to assess mechanisms of restenosis. METHODS AND RESULTS The Tryton FIM study was a multicentre, prospective, single-arm, "first-in-man" study to treat de novo bifurcation lesions. Minimum lumen area (MLA) sites and overall volumes were analysed within main vessels and side branches. Overall, 27 main vessels and 22 side branches had paired baseline and follow-up IVUS. The post-intervention main vessel MLA decreased from 5.3 (4.1, 6.2) to 4.8 (3.4, 5.7) mm2 at follow-up, p=0.02, and the side branch MLA decreased from 3.5 (3.0, 3.8) to 2.5 (2.2, 3.2) mm2, p=0.0005. Stent area at the side branch did not change (mean stent area from 4.0 [3.3, 4.1] to 3.8 [3.4, 4.2] mm3/mm, p=0.95). Neointimal hyperplasia (NIH) net volume obstruction (%) measured 1.8% (0.5, 7.0) for the entire main vessel and 14.9% (2.3, 31.1) for the entire side branch stents. In both main vessel and side branches the decrease in lumen area correlated significantly with NIH. CONCLUSIONS Serial IVUS analysis of a new side branch Tryton stent showed no chronic stent recoil. Side branch underexpansion was common and along with superimposed NIH contributed to the reduction in lumen dimensions at follow-up.
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Affiliation(s)
- Akiko Maehara
- Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA
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Kherada NI, Sartori S, Tomey MI, Mennuni MG, Meelu OA, Roy S, Mohanty BD, Baber U, Pyo R, Kovacic JC, Sweeny J, Moreno P, Krishnan P, Dangas GD, Mehran R, Sharma SK, Kini AS. Dedicated two-stent technique in complex bifurcation percutaneous coronary intervention with use of everolimus-eluting stents: the EES-bifurcation study. Int J Cardiol 2014; 174:13-7. [PMID: 24731975 DOI: 10.1016/j.ijcard.2014.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/09/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the outcomes of initial one-stent (1S) versus dedicated two-stent (2S) strategies in complex bifurcation percutaneous coronary intervention (PCI) using everolimus-eluting stents (EES). BACKGROUND PCI of true bifurcation lesions is technically challenging and historically associated with reduced procedural success and increased restenosis. Prior studies comparing initial one-stent (1S) versus dedicated two-stent (2S) strategies using first-generation drug-eluting stents have shown no reduction in ischemic events and more complications with a 2S strategy. METHODS We performed a retrospective study of 319 consecutive patients undergoing PCI at a single referral center with EES for true bifurcation lesions, defined by involvement of both the main vessel (MV) and side branch (SB). Baseline, procedural characteristics, quantitative coronary angiography and clinical outcomes in-hospital and at one year were compared for patients undergoing 1S (n=175) and 2S (n=144) strategies. RESULTS Baseline characteristics were well-matched. 2S strategy was associated with greater SB acute gain (0.65±0.41 mm vs. 1.11±0.47 mm, p<0.0001). In-hospital serious adverse events were similar (9% with 2S vs. 8% with 1S, p=0.58). At one year, patients treated by 2S strategy had non-significantly lower rates of target vessel revascularization (5.8% vs. 7.4%, p=0.31), myocardial infarction (7.8% vs. 12.2%, p=0.31) and major adverse cardiovascular events (16.6% vs. 21.8%, p=0.21). CONCLUSION In this study of patients undergoing PCI for true coronary bifurcation lesions using EES, 2S strategy was associated with superior SB angiographic outcomes without excess complications or ischemic events at one year.
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Affiliation(s)
- Nisharahmed I Kherada
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Matthew I Tomey
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marco G Mennuni
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Omar A Meelu
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Swathi Roy
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bibhu D Mohanty
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Robert Pyo
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jason C Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Pedro Moreno
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Prakash Krishnan
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Estrada JR, Paul JD, Shah AP, Nathan S. Overview of Technical and Cost Considerations in Complex Percutaneous Coronary Intervention. Interv Cardiol 2014; 9:17-22. [PMID: 29588772 PMCID: PMC5808630 DOI: 10.15420/icr.2011.9.1.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/23/2014] [Indexed: 11/04/2022] Open
Abstract
Complex percutaneous coronary intervention (PCI), encompassing an ever-expanding range of challenging lesion sets and patient populations, accounts for a significant proportion of PCI procedures being performed currently. Specific lesion types associated with lower rates of procedural success and higher rates of recurrence or major adverse cardiac events (MACE) include multivessel disease, unprotected left main coronary artery disease, fibrocalcific or undilatable lesions, chronic total occlusions, degenerated saphenous vein graft lesions, thrombotic lesions, and bifurcation disease. Validated tools and technical strategies currently exist to address most procedural scenarios encountered and should be familiar to the complex PCI operator. Anticipated clinical outcomes, projected resource utilization, and cost considerations should all factor into the decisions of when, how, and in whom to intervene.
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Affiliation(s)
- J Raider Estrada
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
| | - Jonathan D Paul
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
| | - Atman P Shah
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
| | - Sandeep Nathan
- University of Chicago Medicine, Section of Cardiology, Chicago, Illinois, US
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Colombo A, Chieffo A. One versus two stents: the cause or the effect? JACC Cardiovasc Interv 2014; 7:264-5. [PMID: 24529930 DOI: 10.1016/j.jcin.2013.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 10/16/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Antonio Colombo
- Interventional Cardiology Unit, EMO GVM Columbus and San Raffaele Scientific Institute, Milan, Italy.
| | - Alaide Chieffo
- Interventional Cardiology Unit, EMO GVM Columbus and San Raffaele Scientific Institute, Milan, Italy
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Dash D. Recent perspective on coronary artery bifurcation interventions. HEART ASIA 2014; 6:18-25. [PMID: 27326157 PMCID: PMC4832703 DOI: 10.1136/heartasia-2013-010451] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/17/2014] [Indexed: 02/03/2023]
Abstract
Coronary bifurcation lesions are frequent in routine practice, accounting for 15-20% of all lesions undergoing percutaneous coronary intervention (PCI). PCI of this subset of lesions is technically challenging and historically has been associated with lower procedural success rates and worse clinical outcomes compared with non-bifurcation lesions. The introduction of drug-eluting stents has dramatically improved the outcomes. The provisional technique of implanting one stent in the main branch remains the default approach in most bifurcation lesions. Selection of the most effective technique for an individual bifurcation is important. The use of two-stent techniques as an intention to treat is an acceptable approach in some bifurcation lesions. However, a large amount of metal is generally left unapposed in the lumen with complex two-stent techniques, which is particularly concerning for the risk of stent thrombosis. New technology and dedicated bifurcation stents may overcome some of the limitations of two-stent techniques and revolutionise the management of bifurcation PCI in the future.
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Roik M, Wretowski D, Wolny R, Łabyk A, Kostrubiec M, Pruszczyk P. StentBoost imaging for the assessment of optimal stent deployment and coverage of side branch ostium in coronary bifurcation intervention. Int J Cardiol 2014; 172:e458-60. [PMID: 24485620 DOI: 10.1016/j.ijcard.2014.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/28/2013] [Accepted: 01/01/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Lindley'a 4, 02-005 Warsaw, Poland.
| | - Dominik Wretowski
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Lindley'a 4, 02-005 Warsaw, Poland
| | - Rafał Wolny
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Lindley'a 4, 02-005 Warsaw, Poland
| | - Andrzej Łabyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Lindley'a 4, 02-005 Warsaw, Poland
| | - Maciej Kostrubiec
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Lindley'a 4, 02-005 Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Lindley'a 4, 02-005 Warsaw, Poland
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Evaluating stent optimisation technique (StentBoost®) in a dedicated bifurcation stent (the Tryton™). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:92-6. [PMID: 24560297 DOI: 10.1016/j.carrev.2014.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND/PURPOSE To evaluate the use of StentBoost® in the Tryton™ dedicated SideBranch Stent. METHODS & RESULTS The Tryton™ SideBranch Stent has been effectively used to manage complex bifurcations. However, the paucity of scaffolding in the proximal part of the stent makes it often difficult to visualise under standard radiographic imaging. We set out to evaluate whether by using an augmented radiographic imaging technique it was possible to aid visualisation of the stent. In particular the so call 'wedding ring' band which is crucial to the procedural success. We further evaluated whether it was possible to determine the apposition of the stent at the carina, its coverage and the ability to aid recrossing of the struts closest to the carina as well as the added radiation exposure. CONCLUSIONS StentBoost® was found to be invaluable to the procedural success of the Tryton™ deployment without adding any extra cost to the procedure and with only a 3.7% increase in radiation to the patient. It allowed enhanced visualisation in all cases to aid apposition, recrossing and coverage.
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Giannini F, Naim C, Costopoulos C, Latib A, Colombo A. Drug-coated balloons in interventional cardiology. Expert Rev Cardiovasc Ther 2014; 11:1379-91. [DOI: 10.1586/14779072.2013.837758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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To kiss or not to kiss? Impact of final kissing-balloon inflation on early and long-term results of percutaneous coronary intervention for bifurcation lesions. Heart Vessels 2013; 29:732-42. [PMID: 24077644 DOI: 10.1007/s00380-013-0416-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/13/2013] [Indexed: 02/08/2023]
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Depta JP, Patel Y, Patel JS, Novak E, Yeung M, Zajarias A, Kurz HI, Lasala JM, Bach RG, Singh J. Long-term clinical outcomes with the use of a modified provisional Jailed-Balloon stenting technique for the treatment of nonleft main coronary bifurcation lesions. Catheter Cardiovasc Interv 2013; 82:E637-46. [DOI: 10.1002/ccd.24778] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 10/29/2012] [Accepted: 12/07/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Jeremiah P. Depta
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Yogesh Patel
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Jayendrakumar S. Patel
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Eric Novak
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Michael Yeung
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Alan Zajarias
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Howard I. Kurz
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - John M. Lasala
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Richard G. Bach
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Jasvindar Singh
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
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Late Thrombosis After Double Versus Single Drug-Eluting Stent in the Treatment of Coronary Bifurcations. JACC Cardiovasc Interv 2013; 6:687-95. [DOI: 10.1016/j.jcin.2013.03.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/06/2013] [Accepted: 03/15/2013] [Indexed: 12/19/2022]
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Grundeken MJ, Asgedom S, Damman P, Lesiak M, Norell MS, Garcia E, Bethencourt A, Woudstra P, Koch KT, Vis MM, Henriques JP, Onuma Y, Foley DP, Bartorelli AL, Stella PR, Tijssen JG, de Winter RJ, Wykrzykowska JJ. Six-month and one-year clinical outcomes after placement of a dedicated coronary bifurcation stent: a patient-level pooled analysis of eight registry studies. EUROINTERVENTION 2013; 9:195-203. [DOI: 10.4244/eijv9i2a34] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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47
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Loh JP, Waksman R. Paclitaxel drug-coated balloons: a review of current status and emerging applications in native coronary artery de novo lesions. JACC Cardiovasc Interv 2013; 5:1001-12. [PMID: 23078727 DOI: 10.1016/j.jcin.2012.08.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/24/2012] [Accepted: 08/29/2012] [Indexed: 11/30/2022]
Abstract
The paclitaxel drug-coated balloon (DCB) is an emerging device in percutaneous coronary intervention, which has shown promising results by means of a high-concentration, rapid local release of an antirestenotic drug without the use of a durable polymer or metal scaffold. DCB have already proven effective in clinical trials for the treatment of in-stent restenosis. Its coronary applications may potentially be widened to a host of complex coronary de novo lesion subsets, such as small-caliber vessels, diabetes, and diffuse lesions, where the use of stents may be hampered by suboptimal results. Recently, this technology has rapidly evolved with newer studies added to assess the value of DCB in coronary applications other than in-stent restenosis. We present a review of the role of DCB in de novo coronary lesions based on this latest clinical evidence.
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Affiliation(s)
- Joshua P Loh
- Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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48
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Weisz G, Metzger DC, Liberman HA, O'Shaughnessy CD, Douglas JS, Turco MA, Mehran R, Gershony G, Leon MB, Moses JW. A provisional strategy for treating true bifurcation lesions employing a scoring balloon for the side branch: final results of the AGILITY trial. Catheter Cardiovasc Interv 2013; 82:352-9. [PMID: 22927100 DOI: 10.1002/ccd.24630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 08/22/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND The provisional approach for bifurcation stenting with side-branch balloon angioplasty is associated with dissections and suboptimal results requiring kissing balloon techniques or bailout stenting. We hypothesized that using a scoring balloon for the side branch and a drug-eluting stent for the main vessel might improve outcomes of true bifurcation lesions. METHODS AND RESULTS A total of 93 patients with complex bifurcations were enrolled in a multicenter, single-arm, prospective clinical trial. A drug-eluting stent was deployed in the main vessel following dilatation of the side-branch stenosis with a scoring balloon. The overall angiographic success rate was 93.5%, and procedural success rate was 91.4%. The final diameter stenosis was 13.9% ± 7.2% for the main vessel and 33.3% ± 22.9% for the side branch. Crossover to stent deployment in the side branch was required in 10.8%. The postscoring balloon dissection rate was 8.2% and 6% (all ≤ class C) for the main vessel and side branch respectively, which was reduced to 1.1 and 2.1% poststenting. At 9-month follow-up, the composite MACE rate [cardiac death, myocardial infarction, or target lesion revascularization (TLR)] was 5.4%, including a TLR rate of 3.3% (1.1% from hospital discharge to 9 months). CONCLUSION The 9-month results of the AGILITY trial support a simple provisional strategy for treating complex true bifurcation lesions with deployment of a drug-eluting stent in the main vessel after dilatation of the side-branch vessel with a scoring balloon. This strategy was associated with excellent and safe procedural results, a low rate of crossover to side-branch stenting, and favorable outcomes.
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Affiliation(s)
- Giora Weisz
- NewYork Presbyterian Hospital, Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
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Werner M, Scheinert S, Bausback Y, Bräunlich S, Ulrich M, Piorkowski M, Scheinert D, Schmidt A. Bifurcation stenting after failed angioplasty of infrapopliteal arteries in critical limb ischemia: techniques and short-term follow-up. Catheter Cardiovasc Interv 2013; 82:E522-8. [PMID: 23404942 DOI: 10.1002/ccd.24828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/20/2012] [Accepted: 01/10/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To report on the efficacy of drug eluting stents (DES) in below the knee lesions involving arterial bifurcations after failed angioplasty. BACKGROUND DES have become a mainstay in the treatment of below the knee lesions. However, little is known about the efficacy of DES in infrapopliteal lesions involving the arterial bifurcations. This is the first report on the endovascular treatment of below-the knee bifurcations. METHODS 11 patients with critical lower limb ischemia and complex infrapopliteal atherosclerotic disease underwent provisional DES placement in infrapopliteal bifurcation lesions. Clinical and angiographic follow-up data were prospectively collected in all patients. RESULTS Technical success was achieved in all cases. After 6 months, the two vessel primary patency (2VPP) rate was 54.5% and the 1VPP rate was 81.8%. Between baseline and the follow-up, mean ankle-brachial index increased from 0.31 ± 0.10 to 0.68 ± 0.16, and mean Rutherford-Becker class decreased from 4.73 ± 0.20 to 3.00 ± 1.41 (P < 0.001 for both comparisons). CONCLUSIONS Bifurcation stenting techniques, that are described for the coronary arteries can be also performed in the infrapopliteal arteries. However, early reocclusion was frequent in this case series, when stenting was performed in a bail-out setting. If balloon angioplasty alone leads to no sufficient results in bifurcation lesions, a single stent strategy could also be considered.
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Affiliation(s)
- Martin Werner
- Center of Vascular Medicine, Park Hospital Leipzig, Germany
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Alegría-Barrero E, Foin N, Chan PH, Syrseloudis D, Lindsay AC, Dimopolous K, Alonso-González R, Viceconte N, De Silva R, Di Mario C. Optical coherence tomography for guidance of distal cell recrossing in bifurcation stenting: choosing the right cell matters. EUROINTERVENTION 2012; 8:205-13. [PMID: 22581489 DOI: 10.4244/eijv8i2a34] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to assess the ability of optical coherence tomography (OCT) to guide recrossing during percutaneous coronary interventions in bifurcations and to reduce strut malapposition. METHODS AND RESULTS Fifty-two patients undergoing elective treatment of bifurcation lesions using provisional stenting as default strategy were included in the study. Patients were divided into two groups: OCT-guided stent recrossing (group 1, n=12), and angiography-guided recrossing (group 2, n=40). Malapposition in the various bifurcation segments was compared in the two groups, using propensity score analysis to correct for confounders. In 4/12 patients (33%) of the OCT-guided group after the first attempt to recross the stent towards the SB the wire was found to have crossed in a proximal cell, requiring a second and in one case a third attempt to successfully cross through a distal cell. Patients who were treated using OCT-guided recrossing had a significantly lower number of malapposed stent struts, especially in the quadrants towards the SB ostium (9.5%[7.5-17.4%] vs 42.3%[31.2-54.7%] in the angiography-guided group, p<0.0001). CONCLUSIONS The rate of strut malapposition was significantly reduced when OCT was used to confirm that wire recrossing was performed in a distal cell of the SB ostium.
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