1
|
Levi Y, Kobo O, Halabi M, Al Haddad I, Chevalier B, Polad J, Laanmets P, Witkowski A, Monsegu J, Iniguez AR, Mamas MA, Roguin A. Treatment of Ostial Right Coronary Artery Narrowings: Outcomes From the Multicenter Prospective e-ULTIMASTER Registry. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100604. [PMID: 39130698 PMCID: PMC11308816 DOI: 10.1016/j.jscai.2023.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 08/13/2024]
Abstract
Background Treatment of right coronary artery (RCA) aorto-ostial (AO) lesions with bare-metal stents and first-generation drug-eluting stents (DES) was associated with worse outcomes. This study aimed to assess the effect of RCA-AO stenting with current-generation DES on the clinical outcome. Methods The large all-comer, multicontinental e-ULTIMASTER registry included 37,198 patients of whom 4775 underwent ostial and proximal RCA percutaneous coronary intervention (PCI) using the Ultimaster stent (Terumo). The primary clinical end point was 1-year target lesion failure (TLF), a composite of cardiac death; target vessel-related myocardial infarction; or clinically indicated target lesion revascularization. Results We compared 591 (12.4%) patients who underwent RCA-AO PCI with 4184 (87.6%) patients who underwent proximal RCA PCI. The RCA-AO group included more men and recorded significantly more comorbidities and more complex coronary anatomy. After propensity matching, the primary end point TLF occurred in 4.49% of the RCA-AO group compared with 3.00% of the proximal RCA group (P = .06). Target vessel revascularization (3.29% vs 1.90%; P = .03) and stent thrombosis (1.23% vs 0.42%, P = .01) were significantly higher among patients with RCA-AO lesions than those among patients with proximal RCA lesions. All-cause mortality was similar between the groups (2.97% vs 2.26%; P = .30). Conclusions The treatment of RCA-AO with DES is feasible, with similar rates of TLF but with an increased risk of target vessel revascularization and stent thrombosis.
Collapse
Affiliation(s)
- Yaniv Levi
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Majdi Halabi
- Department of Cardiology, Ziv Hospital, Safed, Israel
| | - Imad Al Haddad
- Cardiovascular Division, Department of Medicine, Jordan Hospital, Amman, Jordan
| | - Bernard Chevalier
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Jawed Polad
- Department of Cardiology, Jeroen Bosch Ziekenhuis, Hertogenbosch, the Netherlands
| | - Peep Laanmets
- Department of Cardiology, North Estonia Medical Centre, Tallinn, Estonia
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Jacques Monsegu
- Institut Cardio-Vasculaire, Groupe Hospitalier Mutualiste, Grenoble, France
| | | | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, Newcastle, United Kingdom
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - e-ULTIMASTER Registry Investigators‡
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
- Department of Cardiology, Ziv Hospital, Safed, Israel
- Cardiovascular Division, Department of Medicine, Jordan Hospital, Amman, Jordan
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
- Department of Cardiology, Jeroen Bosch Ziekenhuis, Hertogenbosch, the Netherlands
- Department of Cardiology, North Estonia Medical Centre, Tallinn, Estonia
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
- Institut Cardio-Vasculaire, Groupe Hospitalier Mutualiste, Grenoble, France
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, Newcastle, United Kingdom
| |
Collapse
|
2
|
Abdulrahman B, Mashayekhi K, Tajti P, Ferenc M, Valina CM, Hochholzer W, Neumann FJ, Nührenberg TG. Clinical Outcomes after Additional Dynamic Renal® Stent Implantation for Stent Recoil in Ostial Coronary Lesions. J Clin Med 2020; 9:jcm9123964. [PMID: 33297448 PMCID: PMC7762371 DOI: 10.3390/jcm9123964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Interventional treatment of aorto-ostial coronary stenoses is limited by stent recoil and suboptimal angiographic results, leading to restenosis and frequent re-interventions. As a potential bail-out strategy for stent recoil, implantation of an additional stent to increase radial force has been reported. Thus, we sought to investigate clinical outcomes after additional implantation of a Dynamic Renal® stent (DRS), a non-coronary; bare-metal stent with very high radial force, in aorto-ostial coronary stenoses. Methods: Patients treated by implantation of DRSs for stent recoil in the ostial right coronary artery or the left main stem were identified from the hospital database. Baseline clinical and procedural characteristics were compared to patients who underwent re-intervention for in-stent-restenosis in similar segments by either implantation of conventional drug-eluting stents (DES) or paclitaxel-coated balloons (PCB). Clinical follow-ups were performed up to three years following re-intervention with the assessment of death, target lesion reintervention (TLR), and major adverse cardiac events (MACE) as a combination death, myocardial infarction and target vessel revascularization. Kaplan–Meier analyses were performed for event-free survival between the three groups. Results: Between 05/2013 and 07/2019, 28 patients underwent DRS implantation of aorto-ostial coronary lesions. In comparison with 49 patients with DES implantation and 29 patients undergoing PCB treatment, no relevant differences in baseline parameters were identified. Median follow-up was 714 days, with an available follow-up of >1 year after intervention in 82.1% of patients. In the entire study cohort at two years after re-intervention, the TLR rate was 16% (17 patients), the MACE rate 37% (39 patients), and all-cause mortality 9% (10 patients), with no significant differences between the three groups. Conclusions: DRS implantation for treating stent recoil of aorto-ostial coronary lesions resulted in a high rate of TLR, and was associated with similar risk for death and MACE compared to treatment of in-stent-restenosis with DES or PCB. Randomized, larger comparisons of contemporary DES in patients exclusively presenting with stent recoil are necessary to further define the efficacy and safety of this approach.
Collapse
|
3
|
In-Hospital Outcomes After Recanalization of Ostial Chronic Total Occlusions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:661-665. [PMID: 31672534 DOI: 10.1016/j.carrev.2019.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/21/2019] [Accepted: 09/18/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. Recanalization of ostial lesions is challenging and complex. This present study aims to evaluate the outcome of patients with ostial and non-ostial CTO-PCI with regard to acute, in-hospital outcome. METHODS Between 2012 and 2018 we included 600 patients. Ostial lesions (OL) were defined as a coronary arterial stenosis within 3 mm of the vessel origin. Antegrade and retrograde CTO-PCI techniques were used and a composite safety endpoint comprising in-hospital death, vascular complications, cardiac tamponade, stroke and acute myocardial infarction. RESULTS The majority of the patients were male (82.3%) and the mean age was 62.1 years (±10.3 years). The right coronary artery (RCA) was the most frequent target vessel in 58.5%, followed by the left circumflex artery (LCX) (15.4%) and the left anterior descending artery (LAD) (26.2%). The success (p = .439) and complication rates (p = .169) were independent of the target vessel. We determined that examination and fluoroscopy time were longer in patients with OL (120.7 min vs. 99.0 min, p < .001 and 44.9 min vs. 34.5 min, p < .001) and that in this group of patients the retrograde approach was used more frequent (38.8% vs. 18.2%, p < .001). Overall success rates were lower in OL than compared to NOL (74.6% vs. 86.5%, p = .016). CONCLUSIONS Our retrospective study suggests that recanalization of ostial CTO lesions is associated with reduced PCI success rates as well as long examination and high fluoroscopy times.
Collapse
|
4
|
Shiraishi J, Nishimura T, Kimura M, Koshi N, Matsubara Y, Ito D, Kishita E, Nakagawa Y, Hyogo M, Sawada T. Potent Stent-Less Procedure Using Rotational Atherectomy and Drug-Coated Balloon to Right Coronary Ostial Lesion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:822-826. [DOI: 10.1016/j.carrev.2018.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/03/2018] [Accepted: 11/16/2018] [Indexed: 11/26/2022]
|
5
|
Ohashi K, Abe D, Kuroki N, Yuba T, Suzuki K. Clinical impact of the gap-angle ratio in patients with ostial lesions of the right coronary artery undergoing percutaneous coronary intervention. Heart Vessels 2019; 34:1717-1727. [PMID: 31028408 DOI: 10.1007/s00380-019-01417-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 04/19/2019] [Indexed: 11/24/2022]
Abstract
The aim of this study was to investigate the incidence of binary restenosis and its predictors in patients with ostial lesions of the right coronary artery (RCAos) who underwent percutaneous coronary intervention (PCI). RCAos are associated with a high incidence of restenosis, and the implantations of drug-eluting stents for RCAos have not been fully elucidated. The study participants included 75 patients (72.3 ± 9.5 years, 72% men) who underwent PCI for RCAos at our institution between November 2001 and May 2017. The angle between the greater curvature of the aortic wall and the right coronary artery take-off in the diastolic and systolic phases in the left anterior oblique position view was investigated. Clinical outcome was defined as binary restenosis at follow-up coronary angiography. We also evaluated target lesion failure (TLF) defined as a composite of cardiac mortality, target vessel myocardial infarction, and target lesion revascularization (TLR). The incidence of binary restenosis was 48.0% (n = 36) of the entire cohort. The incidence of TLF was 49.3% (n = 37) of the entire cohort, which was mainly driven by TLR (36.0%, n = 27). The area under the curve of the gap-angle ratio [(difference between the maximum and minimum angles)/(minimum angle); GAR] for binary restenosis was 0.73, and the cutoff value was 0.306 (sensitivity 67%, specificity 82%). The patients were divided into two groups: a low-GAR (< 0.306; n = 30) and high-GAR group (> 0.306; n = 45). Binary restenosis was more frequent in the high-GAR group than in the low-GAR group (76.7% vs. 28.9%, p = 0.007). The cumulative rate of TLF was significantly higher in the high-GAR group when compared with the low-GAR group (53.3% vs. 40.0%, p = 0.01), which was mainly driven by TLR (56.7% vs. 22.2%, p = 0.01). High-GAR (> 0.306) [OR 2.66 (1.34-5.31), p = 0.005] and stent under expansion [OR 2.37 (1.10-5.11), p = 0.03] were found to be independent predictors of binary restenosis after adjustment for multiple confounders. Multivariable analysis also revealed that high-GAR (> 0.306) [OR 2.06 (1.02-4.14), p = 0.03] and stent under expansion [OR 2.82 (1.28-6.19), p = 0.01] were independent predictors of TLF. We suggest that GAR (> 0.306) predicts binary restenosis and TLF in patients undergoing PCI for RCAos.
Collapse
Affiliation(s)
- Koichi Ohashi
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-0022, Japan.
| | - Daisuke Abe
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-0022, Japan
| | - Norihiro Kuroki
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-0022, Japan
| | - Takao Yuba
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-0022, Japan
| | - Kou Suzuki
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-0022, Japan
| |
Collapse
|
6
|
Comparison of mid-term clinical outcomes after treatment of ostial right coronary artery lesions with early and new generation drug-eluting stents: Insights from an international multicenter registry. Int J Cardiol 2018; 254:53-58. [DOI: 10.1016/j.ijcard.2017.10.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 11/21/2022]
|
7
|
Nasu K, Oikawa Y, Habara M, Shirai S, Abe H, Kadotani M, Gotoh R, Hozawa H, Ota H, Suzuki T, Shibata Y, Tanabe M, Nakagawa Y, Serikawa T, Nagasaka S, Takeuchi Y, Fujimoto Y, Tamura H, Kobori Y, Yajima J, Aizawa T, Suzuki T. Efficacy of biolimus A9-eluting stent for treatment of right coronary ostial lesion with intravascular ultrasound guidance: a multi-center registry. Cardiovasc Interv Ther 2017; 33:321-327. [PMID: 28929334 DOI: 10.1007/s12928-017-0487-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/24/2017] [Indexed: 11/26/2022]
Abstract
The aim of this study was to assess the efficacy of a biolimus A9-eluting stent in patients with a right coronary artery (RCA) ostial lesion. Ostial lesions of the RCA have been a limitation of percutaneous coronary intervention even in the drug-eluting stent (DES) era. However, clinical outcomes after the deployment of a second generation DES to an RCA ostial lesion with intravascular ultrasound (IVUS) guidance have not been fully elucidated. From September 2011 to March 2013, 74 patients were enrolled in 17 centers from Japan. RCA ostial lesion was defined as de novo significant stenotic lesion located within 15 mm from ostium. IVUS was used for all cases to confirm the location of ostium and evaluate stent coverage of ostium. Patients with hemodialysis were excluded. The primary endpoint is a major adverse cardiac event (MACE) at 1 year. Forty two percent of patients had multi-vessel disease. Angiographically severe calcification was observed in 26% of the lesions. The mean stent diameter was 3.3 ± 0.3 mm (3.5 mm, 72%, 3.0 mm, 25%, and 2.75 and 2.5 mm, 3%), stent length was 17.5 ± 5.8 mm, and dilatation pressure of stenting was 15.6 ± 4.1 atm. RCA ostium was covered by stent in all lesions in IVUS findings. Post dilatation was performed for 64% of lesions (balloon size 3.7 ± 0.6 mm). MACE rate at 1 year was 5.4% (target lesion revascularization 5.4%, myocardial infarction 1.2%, and no cardiac death). The biolimus A9-eluting stent for RCA ostial lesions with IVUS guidance showed favorable results at 1-year follow-up.
Collapse
Affiliation(s)
- Kenya Nasu
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobutori, Oyamacho, Toyohashi, Aichi, 441-8530, Japan.
| | - Yuji Oikawa
- Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan
| | - Maoto Habara
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobutori, Oyamacho, Toyohashi, Aichi, 441-8530, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hidetoshi Abe
- Cardiovascular Center, Matsumoto Kyoritsu Hospital, Matsumoto, Japan
| | - Makoto Kadotani
- Department of Cardiology, Kakogawa East City Hospital, Kakogawa, Japan
| | - Ryo Gotoh
- Division of Cardiology, Shuwa General Hospital, Saitama, Japan
| | - Hidenari Hozawa
- Department of Cardiovascular Medicine, Newheart Watanabe Institute, Tokyo, Japan
| | - Hiroshi Ota
- Department of Cardiology, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Takashi Suzuki
- Cardiovascular Center, Kin-ikyo Central Hospital, Sapporo, Japan
| | - Yoshihisa Shibata
- Department of Cardiology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Masaki Tanabe
- Department of Cardiology, Daini Okamoto General Hospital, Uji, Japan
| | - Yuya Nakagawa
- Department of Cardiology, Tokyo-Kita Social Insurance Hospital, Tokyo, Japan
| | - Takeshi Serikawa
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Shiro Nagasaka
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yasuyo Takeuchi
- Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Hiroshi Tamura
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Yuichi Kobori
- Department of Cardiology, Toda Chuo General Hospital, Toda, Japan
| | - Junji Yajima
- Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan
| | - Tadanori Aizawa
- Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan
| | - Takahiko Suzuki
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobutori, Oyamacho, Toyohashi, Aichi, 441-8530, Japan
| |
Collapse
|
8
|
Sugihara R, Ueda Y, Nishimoto Y, Takahashi K, Murakami A, Ueno K, Takeda Y, Hirata A, Kashiwase K, Higuchi Y, Yasumura Y. Outcomes of First- Versus Second-Generation Drug-Eluting Stent Implanted for Right Coronary Artery Ostial Narrowing. Am J Cardiol 2017; 119:852-855. [PMID: 28073430 DOI: 10.1016/j.amjcard.2016.11.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
Clinical outcome is generally poor when stents are implanted at right coronary artery ostial lesion (RCAos). We compared the clinical outcome between the first-generation drug-eluting stent (first DES) and second-generation drug-eluting stent (second DES) used for RCAos. Consecutive 88 patients who underwent percutaneous coronary interventions of de novo RCAos using the first DES (33 patients) or second DES (55 patients) were analyzed. The incidence of major adverse cardiac events (MACE) defined as the composite of cardiac death, myocardial infarction attributed to right coronary artery, and target lesion revascularization within 2.5 years was compared. The incidence of MACE was significantly lower in second DES (11% vs 36%, p = 0.010) than that in the first DES. Multivariate analysis revealed use of second DES (odds ratio 0.24, 95% CI 0.11 to 0.93, p = 0.008) alone was significantly associated with MACE. In conclusion, second DES revealed better clinical outcome than the first DES when used in de novo RCAos.
Collapse
Affiliation(s)
- Ryuta Sugihara
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Yasunori Ueda
- Cardiovascular Division, Osaka National Hospital, Osaka, Japan.
| | - Yuji Nishimoto
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | | | - Ayaka Murakami
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Keisuke Ueno
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Yasuharu Takeda
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | | | | | - Yoshio Yasumura
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| |
Collapse
|
9
|
Watanabe Y, Takagi K, Naganuma T, Nakamura S. Comparison of early- and new-generation drug-eluting stent implantations for ostial right coronary artery lesions. Cardiovasc Ther 2017; 35. [DOI: 10.1111/1755-5922.12247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yusuke Watanabe
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Kensuke Takagi
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Toru Naganuma
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Sunao Nakamura
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| |
Collapse
|
10
|
Ohya M, Kadota K, Kubo S, Tada T, Habara S, Shimada T, Amano H, Izawa Y, Hyodo Y, Otsuru S, Hasegawa D, Tanaka H, Fuku Y, Goto T, Mitsudo K. Incidence, predictive factors, and clinical impact of stent recoil in stent fracture lesion after drug-eluting stent implantation. Int J Cardiol 2016; 214:123-9. [PMID: 27060271 DOI: 10.1016/j.ijcard.2016.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/21/2015] [Accepted: 03/12/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Stent fracture (SF) after drug-eluting stent (DES) implantation was reported to be associated with target lesion revascularization (TLR). We have noted abnormal late acquired stent axial deformation in lesions after DES implantation, especially in SF lesions, and defined it as stent recoil (SR). We evaluated the incidence, predictive factors, and clinical impact of SR in SF lesions. METHODS Between 2003 and 2012, 5456 patients (11,712 lesions) underwent DES implantations and follow-up angiography within one year after the index procedure. SR was defined as an axial recoil deformation less than 80% of the stent diameter and SF was defined as the separation of stent segments or stent struts. SF and SR were confirmed by follow-up angiography. The primary endpoint was defined as clinically driven TLR. RESULTS SF was observed in 494 lesions (4.2%) and SR in 138 of SF lesions (27.9%). According to multinomial logistic regression analyses, severe calcification and ostial lesion in the right coronary artery were stronger predictive factors of SF with SR lesions. The cumulative incidences of any and clinically driven TLR at 5years were both significantly higher in the SF with SR group than in the SF without SR group (51.7% versus 35.0%, P<0.001; 22.2% versus 12.8%, P=0.019; respectively). CONCLUSIONS SR in SF lesions after DES implantation could be related to the lesion characteristics. SF with SR was highly associated with subsequent TLR compared with SF without SR.
Collapse
Affiliation(s)
- Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan..
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Seiji Habara
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Takenobu Shimada
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Hidewo Amano
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Yu Izawa
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Yusuke Hyodo
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Suguru Otsuru
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Daiji Hasegawa
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Tsuyoshi Goto
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Kazuaki Mitsudo
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| |
Collapse
|
11
|
Helmy TA, Sanchez CE, Bailey SR. Coronary and peripheral stenting in aorto-ostial protruding stents: The balloon assisted access to protruding stent technique. Catheter Cardiovasc Interv 2015; 87:735-41. [DOI: 10.1002/ccd.26111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 11/03/2014] [Accepted: 06/27/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Tarek A. Helmy
- Division of Cardiology; Saint Louis University School of Medicine; Saint Louis Missouri
| | - Carlos E. Sanchez
- Division of Cardiology; Ohiohealth Heart and Vascular Institute, Riverside Methodist Hospital; Columbus Ohio
| | - Steven R. Bailey
- Division of Cardiology; University of Texas Health Science Center at San Antonio; San Antonio Texas
| |
Collapse
|
12
|
Patel Y, Depta JP, Patel JS, Masrani SK, Novak E, Zajarias A, Kurz HI, Lasala JM, Bach RG, Singh J. Impact of intravascular ultrasound on the long-term clinical outcomes in the treatment of coronary ostial lesions. Catheter Cardiovasc Interv 2015; 87:232-40. [PMID: 23728924 DOI: 10.1002/ccd.25034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/07/2013] [Accepted: 05/19/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate the long-term outcomes of patients with ostial lesions who underwent percutaneous coronary intervention (PCI) with and without the use of intravascular ultrasound (IVUS). BACKGROUND A higher rate of adverse cardiac events is associated with PCI of ostial lesions as compared with nonostial disease. METHODS From 7/2002 to 8/2010, 225 patients with 233 coronary ostial lesions underwent PCI with (n = 82) and without (n = 143) IVUS guidance. Ostial lesions included both native aorto-ostial or major coronary vessel (left anterior descending, left circumflex, and ramus intermedius) lesions. Clinical outcomes [cardiovascular death, myocardial infarction (MI), and target lesion revascularization (TLR)] at a mean follow-up of 4.2 ± 2.5 years were compared between patients undergoing PCI of an ostial lesion with and without use of IVUS using univariate and propensity score adjusted analyses. RESULTS Aorto-ostial lesions (n = 109) comprised 47% of lesions, whereas the remaining lesions (53%) involved major coronary vessels. After propensity score adjustment, IVUS use was associated with lower rates of the composite of cardiovascular death, MI, or TLR (HR 0.54, 95% CI 0.29-0.99; P = 0.04), composite MI or TLR (HR 0.39, 95% CI 0.18-0.83; P = 0.01), and MI (HR 0.31, 95% CI 0.11-0.85; P = 0.02) as compared with no IVUS. The use of IVUS was also associated with a trend towards a lower rate of TLR (HR 0.42, 95% CI 0.17-1.02; P = 0.06). CONCLUSIONS PCI of coronary ostial lesions with the use of IVUS was associated with significantly lower rates of adverse cardiac events.
Collapse
Affiliation(s)
- Yogesh Patel
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jeremiah P Depta
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jayendrakumar S Patel
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Shriti K Masrani
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Eric Novak
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Alan Zajarias
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Howard I Kurz
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - John M Lasala
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Richard G Bach
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jasvindar Singh
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
13
|
Percutaneous treatment of aorto-ostial coronary lesions: Current challenges and future directions. Int J Cardiol 2015; 186:61-6. [DOI: 10.1016/j.ijcard.2015.03.161] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 02/07/2015] [Accepted: 03/15/2015] [Indexed: 11/23/2022]
|
14
|
Taştan A, Özel E, Öztürk A, Uyar S, Özcan EE, Şenarslan Ö, Tavlı T. Comparison of floating wire and single wire techniques in right coronary ostial lesions in terms of procedural features and one-year clinical follow-up results. Anatol J Cardiol 2014; 15:830-5. [PMID: 25592104 PMCID: PMC5336970 DOI: 10.5152/akd.2014.5730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: The floating wire technique is a special technique for solving interventional problems in aortaostial lesions. There are no long-term data in the literature for the floating wire technique in right aorto-ostial lesions. Methods: One hundred twenty six patients were retrospectively analyzed in this study. All of these patients had a critical right coronary aortoostial lesion. The floating wire technique was performed on 64 patients, and the single wire technique was performed on 62 patients. The two groups were compared with each other in terms of lesional and procedural properties. Additionally, 1-year clinical follow-up results were compared between the two groups. Results: There was no significant difference in terms of lesion properties between the groups. In the floating wire group, mean stent length, number of stents, mean procedure time, mean contrast volume, and mean fluoroscopy time were significantly lower than in the single wire group. At 1 year, 1 patient from each group had myocardial infarction, and no mortality was observed. In the floating wire group, the number of patients who experienced angina and the target lesion revascularization rate were both significantly lower than in the single wire group. Conclusion: The floating wire technique in right coronary ostial lesions provides a significant advantage over the single wire technique according to procedural and clinical follow-up results.
Collapse
Affiliation(s)
- Ahmet Taştan
- Department of Cardiology, Faculty of Medicine, Şifa University; İzmir-Turkey.
| | | | | | | | | | | | | |
Collapse
|
15
|
Lam MK, Sen H, Tandjung K, Löwik MM, Basalus MW, Mewes JC, Stoel MG, van Houwelingen KG, Linssen GC, Ijzerman MJ, Doggen CJ, von Birgelen C. Clinical outcome of patients with implantation of second-generation drug-eluting stents in the right coronary ostium: Insights from 2-year follow-up of the TWENTE trial. Catheter Cardiovasc Interv 2014; 85:524-31. [DOI: 10.1002/ccd.25518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/14/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Ming Kai Lam
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - Hanim Sen
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - Kenneth Tandjung
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - Marije M. Löwik
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - Mounir W.Z. Basalus
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - Janne C. Mewes
- Health Technology and Services Research; MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede Netherlands
| | - Martin G. Stoel
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - K. Gert van Houwelingen
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | | | - Maarten J. Ijzerman
- Health Technology and Services Research; MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede Netherlands
| | - Carine J.M. Doggen
- Health Technology and Services Research; MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede Netherlands
| | - Clemens von Birgelen
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
- Health Technology and Services Research; MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede Netherlands
| |
Collapse
|
16
|
Ko E, Natsuaki M, Toyofuku M, Morimoto T, Matsumura Y, Oi M, Motohashi Y, Takahashi K, Kawase Y, Tanaka M, Kitada M, Yuzuki Y, Tamura T, Inoue K, Mitsudo K, Kimura T. Sirolimus-eluting stent implantation for ostial right coronary artery lesions: five-year outcomes from the j-Cypher registry. Cardiovasc Interv Ther 2014; 29:200-8. [PMID: 24390936 DOI: 10.1007/s12928-013-0236-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/13/2013] [Indexed: 12/01/2022]
Abstract
Ostial right coronary artery (RCA) lesions are associated with a high restenosis rate after bare-metal stent implantation. However, long-term outcomes after drug-eluting stent (DES) implantation for ostial RCA lesions have not been adequately evaluated. Among 12824 patients enrolled in the j-Cypher registry, 5-year outcomes were compared between 397 patients with ostial RCA lesions, and 3716 patients with non-ostial RCA lesions treated with sirolimus-eluting stents (SES). Through 5-year follow-up, patients with ostial RCA lesions had a significantly higher cumulative incidence of target lesion revascularization (TLR) (28.2 versus 13.7 %, P < 0.0001) than those with non-ostial RCA lesions. After adjusting for confounders, excess TLR risk of the ostial group relative to the non-ostial group was significant for both early TLR within 1-year and late TLR beyond 1-year (HR 2.14 [95 % CI 1.59-2.84], P < 0.0001, and HR 1.58 [95 % CI 1.06-2.26], P = 0.02, respectively). Although the cumulative incidence of death was also significantly higher in the ostial group than in the non-ostial group (25.7 versus 14.4 %, P < 0.0001), the excess risk of the ostial group relative to the non-ostial group was no longer significant after adjusting for confounders (HR 1.25 [95 % CI 0.99-1.57], P = 0.07). SES implantation for ostial RCA lesions was associated with higher risk for TLR as compared with that for non-ostial RCA lesions. Restenosis, both early and late, remains an issue in coronary DES implantation for ostial RCA lesions.
Collapse
Affiliation(s)
- Euihong Ko
- Japanese Red Cross Society Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Jurado-Román A, López-Melgar B, García-Tejada J, Hernández-Hernández F, Velázquez-Martín MT, Albarrán-González-Trevilla A, Rubio-Alonso B, Díaz-Anton B, Andreu-Dussac J, Tascón-Pérez JC. Percutaneous coronary intervention in aorto-ostial lesions. Immediate and medium-term results in a real world cohort. Int J Cardiol 2013; 168:3067-9. [PMID: 23684564 DOI: 10.1016/j.ijcard.2013.04.093] [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: 03/26/2013] [Accepted: 04/06/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Alfonso Jurado-Román
- Cardiology Department, Hospital Universitario 12 de Octubre, Avenida de Cordoba s/n, 28041 Madrid, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|