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Moroni A, Marin F, Venturi G, Scarsini R, Ribichini F, De Maria GL, Banning AP. Management of failed stenting of the unprotected left main coronary artery. Catheter Cardiovasc Interv 2023; 101:1001-1013. [PMID: 37002949 DOI: 10.1002/ccd.30636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
Abstract
Percutaneous coronary intervention (PCI) is increasingly accepted as treatment for unprotected left main coronary artery (ULMCA) disease especially in those patients who are unsuitable for cardiac surgery. Treatment of any stent failure is associated with increased complexity and worse clinical outcomes when compared with de novo lesion revascularization. Intracoronary imaging has provided new insight into mechanisms of stent failure and treatment options have developed considerably over the last decade. There is paucity of evidence on the management strategy for stent failure in the specific setting of ULMCA. Treating any left main with PCI requires careful consideration and consequently treatment of failed stents in ULMCA is complex and provides unique challenges. Consequently, we provide an overview of ULMCA stent failure, proposing a tailored algorithm to guide best management and decision in daily clinical practice, with a special focus on intracoronary imaging characterization of causal mechanisms and specific technical and procedural considerations.
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Affiliation(s)
- Alice Moroni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Italy
| | - Federico Marin
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Luigi De Maria
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian P Banning
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Selan JC, Yoshimura T, Bhatheja S, Sharma SK, Kini AS. Treatment strategies for coronary bifurcation lesions made easy in the current era by introduction of the BIFURCAID app. Future Cardiol 2019; 15:39-52. [PMID: 30642205 DOI: 10.2217/fca-2018-0068] [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] [Indexed: 12/15/2022] Open
Abstract
Coronary bifurcation lesions account for 15-20% of all percutaneous coronary interventions. Percutaneous revascularization of these lesions is technically challenging and results in lower success rates than nonbifurcation lesions. There are unique procedural considerations and techniques that are employed in the percutaneous revascularization of these lesions. Our objective is to define the procedural complexities of treating coronary bifurcation lesions and describe the leading provisional and dedicated two stent techniques used to optimize procedural and clinical results, as described in the BIFURCAID app.
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Affiliation(s)
- Jeffrey C Selan
- Division of Cardiology, Mount Sinai Hospital & Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Takahiro Yoshimura
- Division of Cardiology, Mount Sinai Hospital & Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samit Bhatheja
- Division of Cardiology, Mount Sinai Hospital & Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samin K Sharma
- Division of Cardiology, Mount Sinai Hospital & Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annapoorna S Kini
- Division of Cardiology, Mount Sinai Hospital & Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Schmidt T, Hansen S, Meincke F, Frerker C, Kuck KH, Bergmann MW. Safety and efficacy of lesion preparation with the AngioSculpt Scoring Balloon in left main interventions: the ALSTER Left Main registry. EUROINTERVENTION 2016; 11:1346-54. [PMID: 25990742 DOI: 10.4244/eijy15m05_04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Left main interventions require optimal initial results for good clinical outcome. Lesion preparation with the AngioSculpt Scoring Balloon (ASB) combined with the provisional T-stenting technique, if proven safe, might lead to better lumen gain and better clinical outcome. The aim of this registry was to investigate the safety and efficacy of the ASB as an option for lesion preparation in unprotected left main interventions (ULMI). METHODS AND RESULTS Out of the all-comers unprotected left main registry (ULMI ALSTER), 47 patients with elective ULMI fulfilled the inclusion criteria for this study. The endpoints were acute lumen gain and 12-month MACCE. The drop-out rate was 4%. The provisional T-stenting technique was used in 97% of distal ULMI. The interventions were grouped according to use of ASB with an in-house, historical no-ASB patient control group. Lumen gain was 1.63±0.12 mm in the ASB group (n=34) and 1.35±0.12 mm in the no-ASB group (n=8, p=0.26), respectively. The use of the ASB was safe. Intravascular ultrasound (IVUS) data for 21 patients showed numerically greater lumen area gain of 3.14±0.33 mm2 in the ASB group compared to 2.33±0.88 mm2 with the conventional technique. TLR/TVR was 6.6% overall. Twelve-month MACCE was 12.5% (4/32) for ASB and 15.4% (2/13) in the historical control group. CONCLUSIONS Adding ASB lesion preparation to the standard provisional T-stenting technique for ULMI is feasible and safe. Low TLR and TVR rates were observed. Lesion preparation led to a numerically larger lumen gain; the data allow valid power statistics to show this approach as leading to improved outcome in a possible randomised trial.
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Affiliation(s)
- Tobias Schmidt
- Division of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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D'Ascenzo F, Iannaccone M, Giordana F, Chieffo A, Connor SO, Napp LC, Chandran S, de la Torre Hernández JM, Chen SL, Varbella F, Omedè P, Taha S, Meliga E, Kawamoto H, Montefusco A, Chong M, Garot P, Sin L, Gasparetto V, Abdirashid M, Cerrato E, Biondi-Zoccai G, Gaita F, Escaned J, Hiddick Smith D, Lefèvre T, Colombo A, Sheiban I, Moretti C. Provisional vs. two-stent technique for unprotected left main coronary artery disease after ten years follow up: A propensity matched analysis. Int J Cardiol 2016; 211:37-42. [PMID: 26970964 DOI: 10.1016/j.ijcard.2016.02.136] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 02/28/2016] [Indexed: 02/08/2023]
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Song YB, Park TK, Hahn JY, Yang JH, Choi JH, Choi SH, Lee SH, Gwon HC. Optimal Strategy for Provisional Side Branch Intervention in Coronary Bifurcation Lesions. JACC Cardiovasc Interv 2016; 9:517-26. [DOI: 10.1016/j.jcin.2015.11.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/14/2015] [Accepted: 11/19/2015] [Indexed: 12/22/2022]
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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Lefèvre T, Girasis C, Lassen JF. Differences between the left main and other bifurcations. EUROINTERVENTION 2015; 11 Suppl V:V106-10. [DOI: 10.4244/eijv11sva24] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619. [PMID: 25173339 DOI: 10.1093/eurheartj/ehu278] [Citation(s) in RCA: 3299] [Impact Index Per Article: 329.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Pfahl K, Boudoulas KD. Left main coronary artery stent thrombosis: a challenging case. Am J Med 2014; 127:e9-10. [PMID: 24758885 DOI: 10.1016/j.amjmed.2014.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/27/2014] [Accepted: 01/27/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Kyle Pfahl
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus
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Sato K, Naganuma T, Costopoulos C, Takebayashi H, Goto K, Miyazaki T, Yamane H, Hagikura A, Kikuta Y, Taniguchi M, Hiramatsu S, Latib A, Ito H, Haruta S, Colombo A. Calcification analysis by intravascular ultrasound to define a predictor of left circumflex narrowing after cross-over stenting for unprotected left main bifurcation lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:80-5. [DOI: 10.1016/j.carrev.2014.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/27/2014] [Accepted: 01/31/2014] [Indexed: 11/17/2022]
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Binder RK, Boone RH, Webb JG. Left main dissection conservatively managed with optical coherence tomography guidance. Catheter Cardiovasc Interv 2014; 83:65-8. [PMID: 23613429 DOI: 10.1002/ccd.24978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 04/14/2013] [Indexed: 11/12/2022]
Abstract
Left main dissection (LMD) is a rare but feared complication of cardiac catheterization. It is usually managed by bailout stent implantation or coronary artery bypass surgery. We describe a case of iatrogenic, retrograde LMD during percutaneous coronary intervention. After covering the retrograde entry of the dissection in the ostial left anterior descending artery (LAD), optical coherence tomography (OCT) showed, that there was no antegrade entry in the left main and that the minimal true lumen area in the left main was 7.2 mm(2) . It was therefore decided to treat the LMD conservatively and reassess the results by angiography 6 months later. At follow-up angiography, no stenosis or residual dissection in the left main were noted. The patient was doing fine at 1-year follow-up. OCT is a valuable tool for assessing coronary artery dissections and may guide the decision, whether to stent or not to stent a dissection. In selected cases LMD may be managed conservatively.
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Affiliation(s)
- Ronald K Binder
- St. Paul's Hospital, University of British Columbia, V6Z 1Y6, Vancouver, BC, Canada
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De Caterina AR, Cuculi F, Banning AP. Incidence, predictors and management of left main coronary artery stent restenosis: a comprehensive review in the era of drug-eluting stents. EUROINTERVENTION 2013; 8:1326-34. [DOI: 10.4244/eijv8i11a201] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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