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Higashitani M, Ueshima D, Suzuki K, Yamauchi Y, Hirokami M, Tsubakimoto Y, Takahashi A, Kato T, Ando H, Nakamura M. Comparison of the Pre-Established and Finally Selected Treatment Strategies for Endovascular Treatment in Femoropopliteal Artery Lesions. Int Heart J 2024; 65:230-236. [PMID: 38479851 DOI: 10.1536/ihj.23-167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
This study aimed to compare lower limb events associated with preplanned and finally selected treatment strategies-the validity and usefulness of the physician-chosen strategy were verified.We examined the data of 1003 patients in the registry of multicenter endovascular treatment for superficial femoral and popliteal artery disease study and prospectively enrolled patients who underwent endovascular treatment (EVT) of the femoropopliteal (FP) artery between February 2017 and June 2018 from 67 Japanese institutes. The outcome measures were major adverse limb events (MALE) and target vessel revascularization.The EVT strategies were classified into balloon angioplasty-alone (37.3%), primary stenting (26.7%), and provisional stenting (36.0%) groups. In the initial strategy analysis for the balloon angioplasty-alone, primary stenting, and provisional stenting groups, two-year rates of freedom from MALE (95% confidence interval) were 0.680 (0.620-0.732), 0.754 (0.688-0.808), and 0.798 (0.746-0.840), respectively. Additionally, the rate of MALE was significantly higher among patients in the balloon angioplasty-alone group than among those in the primary or provisional stenting groups in the initial strategy analysis (P = 0.007). Changes in treatment strategy were more frequent in the primary stenting group than in the other groups. Furthermore, the rate of MALE did not significantly differ among the three groups in the final strategy analysis (P = 0.56).Limb outcomes for the final applied strategy did not differ among the three strategies. Additionally, the physician's selection bias was mostly appropriate in the EVT of the FP artery.
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Affiliation(s)
| | | | - Kenji Suzuki
- Department of Cardiology, Tokyo Saiseikai Central Hospital
| | | | | | | | | | - Taku Kato
- Department of Cardiology, Rakuwakai Otowa Hospital
| | - Hiroshi Ando
- Department of Cardiology, Kasukabe Chuo General Hospital
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
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Kumar A, Shariff M, Singal A, Bhat V, Stulak J, Reed G, Kalra A. A Bayesian meta-analysis of double kissing (DK) crush or provisional stenting for coronary artery bifurcation lesions. Indian Heart J 2024:S0019-4832(24)00049-X. [PMID: 38537883 DOI: 10.1016/j.ihj.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVE Despite the development of dedicated, two-stent strategies, including the double kissing (DK) crush technique, the ideal technique for coronary artery bifurcation stenting has not been identified. We aimed to compare and determine the absolute risk difference (ARD) of the DK crush technique alone versus provisional stenting approaches for coronary bifurcation lesions, using the Bayesian technique. METHOD We queried PubMed/MEDLINE to identify randomized controlled trials (RCTs) that compared DK crush technique with provisional stenting for bifurcation lesions, published till January 2023. We used Bayesian methods to calculate the ARD and 95% credible interval (CrI). RESULTS We included three RCTs, with 916 patients, in the final analysis. The ARD of cardiac death was centered at -0.01 (95% CrI: -0.04 to 0.02; Tau: 0.02, 85% probability of ARD of DK crush vs. provisional stenting <0). ARD for myocardial infarction was centered at -0.03 (95%CrI: -0.9 to 0.03; Tau: 0.05, 87% probability of ARD of DK crush vs. provisional stenting <0). ARD for stent thrombosis was centered at 0.00 (95% CrI: -0.04 to 0.03, Tau: 0.03, 51% probability of ARD for DK crush vs. provisional stenting <0). Finally, ARD for target lesion revascularization was centered at -0.05 (95% CrI: -0.08 to -0.03, Tau: 0.02, 99.97% probability of ARD for DK crush vs. provisional stenting <0). CONCLUSIONS Bayesian analysis demonstrated a lower probability of cardiac death, myocardial infarction and target lesion revascularization, with DK crush compared with provisional stenting techniques, and a minimal probability of difference in stent thrombosis.
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Affiliation(s)
- Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mariam Shariff
- Department of General Surgery, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Aayush Singal
- Department of Cardiology, Aakash Healthcare, New Delhi, India
| | - Vivek Bhat
- Department of Medicine, St. John's Medical College, Bangalore, India
| | - John Stulak
- Department of General Surgery, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Grant Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ankur Kalra
- Franciscan Health, Lafayette, IN, USA; Krannert Cardiovascular Research Center, Indianapolis, IN, USA.
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Dérimay F, Aminian A, Lattuca B, Souteyrand G, Maillard L, Alvain S, Cayla G, Motreff P, Bochaton T, Hayek A, Rioufol G, Finet G. One year results of coronary bifurcation revascularization with the re-POT provisional sequential technique. The CABRIOLET registry. Int J Cardiol 2024; 397:131632. [PMID: 38048882 DOI: 10.1016/j.ijcard.2023.131632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/18/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Re-POT (proximal optimization technique (POT)) is a simple provisional sequential technique for percutaneous coronary bifurcation revascularization with better arterial geometry respect compared to classical techniques. Re-POT has demonstrated excellent mechanical and short-term clinical results. The multicenter CABRIOLET registry (NCT03550196) evaluate the long-term clinical benefit of the re-POT sequence in non-selected patients. METHODS All consecutive patients presenting a coronary bifurcation lesion for which provisional stenting was indicated were included in 5 european centers. Re-POT strategy was systematically attempted. The primary endpoint was target lesion failure (TLF), comprising cardiac death, myocardial infarction, stent thrombosis and target lesion revascularization (TLR) at 12 months' follow-up. The secondary endpoints were the individual components of the primary endpoint, all-cause death, target vessel failure (TVF) and target vessel revascularization (TVR). Complex bifurcation was defined as Medina 0.1.1 or 1.1.1. RESULTS A total of 500 patients aged 67.7 ± 11.7 years, 78.4% male, were included from 2015 to 2019, 174 of whom (34.8%) were considered having complex bifurcation lesions. Bifurcations involved the left main in 35.2% of cases. The full re-POT sequence was systematically performed in all cases. At 1 year, TLF was 2.0% (1.7% in complex vs. 2.1% in non-complex bifurcation; p = NS), and TLR was 1.6%, (1.1% vs. 1.8% respectively; p = NS). TVF and TVR rates were 3.2% and 2.8%. On multivariate analysis, only multivessel disease was predictive of TLF at 1 year (OR = 1.66 (1.09-2.53), p = 0.02). CONCLUSIONS In this large prospective all-comer registry, provisional stenting with re-POT technique appeared safe and effective at 1 year, without anatomical bifurcation restriction.
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Affiliation(s)
- François Dérimay
- Department of Interventional Cardiology, Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France.
| | - Adel Aminian
- Cardiology Department, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Benoit Lattuca
- ACTION Study Group, Cardiology Department, Centre Hospitalier Universitaire de Nimes, Nimes, France
| | - Géraud Souteyrand
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Sean Alvain
- Department of Interventional Cardiology, Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
| | - Guillaume Cayla
- ACTION Study Group, Cardiology Department, Centre Hospitalier Universitaire de Nimes, Nimes, France
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Thomas Bochaton
- INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France; Department of Intensive Cardiac Care, Cardiovascular Hospital, Hospices Civils de Lyon, Bron, France
| | - Ahmad Hayek
- INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France; Department of Intensive Cardiac Care, Cardiovascular Hospital, Hospices Civils de Lyon, Bron, France
| | - Gilles Rioufol
- Department of Interventional Cardiology, Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France
| | - Gérard Finet
- Department of Interventional Cardiology, Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France
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Khelimskii D, Bessonov I, Kashtanov M, Sapozhnikov S, Badoian A, Baranov A, Manukyan S, Utegenov R, Krestyaninov O. Long-term clinical outcomes after kissing balloon inflation in patients with coronary bifurcation lesions treated with provisional stenting technique. Results from the real-world multicenter registry. Indian Heart J 2023; 75:313-320. [PMID: 37178866 PMCID: PMC10568054 DOI: 10.1016/j.ihj.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE There is a lack of data regarding the long-term clinical efficacy of the kissing balloon inflation (KBI) after provisional stenting of coronary bifurcation lesions. The aim of this study was to analyze the impact of KBI on long-term clinical outcomes in patients undergoing provisional stenting for the coronary bifurcation lesions in a large real-world population. METHODS A total of 873 patients who underwent percutaneous coronary interventions (PCI) with provisional stenting and had clinical follow up were analyzed. Patients treated with 2-stent strategy were excluded. To reduce the effect of potential confounding factors in this observational study, propensity score matching was conducted. RESULTS KBI was performed in 325 patients (37.2%). The median follow-up duration was 37.3 months. Patients treated with KBI more often had a previous PCI (48.6% vs. 42.5% SMD = 0.123). Patients in non-kissing group had more complex coronary disease with higher prevalence of calcification (14.8% vs. 21.4% SMD = 0.172), thrombosis (2.8% vs. 5.8% SMD = 0.152) and longer side branch lesions (8.3% vs. 11.7% SMD = 0.113). There were no significant differences in the major adverse cardiac events including death, myocardial infarction, target lesion revascularization after KBI versus no KBI (15.4% vs. 15.7%, p = 0.28), in total cohort or in matched patients (17.1% vs. 15.8%, adjusted HR 1.01, 95% CI: 0.65-1.65, p = 0.95). The lack of effect of KBI on clinical outcomes was consistent across various subgroups including left main disease. CONCLUSION In this multicenter real-world registry, KBI did not improve long-term clinical outcomes in patients with coronary bifurcation lesions treated with provisional stenting technique.
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Affiliation(s)
- Dmitrii Khelimskii
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation.
| | - Ivan Bessonov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 625026, Russian Federation
| | - Maksim Kashtanov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 625026, Russian Federation; Ural Federal University, Ekaterinburg, Russian Federation
| | - Stanislav Sapozhnikov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 625026, Russian Federation
| | - Aram Badoian
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Aleksey Baranov
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Serezha Manukyan
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
| | - Ruslan Utegenov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 625026, Russian Federation
| | - Oleg Krestyaninov
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
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Ge Z, Gao XF, Zhan JJ, Chen SL. Coronary Bifurcation Lesions. Interv Cardiol Clin 2022; 11:405-417. [PMID: 36243486 DOI: 10.1016/j.iccl.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) for the treatment of coronary bifurcation lesions (CBLs) is still technically demanding, mainly because of higher rates of both acute and chronic complication as compared with non-CBLs. Although provisional stenting (PS) is considered as the preferred strategy for most of the CBLs, a systematic two-stent technique (double kissing [DK] crush) should be considered in patients with complex left main (LM)-CBLs or non-LM-CBLs stratified by the DEFINITION criteria. Intracoronary imaging and/or physiologic evaluation should be used to optimize CBLs intervention. PCI with DES for the treatment of CBLs is technically demanding, mainly because of higher rates of both acute and chronic complication as compared with non-CBLs. PS is a default strategy for most of the CBLs. Double kissing (DK) crush is associated with better clinical outcomes compared with PS in patients with complex LM-CBLs or non-LM-CBLs stratified by the DEFINITION criteria. Intracoronary imaging and/or physiologic evaluation are useful tools to guide the treatment of CBLs. The use of drug-coated balloons in CBLs needs further data to support the clinical benefits.
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Affiliation(s)
- Zhen Ge
- Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, Jiangsu, China
| | - Xiao-Fei Gao
- Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, Jiangsu, China
| | - Jun-Jie Zhan
- Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, Jiangsu, China.
| | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, Jiangsu, China.
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6
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Kawasaki D, Nakata A, Nishian K, Nishimura M, Fujiwara R, Nakata T, Fukunaga M. Impact of Peak Systolic Velocity Ratio after Drug-Coated Balloon for Femoropopliteal Disease: Three-Month Serial Observation Vessel Echo Study. J Atheroscler Thromb 2021; 29:1352-1358. [PMID: 34588389 PMCID: PMC9444800 DOI: 10.5551/jat.63197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM No flow-limiting dissection after drug-coated balloon (DCB) treatment for femoropopliteal (FP) lesions is considered as one of the endpoints, but it has not investigated the difference between each vessel dissection. This study aimed to clarify whether there is a difference between no dissection and type C dissection without flow-limiting dissection for 3 months by peak systolic velocity ratio (PSVR) based on duplex ultrasonography. METHODS Between February 2020 and April 2021, 44 consecutive de novo FP diseases that underwent endovascular therapy (EVT) with DCB were enrolled in this study. 65.9% of the patients had intermittent claudication, and mean lesion lengths were 194±107 mm. The chronic total occlusion was 38.6%. After DCB treatment, vessel dissection pattern was categorized by angiography. The minimum lumen area (MLA) identified by intravascular ultrasound was serially evaluated with PSVRs at 1 day, 1 month, and 3 months after EVT. RESULT All lesions were treated with DCB without provisional stents. The vessel dissection pattern after DCB treatment showed that types D, E, and F were not observed, 9% were no dissection, 27% were type A, 32% were type B, and 32% were type C. In all cases, the PSVR values of MLA site were less than 2.6 at 3 months, and there were no significant differences between no dissection and type C dissection. CONCLUSION Up to dissection pattern "C" is considered acceptable as one of the endpoints to determine the need for provisional stenting after DCB treatment.
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Affiliation(s)
- Daizo Kawasaki
- Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital
| | - Aya Nakata
- Department of Clinical Engineer, Morinomiya Hospital
| | - Kunihiko Nishian
- Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital
| | - Machiko Nishimura
- Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital
| | - Reiko Fujiwara
- Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital
| | - Tsuyoshi Nakata
- Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital
| | - Masashi Fukunaga
- Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital
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7
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Zhang JJ, Ye F, Xu K, Kan J, Tao L, Santoso T, Munawar M, Tresukosol D, Li L, Sheiban I, Li F, Tian NL, Rodríguez AE, Paiboon C, Lavarra F, Lu S, Vichairuangthum K, Zeng H, Chen L, Zhang R, Ding S, Gao F, Jin Z, Hong L, Ma L, Wen S, Wu X, Yang S, Yin WH, Zhang J, Wang Y, Zheng Y, Zhou L, Zhou L, Zhu Y, Xu T, Wang X, Qu H, Tian Y, Lin S, Liu L, Lu Q, Li Q, Li B, Jiang Q, Han L, Gan G, Yu M, Pan D, Shang Z, Zhao Y, Liu Z, Yuan Y, Chen C, Stone GW, Han Y, Chen SL. Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial. Eur Heart J 2021; 41:2523-2536. [PMID: 32588060 DOI: 10.1093/eurheartj/ehaa543] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/28/2020] [Accepted: 06/12/2020] [Indexed: 12/29/2022] Open
Abstract
AIM The present study aimed to assess the benefits of two-stent techniques for patients with DEFINITION criteria-defined complex coronary bifurcation lesions. METHODS AND RESULTS In total, 653 patients with complex bifurcation lesions at 49 international centres were randomly assigned to undergo the systematic two-stent technique (two-stent group) or provisional stenting (provisional group). The primary endpoint was the composite of target lesion failure (TLF) at the 1-year follow-up, including cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularization (TLR). The safety endpoint was definite or probable stent thrombosis. At the 1-year follow-up, TLF occurred in 37 (11.4%) and 20 (6.1%) patients in the provisional and two-stent groups, respectively [77.8%: double-kissing crush; hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.30-0.90; P = 0.019], largely driven by increased TVMI (7.1%, HR 0.43, 95% CI 0.20-0.90; P = 0.025) and clinically driven TLR (5.5%, HR 0.43, 95% CI 0.19-1.00; P = 0.049) in the provisional group. At the 1 year after indexed procedures, the incidence of cardiac death was 2.5% in the provisional group, non-significant to 2.1% in the two-stent group (HR 0.86, 95% CI 0.31-2.37; P = 0.772). CONCLUSION For DEFINITION criteria-defined complex coronary bifurcation lesions, the systematic two-stent approach was associated with a significant improvement in clinical outcomes compared with the provisional stenting approach. Further study is urgently warranted to identify the mechanisms contributing to the increased rate of TVMI after provisional stenting. STUDY REGISTRATION http://www.clinicaltrials.com; Identifier: NCT02284750.
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Affiliation(s)
- Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Kai Xu
- Division of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jing Kan
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China
| | - Ling Tao
- Division of Cardiology, Xijing Hospital, 4th Military Medical University, Xi'an, China
| | - Teguh Santoso
- Division of Cardiology, Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia
| | - Muhammad Munawar
- Division of Cardiology, Binawaluya Cardiac Center, Jakarta, Indonesia
| | - Damras Tresukosol
- Division of Cardiology, Medicine Siriraj Hospital, Bangkok, Thailand
| | - Li Li
- Division of Cardiology, Guangzhou Red Cross Hospital, Guangzhou, China
| | - Imad Sheiban
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Feng Li
- Division of Cardiology, Oriental General Hospital, Huainan, China
| | - Nai-Liang Tian
- Division of Cardiology, Nanjing Heart Center, Nanjing, China
| | | | | | - Francesco Lavarra
- Division of Cardiology, Jilin Cardiovascular Hospital, Changchun, China
| | - Shu Lu
- Division of Cardiology, Taicang 1st People's Hospital, Taicang, China
| | | | - Hesong Zeng
- Division of Cardiology, Wuhan Tongji Hospital, United Medical University, Wuhan, China
| | - Lianglong Chen
- Division of Cardiology, Fujian Medical University Union Hospital, Fujian Institute of Coronary Artery Disease, Fujian Heart Medical Center, Fuzhou, China
| | - Ruiyan Zhang
- Division of Cardiology, Shanghai Ruijin Hospital, Shanghai Communication University, Shanghai, China
| | - Shiqin Ding
- Division of Cardiology, Xinhua Hospital, Huainan, China
| | - Fengtang Gao
- Division of Cardiology, Gansu Provincial People's Hospital, Lanzhou, China
| | - Zening Jin
- Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lang Hong
- Division of Cardiology, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Likun Ma
- Division of Cardiology, Anhui Provincial Hospital, Hefei, China
| | - Shangyu Wen
- Division of Cardiology, Tianjin 4th Central Hospital, Tianjin, China
| | - Xueming Wu
- Division of Cardiology, Wuxi 3rd People's Hospital, Wuxi, China
| | - Song Yang
- Division of Cardiology, Yixing People's Hospital, Yixing, China
| | - Wei-Hsian Yin
- Division of Cardiology, Cheng-Hsin General Hospital, Taipei, China
| | - Jun Zhang
- Division of Cardiology, Cangzhou Central Hospital, Cangzhou, China
| | - Yan Wang
- Division of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Yonghong Zheng
- Division of Cardiology, Jintan Traditional Chinese Medicine Hospital, Jintan, China
| | - Lei Zhou
- Division of Cardiology, Liyang Hospital of Traditional Chinese Medicine, Liyang, China
| | - Limin Zhou
- Division of Cardiology, Chuzhou People's Hospital, Chuzhou, China
| | - Yuansheng Zhu
- Division of Cardiology, Huaian 2nd People's Hospital, Huaian, China
| | - Tan Xu
- Division of Cardiology, Xinyang Central Hospital, Xinyang, China
| | - Xin Wang
- Division of Cardiology, Lianyungang Traditional Chinese Medicine Hospital, Lianyungang, China
| | - Hong Qu
- Division of Cardiology, XuanCheng Central Hospital, Xuancheng, China
| | - Yulong Tian
- Division of Cardiology, Xuyi People's Hospital, Xuyi, China
| | - Song Lin
- Division of Cardiology, Jintan People's Hospital, Jintan, China
| | - Lijun Liu
- Division of Cardiology, Huainan People's Hospital, Huainan, China
| | - Qinghua Lu
- Division of Cardiology, 2nd People's Hospital, Shandong University, Jinan, China
| | - Qihua Li
- Division of Cardiology, Changzhou Traditional Chinese Medicine Hospital, China
| | - Bo Li
- Division of Cardiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Qing Jiang
- Division of Cardiology, Anqing 1st People's Hospital, Anqing, China
| | - Leng Han
- Division of Cardiology, Changshu People's Hospital, Changshu, China
| | - Guojun Gan
- Division of Cardiology, 17th Metallurgical Hospital, Maanshan, China
| | - Mengyue Yu
- Division of Cardiology, Qingdao Campus of Fuwai Hospital, Qingdao, China
| | - Defeng Pan
- Division of Cardiology, Xuzhou 2nd People's Hospital, Xuzhou, China
| | - Zhenglu Shang
- Division of Cardiology, Wuxi Huishan District People's Hospital, Wuxi, China
| | - Yanfang Zhao
- Division of Cardiology, Nanjing 81 Hospital, Nanjing, China
| | - Zhizhong Liu
- Division of Cardiology, Hongze People's Hospital, Huai'an, China
| | - Ye Yuan
- Trinity College, University of Toronto, Toronto, Canada
| | - Cynthia Chen
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Ican School of Medicine at Mount Sinai, New York, NY, USA and The Cardiovascular Research Foundation, New York, NY, USA
| | - Yaling Han
- Division of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China.,College of Pharmacy, Nanjing Medical University, Nanjing, China
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8
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Hakim R, Rangé G. [Left main PCI: Current treatment]. Ann Cardiol Angeiol (Paris) 2019; 68:333-340. [PMID: 31542200 DOI: 10.1016/j.ancard.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022]
Abstract
Percutaneous coronary intervention (PCI) of left main coronary artery has become a strong alternative to coronary artery bypass surgery in selected patients. The treatment decision must be validated by the Heart Team. Several PCI techniques of distal left main PCI have been described but the KISSS (Keep it simple, swift and safe) principle recommended by the European Bifurcation Club must be kept in mind. Provisional stenting is the first-line technique. A two-stent strategy may be needed in the presence of≥2.5mm side branch diameter and significant ostial stenosis as well as in presumably difficult rewiring. In all cases, POT (Proximal Optimisation Technique) is mandatory. Intracoronary imaging can be of great help in perfecting the result or even to improve outcomes.
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Affiliation(s)
- R Hakim
- Hôpitaux de Chartres, 4, rue Claude-Bernard, 28630 Le Coudray, France
| | - G Rangé
- Hôpitaux de Chartres, 4, rue Claude-Bernard, 28630 Le Coudray, France.
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Qu WB, Zhang W, Liu JY, Zhang F, Mu SN, Zhang SM, Tang H, Liu XQ, Li XQ, Liu BC. Modified balloon-stent kissing technique avoid side-branch compromise for simple true bifurcation lesions. BMC Cardiovasc Disord 2019; 19:89. [PMID: 30961533 PMCID: PMC6454702 DOI: 10.1186/s12872-019-1052-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 03/18/2019] [Indexed: 01/25/2023] Open
Abstract
Background Coronary bifurcation remains one of the most challenging lesion subsets in interventinal cardiology. Provisional stenting (PS) is the dominate technique for bifurcation lesions, but the key problem is the deterioration of side branch. Balloon-stent kissing technique (BSKT) as a new systematic approach which is based on modified jailed balloon technique is applied to improve the procedure success. In our center, we proposed a modified balloon-stent kissing technique(M-BSKT), which routine usage of proximal optimizing technique (POT) after rewiring was added as an optimization step to BSKT. Thus, whether M-BSKT for addressing simple true coronary bifurcation lesions can provide more benefits in intra-operation effect and long term outcomes is still unknown. Methods A cohort of 120 consecutive patients underwent Percutaneous Coronary Intervention (PCI) with simple true coronary bifurcation lesions satisfied the criteria were included in this retrospective, single-center registry. To assemble a cohort with similar baseline characteristics, a 1:1 propensity-matched score was used. The primary outcomes were the rate of device and procedural success, the situation of side branch (SB) after main vessel (MV) inflation and the complications during intra-operative. The secondary outcomes were the clinical prognosis at 12 months such as rehospitalization for unstable angina and MACEs. Results Before propensity matching, there were no significant differences in primary and secondary outcomes between two groups. After propensity-matched was used, 68 patients with similar propensity scores were included. At immediate procedural, M-BSKT was associated with a lower risk of SB deterioration and the application of final kissing balloon inflation (FKBI)[P = 0.036]. For ACS patients, besides the significant differences of immediate SB deterioration [P = 0.014] and FKBI application [P = 0.033], the incidence of TIMI flow< 3 in the PS was statistically significant higher than M-BSKT [P= 0.042]. The prognosis at 12 months such as rehospitalization for unstable angina and MACEs were similar for two groups [P = 0.613]. Conclusion These observations prove that the M-BSKT enables side branch to be better protected in simple true bifurcation lesions, by a narrow margin. It may improve the angiographic outcomes about side branch deterioration and final kissing balloon performing compared with PS, especially in ACS patients. However, long-term clinical outcomes did not differ between patients treated for M-BSKT and PS at 12 months.
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Affiliation(s)
- Wen-Bo Qu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People's Republic of China
| | - Wei Zhang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People's Republic of China
| | - Jun-Yan Liu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People's Republic of China
| | - Fan Zhang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People's Republic of China
| | - Shuai-Nan Mu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People's Republic of China
| | - Sheng-Ming Zhang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People's Republic of China
| | - Hao Tang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People's Republic of China
| | - Xi-Qian Liu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People's Republic of China
| | - Xue-Qi Li
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People's Republic of China.
| | - Bing-Chen Liu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150086, People's Republic of China.
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Dérimay F, Rioufol G, Cellier G, Souteyrand G, Finet G. Benefits of final proximal optimization technique (POT) in provisional stenting. Int J Cardiol 2018; 274:71-73. [PMID: 30236500 DOI: 10.1016/j.ijcard.2018.09.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/16/2018] [Accepted: 09/10/2018] [Indexed: 02/04/2023]
Abstract
AIMS Initial proximal optimization technique (POT) in provisional stenting improves global malapposition, side-branch (SB) obstruction (SBO) and conservation of arterial circularity. The specific mechanical effects of a final POT sequence concluding the main provisional stenting techniques, on the other hand, are unknown. METHODS AND RESULTS Synergy™ stents were implanted on fractal coronary bifurcation bench models using the main provisional stenting techniques (n = 5 per group): kissing-balloon inflation (KBI), snuggle, and rePOT (initial POT + SB inflation + final POT). Final results were quantified on 2D and 3D OCT before and after final POT. Whichever the technique, final POT significantly decreased global malapposition (from 7.6 ± 5.3% to 2.2 ± 2.5%, p < 0.05) and proximal elliptic deformation (from 1.15 ± 0.07 to 1.09 ± 0.04, p < 0.05), without impact on SBO (from 11.5 ± 9.6% to 12.9 ± 10.6%, NS). However, final POT failed to completely correct the elliptic deformation induced by balloon juxtaposition during the KBI and snuggle techniques, with final elliptic ratios of 1.11 ± 0.03 and 1.11 ± 0.04 respectively, significantly higher than with the complete rePOT sequence: 1.05 ± 0.02 (p < 0.05). CONCLUSIONS Like initial POT, final POT is recommended whatever the provisional stenting technique used. However, final POT fails to completely correct all proximal elliptic deformation associated with "kissing-like" techniques, in contrast to results with the rePOT sequence.
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Affiliation(s)
- François Dérimay
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France.
| | - Gilles Rioufol
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France
| | - Guillaume Cellier
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France
| | - Géraud Souteyrand
- Cardiology Department, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | - Gérard Finet
- Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unit 1060 CARMEN, Lyon, France
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Worthley S, Hendriks R, Worthley M, Whelan A, Walters DL, Whitbourn R, Meredith I. Paclitaxel-eluting balloon and everolimus-eluting stent for provisional stenting of coronary bifurcations: 12-month results of the multicenter BIOLUX-I study. Cardiovasc Revasc Med 2015; 16:413-7. [PMID: 26346023 DOI: 10.1016/j.carrev.2015.07.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/10/2015] [Accepted: 07/24/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several studies investigated the combination of bare metal stents in the main branch and drug-eluting balloons in the side branch in bifurcation lesions, but data on the combination of drug-eluting stents and drug-eluting balloons are scarce. We aim to assess the feasibility of provisional stenting with an everolimus-eluting stent in the main branch and a paclitaxel-eluting balloon in the side branch. METHODS In this prospective, multi-center study conducted in 5 Australian sites, 35 patients with bifurcation lesions were enrolled. Angiographic and intravascular ultrasound assessments were conducted at 9 months; clinical follow-up was conducted until 12 months. RESULTS The primary endpoint, late lumen loss in the side branch measured by quantitative coronary angiography, was 0.10±0.43mm. No binary restenosis was observed. One patient died; 3 myocardial infarctions (one suspected and two in non-target vessels) and one target lesion revascularization occurred. No probable or definite stent thrombosis was observed. CONCLUSION The combination of an everolimus-eluting stent in the main branch and a paclitaxel-eluting balloon in the side branch appears to be a safe, effective and novel treatment option for bifurcation lesions.
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