1
|
Rigatelli G, Zuin M, Marchese G, Rodino G, Hiso E, Mileva N, Vassilev D, Pasquetto G. Residence time in complex left main bifurcation disease after stenting. Cardiovasc Revasc Med 2024; 61:1-5. [PMID: 37996263 DOI: 10.1016/j.carrev.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 09/23/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Data regarding the mean resident time (RT) after left main (LM) bifurcation stenting are scant. In the present study we performed a patient-specific computational fluid dynamic (CFD) analysis to investigate the different post-stenting mean RT values in LM patients treated with single-or double stenting techniques. METHODS Patients were identified after reviewing the local Optical Coherence Tomography (OCT) scans database. Overall, 27 patients (mean age 65.5 ± 12.4, 21 males) [10 patients treated with provisional cross-over stenting, 7 with the double kissing crush (DK crush) and 10 with the nano-inverted T (NIT) technique, respectively] with isolated and significant LM bifurcation disease were analyzed. RESULTS After LM bifurcation stenting, the NIT showed a higher averages WSS values at all bifurcation sites compared to DK crush and provisional cross-over stenting. Moreover, the mean RT resulted lower after NIT compared to provisional or DK crush. During the diastolic phase, the average RT of the entire LM bifurcation was 0.46 s, 0.38 s and 0.33 s after using the provisional stenting, DK crush and NIT, respectively. Moreover, the average RT in the LM bifurcation decreased by 17.1 % using the DK crush and by 28.2 % using the NIT compared to the Provisional. CONCLUSION The present OCT-derived CFD analysis revealed that, in patients with complex bifurcation LM disease, the provisional approach resulted in lower WSS values, while double stenting techniques, especially the NIT technique, resulted in a marked reduction of average RT compared to the provisional approach. CONDENSED ABSTRACT In the present study we performed a patient-specific Optical coherence tomography (OCT)-based computational fluid dynamic (CFD) analysis to investigate the different post-stenting mean RT values in 27 patients treated with provisional cross-over stenting, DK crush and Nano-inverted-T (NIT) stenting. The NIT showed a higher averages WSS values at all bifurcation sites compared to DK crush and Provisional. The mean RT resulted lower in NIT compared to Provisional or DK crush. During the entire diastolic phase, the average RT of the entire LM bifurcation was 0.46 s, 0.38 s and 0.33 s after using the provisional stenting, DK crush and NIT, respectively. Moreover, the average RT in the entire LM bifurcation decreased by 17.1 % using the DK crush and by 28.2 % using the NIT compared to the Provisional.
Collapse
Affiliation(s)
- Gianluca Rigatelli
- Interventional Cardiology Unit, Division of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy.
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giuseppe Marchese
- Interventional Cardiology Unit, Division of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Giulio Rodino
- Interventional Cardiology Unit, Division of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Ervis Hiso
- Interventional Cardiology Unit, Division of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Niya Mileva
- Department of Cardiology, MedicaCor Hospital, Russe, Bulgaria
| | - Dobrin Vassilev
- Department of Cardiology, MedicaCor Hospital, Russe, Bulgaria
| | - Giampaolo Pasquetto
- Interventional Cardiology Unit, Division of Cardiology, Madre Teresa di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy
| |
Collapse
|
2
|
Ungureanu C, Natalis A, Cocoi M, Dumitrascu S, Noterdaeme T, Gach O, Jossart A, Soetens R, Colletti G. The impact of the bifurcation angle for the Nano-Crush two-stent coronary bifurcation technique on long-term outcomes in a real-world clinical population. Cardiovasc Revasc Med 2024:S1553-8389(24)00070-8. [PMID: 38494371 DOI: 10.1016/j.carrev.2024.02.017] [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: 12/01/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
AIM This study aims to assess the direct impact of bifurcation angle (BA) on immediate procedural outcomes and patient prognosis post-Nano-Crush stenting for coronary bifurcation lesions. METHODS A retrospective analysis was conducted for all consecutive patients treated with the Nano-Crush technique across two high-volume interventional centers from January 2020 to October 2022. PRIMARY ENDPOINT comparison of target lesion failure rate in two cohorts based on bifurcation angle (<70° vs. ≥70°), with secondary endpoints including side branch ostium coverage, rate of successful final kissing balloon inflation (FKBI), need for conversion to another technique, and procedure length. RESULTS Baseline demographics included 71 patients in the BA<70° group and 49 in the BA≥70° group, with well-balanced characteristics. Angiographic characteristics revealed similar trends, including anatomic and morphological lesion characteristics (referencing Syntax score, Medina classification, and presence of calcifications). Both groups predominantly had complex coronary disease, with a baseline mean Syntax score of 24.18 ± 8.19 in the BA<70° group and 23.91 ± 7.29 in the BA≥70° group, respectively. A dedicated debulking device for lesion preparation was used in 25.35 % of patients in the first group and in 28.57 % of patients in the second group. The primary endpoint occurred in 5.63 % of patients in the BA<70° group and in 4.08 % of patients in the BA≥70° group (P = 0.7014) after ≥ 2 years of clinical follow-up. Angiographic success was achieved in 100 % of both groups, with procedural time averaging 74.99 ± 25.55 min in the BA≥70° and 76.94 ± 27.81 min in the BA<70° (P = 0.6922). The rate of successful final kissing balloon inflation was 98.59 % in the BA<70° group and 95.91 % in the BA≥70° group (P = 0.3566). The mean contrast volume was 189.54 ± 73.74 ml in BA<70° and 168.9 ± 62.77 ml in BA≥70° (P = 0.1126). Clinical follow-ups at 30 days and 2 years revealed similar outcomes and complications for each group, as summarized in Table 3. CONCLUSIONS Our results demonstrate that the bifurcation angle does not significantly impact long-term clinical outcomes or procedural parameters, such as side branch ostium coverage, conversion to a modified DK Crush technique, FKBI success rate, and procedure length. These findings suggest that the Nano-Crush technique can be a viable option for bifurcation lesions, irrespective of the bifurcation angle, achieving optimal side branch ostium coverage while preventing excessive protrusion into the main vessel.
Collapse
Affiliation(s)
| | - Alexandre Natalis
- Cardiovascular Department, Clinique Saint Joseph, Vivalia, Arlon, Belgium
| | - Mihai Cocoi
- Cardiovascular Department, Institutul Inimii, Cluj, Romania
| | | | | | - Olivier Gach
- Cardiovascular Departement, MontLégia, Liège, Belgium
| | | | | | - Giuseppe Colletti
- Cardiovascular Department, Clinique Saint Joseph, Vivalia, Arlon, Belgium
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Sivalingam J, Mazhar MW, Chaddad RA, Fouladvand F, Cortese B. Clinical outcomes of a dedicated bifurcation stent system. Cardiovasc Revasc Med 2024; 59:21-26. [PMID: 37666716 DOI: 10.1016/j.carrev.2023.08.015] [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] [Received: 07/19/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) of bifurcation lesions is technically challenging and associated with higher rates of complications such as stent thrombosis or in-stent restenosis. In this paper, we present the clinical outcomes of BiOSS LIM C (Balton, Poland), a dedicated bifurcation stent. METHODS In this retrospective single-center study we analyzed the outcome of patients with bifurcation coronary artery disease treated with the BiOSS LIM C stent system. The primary endpoint was the cumulative rate of major adverse cardiac events (MACE) including cardiac death, myocardial infarction (MI) and target lesion revascularisation (TLR) at the longest available follow-up. RESULTS The study population consisted of 25 patients (mean age 73.6 ± 9.7 years, 25 % females). In 80 % of the cases (n = 20) BiOSS LIM C stent was implanted in the left main coronary artery. Intravascular imaging was used in 70 % of the cases and an additional regular drug-eluting stent (DES) was deployed in the side branch in 24 % of the cases. The device success rate was 100 % and we observed no in-hospital adverse events. At a median follow-up of 15 ± 6 months, the MACE rate was 56 %, cardiac death was 4 %, and clinically driven TLR was 55 %. One patient died in the LM subgroup, 5 months after the index PCI, due to NSTEMI complicated by cardiogenic shock. Two patients died due to non-cardiac causes. CONCLUSIONS In this consecutive series of patients treated with BiOSS LIM C in major coronary bifurcation lesions, mostly in the left main stem, the mid-term clinical outcomes demonstrated a high incidence of major adverse events, mainly caused by TLR, despite an adequate implantation technique.
Collapse
Affiliation(s)
- Jegan Sivalingam
- Hannah Joseph Hospital, Madurai, India; DCB Academy, Milano, Italy
| | - Muhammad Waqas Mazhar
- DCB Academy, Milano, Italy; Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Rima Ayoub Chaddad
- DCB Academy, Milano, Italy; Grand Hopital de I'Est Francilien, Marne la Valee, France
| | | | - Bernardo Cortese
- DCB Academy, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy.
| |
Collapse
|
5
|
Bennett J, Desmet W, Dubois C. The COBRA II (COmplex Bifurcation lesions: RAndomized comparison of a fully bioresorbable modified-T stenting strategy versus bifurcation reconstruction with a dedicated self-expanding stent in combination with bioresorbable scaffolds) study: Final 5-year follow-up. Indian Heart J 2023; 75:473-476. [PMID: 37739221 PMCID: PMC10774576 DOI: 10.1016/j.ihj.2023.09.001] [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] [Received: 08/23/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND In order to advocate further research in bioresorbable scaffold (BVS) technology we report the final 5-year outcomes of the COBRA II study, the only randomized controlled trial (RCT) performed to investigate the safety, feasibility, and performance of Absorb BVS (Abbott Vascular) in true coronary bifurcations. METHODS COBRA II was a prospective single-center RCT. Fifteen patients with true coronary bifurcation lesions were randomized to bifurcation treatment with self-expanding biolimus-eluting Axxess bifurcation device (Biosensors International) combined with additional bioresorbable everolimus-eluting Absorb BVS in the bifurcation branches on (Axxess group) or to 2-stent mod-T stenting technique with Absorb BVS (mod-T group). Optical coherence tomography was performed post-procedure and at 30-months. The primary endpoint was change in minimal luminal area (MLA) on OCT from baseline to 30-months. RESULTS Fifteen patients with coronary bifurcation lesions were randomized to the Axxess group (n = 8) or Modified-T group (n = 7). At 30 months, MLAs were significantly smaller than post-procedure in the majority of bifurcation segments treated with BVS due to neointima formation, while MLAs in the proximal Axxess segment remained stable (primary endpoint). Five-year clinical follow-up was available for all patients. Only 1 major adverse cardiac event occurred; a patient underwent target lesion revascularization at 30 months in the Axxess group. There were no cases of cardiac death, spontaneous MI, or stent/scaffold thrombosis. CONCLUSIONS In this small RCT bifurcation study, BVS luminal dimensions were significantly smaller at 30 months, with acute strut discontinuities and late Intraluminal dismantling frequently observed, although acceptable clinical outcomes were noted at 5 years.
Collapse
Affiliation(s)
- Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Walter Desmet
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
6
|
Yamawaki M, Murasato Y, Watanabe Y, Kinoshita Y, Okubo M, Yumoto K, Masuda N, Otake H, Aoki J, Nakazawa G, Numasawa Y, Ito T, Shite J, Okamura T, Takagi K, Kozuma K, Lefèvre T, Chevalier B, Louvard Y, Suzuki N, Kozuma K. Impact of coronary bifurcation angle on stent malapposition in a randomized comparison between proximal optimization technique followed by side branch dilatation and kissing balloon inflation. Int J Cardiol Heart Vasc 2023; 48:101265. [PMID: 37680550 PMCID: PMC10480620 DOI: 10.1016/j.ijcha.2023.101265] [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: 04/12/2023] [Revised: 07/12/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
Background The impact of coronary bifurcation angle (BA) on incomplete stent apposition (ISA) after crossover stenting followed by side branch (SB) intervention has not been established. Methods A total of 100 crossover stentings randomly treated with proximal optimization technique followed by short balloon dilation in the SB (POT-SBD group, 48 patients) and final kissing balloon technique (KBT group, 52 patients) were analyzed in the PROPOT trial. Major ISA with maximum distance > 400 μm and its location was determined using optical coherence tomography before SB intervention and at the final procedure. The BA was defined as the angle between the distal main vessel and SB. Optimal POT was determined when the difference in stent volume index between the proximal and distal bifurcation was greater than the median value (0.86 mm3/mm) before SB intervention. Result Major ISA was more frequently observed in the POT-SBD than in the KBT group (35% versus 17%, p < 0.05). In the POT-SBD group, worsening ISA after SBD was prominent at the distal bifurcation. The BA was an independent predictor of major ISA (odds ratio 1.04, 95% confidence interval 1.00-1.07, p < 0.05) with a cut-off value of 59.5° (p < 0.05). However, the cases treated with optimal POT in the short BA (<60°) indicated the lowest incidence of major ISA. In the KBT group, BA had no significant impact. Conclusion A wide BA has a potential risk for the occurrence of major ISA after POT followed by SBD in coronary bifurcation stenting.
Collapse
Affiliation(s)
- Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yusuke Watanabe
- Department of Medicine, Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | | | - Munenori Okubo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Kazuhiko Yumoto
- Department of Cardiology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Naoki Masuda
- Department of Cardiology, Ageo Central General Hospital, Ageo, Japan
| | - Hiromasa Otake
- Department of Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jiro Aoki
- Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Tatsuya Ito
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Takayuki Okamura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kayoko Kozuma
- Department of Biostatistics, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Thierry Lefèvre
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Bernard Chevalier
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Yves Louvard
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Nobuaki Suzuki
- Division of Cardiology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Ken Kozuma
- Department of Medicine, Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Dash D, Mody R, Ahmed N, Malan SR, Mody B. Drug-coated balloon in the treatment of coronary bifurcation lesions: A hope or hype? Indian Heart J 2022; 74:450-457. [PMID: 36347323 PMCID: PMC9773284 DOI: 10.1016/j.ihj.2022.10.193] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/24/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
When compared to non-bifurcation lesions, percutaneous coronary intervention in coronary bifurcation lesions is technically demanding and has historically been limited by lower procedural success rates and inferior clinical results. Following the development of drug-eluting stents, dramatically better results have been demonstrated. In most of the bifurcation lesions, the provisional technique of implanting a single stent in the main branch (MB) remains the default approach. However, some cases require more complex two-stent techniques which carry the risk of side branch (SB) restenosis. The concept of leaving no permanent implant behind is appealing because of the complexity of bifurcation anatomy with significant size mismatch between proximal and distal MB which may drive rates of in-stent restenosis and the potential impact of MB stenting affecting SB coronary flow dynamics. With the perspective of leaving lower metallic burden, a drug-coated balloon (DCB) has been utilized to treat bifurcations in both the MB and SB. The author gives an overview of the existing state of knowledge and prospects for the future for using DCB to treat bifurcation lesions.
Collapse
Affiliation(s)
- Debabrata Dash
- Department of Cardiology, Aster Hospital, Dubai, United Arab Emirates.
| | - Rohit Mody
- Department of Cardiology, Max Superspeciality Hospital, Bathinda, India
| | - Naveed Ahmed
- Department of Cardiology, Aster Hospital, Dubai, United Arab Emirates
| | | | - Bhavya Mody
- Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India
| |
Collapse
|
9
|
Gallone G, D'Ascenzo F, Ielasi A, Landra F, Stefanini GG, Di Biasi M, Mancone M, Tomai F, Infantino V, Rognoni A, Briguori C, Boccuzzi G, Smolka G, Chiarito M, Capodanno D, Chieffo A, Fabbiocchi F, Poli A, Tespili M, D'Urbano M, Giordano A, Escaned J, De Ferrari GM, Sardella G. Polymer-free biolimus-eluting stents or polymer-based zotarolimus-eluting stents for coronary bifurcation lesions. Cardiovasc Revasc Med 2021; 35:66-73. [PMID: 33903036 DOI: 10.1016/j.carrev.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/14/2021] [Revised: 03/22/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND A polymer-free biolimus-eluting stent (PF-BES) and a zotarolimus-eluting stent (ZES) recently showed similar clinical profiles and appear to be competing options in specific clinical settings of patients undergoing percutaneous coronary intervention (PCI). Whether they perform similarly also in complex procedural settings as coronary bifurcation lesions remains unaddressed. METHODS All consecutive patients undergoing coronary bifurcation PCI with PF-BES or the new iteration of the ZES from three large multicenter real-world registries were included. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis (ST). Multiple analyses to adjust for baseline differences were carried out including propensity-score matching, propensity-score stratification and inverse-probability-weighting. Outcomes are reported according to Cox proportional hazard models censored at 400-day follow-up. RESULTS 1169 patients treated with PF-BES (n = 440) or ZES (n = 729) on the main branch of a coronary bifurcation lesion were included (mean age 69 ± 11 years, 75.4% male, 53.8% acute coronary syndrome at presentation, 26.6% left main bifurcation, median dual antiplatelet therapy duration 12 [range 12-12] months). MACE, all-cause death, TLR and ST tended towards non-statistically higher rates with the PF-BES as compared to the ZES. Higher MI and target vessel revascularization occurrence was observed with PF-BES. CONCLUSIONS In this large contemporary cohort of patients undergoing coronary bifurcation PCI, the occurrence of MACE was non-statistically different with the use of PF-BES and ZES devices. However, differences favoring the ZES device that may entail clinical relevance were observed. Further studies are needed to confirm these findings and explore whether they remain valid when a short dual antiplatelet therapy is adopted.
Collapse
Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy.
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Alfonso Ielasi
- Interventional Cardiology Unit, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Federico Landra
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | | | - Maurizio Di Biasi
- Interventional Cardiology Unit, Ospedale Sacco, ASST Fatebenefratelli/Sacco, Milano, Italy
| | - Massimo Mancone
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | | | | | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mauro Chiarito
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Franco Fabbiocchi
- Interventional Cardiology Unit, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, Milan, Italy
| | - Arnaldo Poli
- Division of Cardiology, Ospedale di Legnano, ASST Milanese Ovest, Italy
| | - Maurizio Tespili
- Interventional Cardiology Unit, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Maurizio D'Urbano
- Division of Cardiology, Ospedale di Magenta, ASST Milanese Ovest, Italy
| | | | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Gaetano M De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
10
|
Daggubati R, Sabouni MA, Rigatelli G. Modeling the Ideal 2-Stent Strategy in Coronary Bifurcation! Is There Light at the End of the Tunnel? Cardiovasc Revasc Med 2021; 24:18-19. [PMID: 33478858 DOI: 10.1016/j.carrev.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Ramesh Daggubati
- West Virginia University School of Medicine, Heart and Vascular Institute, Morgantown, WV, United States of America.
| | - Mohammed Amr Sabouni
- West Virginia University School of Medicine, Heart and Vascular Institute, Morgantown, WV, United States of America
| | - Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| |
Collapse
|
11
|
Takagi K, Nagoshi R, Kim BK, Kim W, Kinoshita Y, Shite J, Hikichi Y, Song YB, Nam CW, Koo BK, Kim SJ, Murasato Y. Efficacy of coronary imaging on bifurcation intervention. Cardiovasc Interv Ther 2020; 36:54-66. [PMID: 32894433 PMCID: PMC7829226 DOI: 10.1007/s12928-020-00701-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/14/2023]
Abstract
During the coronary bifurcation intervention procedure, imaging including intravascular ultrasound and optical coherence tomography is essential to provide precise anatomy of the lesion and morphological information. This consensus document between the Korean Bifurcation Club and the Japanese Bifurcation Club summarizes practical guidelines and current evidences on lesion assessment, device selection, procedural guidance, and the optimization of bifurcation intervention by the imaging.
Collapse
Affiliation(s)
- Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ryoji Nagoshi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Byeong-Keuk Kim
- Department of Cardiology, Yonsei Severance Hospital, Seoul, South Korea
| | - Woong Kim
- Department of Cardiology, Yeungnam Medical Center, Daegu, South Korea
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | | | - Young Bin Song
- Department of Cardiology, Samsung Medical Center, Seoul, South Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Soo-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Center, National Hospital Organization, Kyushu Medical Center, 1-8-1, Jigyohama, Chuo, Fukuoka, 810-8563, Japan.
| |
Collapse
|
12
|
Murasato Y, Shibao K, Meno K, Takenaka K. A case of very late stent thrombosis on the protruded struts at the left main coronary bifurcation. J Cardiol Cases 2020; 22:40-43. [PMID: 32636969 DOI: 10.1016/j.jccase.2020.04.007] [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: 02/09/2020] [Revised: 03/27/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022] Open
Abstract
A previous autopsy study has revealed that malapposed or protruded struts in the coronary bifurcation were a risk factor for very late stent thrombosis (VLST); however, a live clinical case has not yet been reported due to difficulty in observation at the VLST site. In this case, a 56-year-old male patient underwent a zotarolimus-eluting stent implantation in the proximal left anterior descending artery for acute myocardial infarction 3 years previously and had been treated with dual antiplatelet therapy. The patient experienced chest pain and suddenly collapsed due to acute coronary syndrome caused by a huge thrombus in the left main coronary bifurcation. After insertion of the intra-aortic balloon pump, kissing balloon inflation improved coronary flow and hemodynamics. Two weeks later, a 3-dimensional optical frequency domain imaging (3-D OFDI) revealed uncovered protruded struts on the ostium of the left circumflex artery (LCX). We removed the protruded struts using a double lumen catheter, for which the second wire was advanced to more distal cell along with the first wire located in the same LCX branch. 3-D OFDI clearly demonstrated that uncovered protruded struts at the LCX ostium were the cause of VLST and navigated optimal wiring with a double lumen catheter. Learning objective: Existence of protruded struts at the coronary bifurcated branch ostium is a risk factor for very late stent thrombosis. Three-dimensional optical frequency domain imaging clearly demonstrates the protruded strut configuration at the side branch of ostium and facilitates optimal guide wire re-crossing for kissing balloon inflation. Usage of double lumen catheter increases the possibility of optimal side branch wiring.
Collapse
Affiliation(s)
- Yoshinobu Murasato
- Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kodai Shibao
- Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kyohei Meno
- Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Katsuhiko Takenaka
- Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| |
Collapse
|
13
|
Yang H, Qian J, Huang Z, Ge J. Szabo 2-stent technique for coronary bifurcation lesions: procedural and short-term outcomes. BMC Cardiovasc Disord 2020; 20:325. [PMID: 32635890 PMCID: PMC7339428 DOI: 10.1186/s12872-020-01605-y] [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] [Received: 05/03/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Provisional 1-stent technique is currently regarded as the default approach for the majority of bifurcation lesions. Nonetheless, 2-stent techniques may be required for complex bifurcations with high compromise risk or fatal consequences of side branch (SB) occlusion. Limitations exist in current approaches, as stents gap, multiple metal layers and stent malapposition caused by imprecise placement with fluoroscopic guide and intrinsic technical defects. This study was designed to investigate the effectiveness of the novel Szabo 2-stent technique for coronary bifurcation lesions. METHODS In the Szabo 2-stent technique, one stent is precisely implanted at the SB ostium with Szabo technique resulting in a single strut protruding into the main vessel (MV). After MV rewiring and SB guidewire withdrawal, another stent is implanted in MV followed by proximal optimization technique, SB rewiring, and final kissing inflation (FKI). RESULTS The technique tested successfully in silicone tubes (n = 9) with: procedure duration, 31.2 ± 6.8 min; MV and SB rewiring time, 26.8 ± 11.2 s and 33.3 ± 15 s; easy FKI; and 2.3 ± 0.5 balloons/procedure. Bifurcation lesions (n = 22) were treated with angiographic success in MV and SB, respectively: increased minimal lumen diameter (0.63 ± 0.32 mm to 3.20 ± 0.35 mm; 0.49 ± 0.37 mm to 2.67 ± 0.25 mm); low residual stenosis (12.4 ± 2.4%; 12.4 ± 2.3%); and intravascular ultrasound confirmed (n = 19) full coverage; minimal overlap and malapposition; minimal lumen area (2.4 ± 1.2 mm2; 2.1 ± 1.0 mm2); plaque burden (78.1 ± 11.3%; 71.6 ± 15.5%); and minimal stent area (9.1 ± 1.6 mm2; 6.1 ± 1.3 mm2). Periprocedural cardiac troponin increased in 1 asymptomatic patient without electrocardiographic change. There was no target lesion failure (cardiac death, myocardial infarction, target lesion revascularization) at 6-month follow-up. CONCLUSIONS The Szabo 2-stent technique for bifurcation lesions provided acceptable safety and efficacy at short-term follow-up.
Collapse
Affiliation(s)
- Hongbo Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Xietu Road No. 1609, Shanghai, 200032, People's Republic of China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Xietu Road No. 1609, Shanghai, 200032, People's Republic of China
| | - Zheyong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Xietu Road No. 1609, Shanghai, 200032, People's Republic of China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Xietu Road No. 1609, Shanghai, 200032, People's Republic of China.
| |
Collapse
|
14
|
Iannaccone M, Barbero U, De Benedictis M, Imori Y, Quadri G, Trabattoni D, Ryan N, Venuti G, Montabone A, Wojakowski W, Rognoni A, Helft G, Parma R, De Luca L, Autelli M, Boccuzzi G, Mattesini A, Templin C, Cerrato E, Wańha W, Smolka G, Huczek Z, Tomassini F, Cortese B, Capodanno D, Chieffo A, Nuñez-Gil I, Gili S, Bassignana A, di Mario C, Doronzo B, Omedè P, D'Amico M, Tedeschi D, Varbella F, Luscher T, Sheiban I, Escaned J, Rinaldi M, D'Ascenzo F. Comparison of bioresorbable vs durable polymer drug-eluting stents in unprotected left main (from the RAIN-CARDIOGROUP VII Study). BMC Cardiovasc Disord 2020; 20:225. [PMID: 32414330 PMCID: PMC7227223 DOI: 10.1186/s12872-020-01420-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/16/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited data regarding the impact of bioresorbable polymer drug eluting stent (BP-DES) compared to durable polymer drug eluting stent (DP-DES) in patients treated with percutaneous coronary intervention using ultrathin stents in left main or bifurcations. METHODS In the RAIN registry (ClinicalTrials NCT03544294, june 2018 retrospectively registered) patients with a ULM or bifurcation stenosis treated with PCI using ultrathin stents (struts thinner than 81 μm) were enrolled. The primary endpoint was the rate of target lesion revascularization (TLR); major adverse cardiovascular events (MACE, a composite of all-cause death, myocardial infarction, TLR and stent thrombosis) and its components, along with target vessel revascularization (TVR) were the secondary ones. A propensity score with matching analysis to compare patients treated with BP-DES versus DP-DES was also assessed. RESULTS From 3001 enrolled patients, after propensity score analysis 1400 patients (700 for each group) were selected. Among them, 352 had ULM disease and 1048 had non-LM bifurcations. At 16 months (12-22), rates of TLR (3.7% vs 2.9%, p = 0.22) and MACE were similar (12.3% vs. 11.6%, p = 0.74) as well as for the other endpoints. Sensitivity analysis of outcomes after a two-stents strategy, showed better outcome in term of MACE (20.4% vs 10%, p = 0.03) and TVR (12% vs 4.6%, p = 0.05) and a trend towards lower TLR in patients treated with BP-DES. CONCLUSION In patients with bifurcations or ULM treated with ultrathin stents BP-DES seems to perform similarly to DP-DES: the trends toward improved clinical outcomes in patients treated with the BP-DES might potentially be of value for speculating the stent choice in selected high-risk subgroups of patients at increased risk of ischemic events. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03544294. Retrospectively registered June 1, 2018.
Collapse
Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, SS. Annunziata Hospital, ASL CN1, Savigliano, Italy
| | - Umberto Barbero
- Division of Cardiology, SS. Annunziata Hospital, ASL CN1, Savigliano, Italy.
| | | | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy.,University of Milan, Milan, Italy
| | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Giuseppe Venuti
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele,", Catania, Italy
| | - Andrea Montabone
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gerard Helft
- Division of Cardiology, Pierre and Marie Curie University, Paris, France
| | | | | | - Michele Autelli
- Cardiology Department, Ospedale San Giovanni Bosco, Turin, Italy
| | - Giacomo Boccuzzi
- Cardiology Department, Ospedale San Giovanni Bosco, Turin, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Christian Templin
- Division of Cardiology, Universityspirtal of Zurich, Zürich, Switzerland
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Wojciech Wańha
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Francesco Tomassini
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Bernardo Cortese
- Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele,", Catania, Italy
| | | | - Ivan Nuñez-Gil
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Sebastiano Gili
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy.,University of Milan, Milan, Italy
| | - Antonia Bassignana
- Division of Cardiology, SS. Annunziata Hospital, ASL CN1, Savigliano, Italy
| | - Carlo di Mario
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele,", Catania, Italy
| | | | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Delio Tedeschi
- Interventional Cardiology, Istituto clinico Sant'anna, Brescia, Italy
| | - Ferdinando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Thomas Luscher
- Division of Cardiology, Universityspirtal of Zurich, Zürich, Switzerland
| | - Imad Sheiban
- Interventional Cardiology, Pederzoli Hospital Peschiera del Garda, Verona, Italy
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Mauro Rinaldi
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| |
Collapse
|
15
|
Grodecki K, Cadet S, Staruch AD, Michalowska AM, Kepka C, Wolny R, Pregowski J, Kruk M, Debski M, Debski A, Michalowska I, Slomka PJ, Witkowski A, Dey D, Opolski MP. Noncalcified plaque burden quantified from coronary computed tomography angiography improves prediction of side branch occlusion after main vessel stenting in bifurcation lesions: results from the CT-PRECISION registry. Clin Res Cardiol 2021; 110:114-23. [PMID: 32385529 DOI: 10.1007/s00392-020-01658-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/26/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the incremental value of quantitative plaque features measured from computed tomography angiography (CTA) for predicting side branch (SB) occlusion in coronary bifurcation intervention. METHODS We included 340 patients with 377 bifurcation lesions in the post hoc analysis of the CT-PRECISION registry. Each bifurcation was divided into three segments: the proximal main vessel (MV), the distal MV, and the SB. Segments with evidence of coronary plaque were analyzed using semi-automated software allowing for quantitative analysis of coronary plaque morphology and stenosis. Coronary plaque measurements included calcified and noncalcified plaque volumes, and corresponding burdens (respective plaque volumes × 100%/vessel volume), remodeling index, and stenosis. RESULTS SB occlusion occurred in 28 of 377 bifurcation lesions (7.5%). The presence of visually identified plaque in the SB segment, but not in the proximal and distal MV segments, was the only qualitative parameter that predicted SB occlusion with an area under the curve (AUC) of 0.792. Among quantitative plaque parameters calculated for the SB segment, the addition of noncalcified plaque burden (AUC 0.840, p = 0.003) and low-density plaque burden (AUC 0.836, p = 0.012) yielded significant improvements in predicting SB occlusion. Using receiver operating characteristic curve analysis, optimal cut-offs for noncalcified plaque burden and low-density plaque burden were > 33.6% (86% sensitivity and 78% specificity) and > 0.9% (89% sensitivity and 73% specificity), respectively. CONCLUSIONS CTA-derived noncalcified plaque burden, when added to the visually identified SB plaque, significantly improves the prediction of SB occlusion in coronary bifurcation intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03709836 registered on October 17, 2018.
Collapse
|
16
|
Tondas AE, Mulawarman R, Trifitriana M, Pranata R, Abisha SE, Toruan MPL. A Systematic Review of Jailed Balloon Technique for Coronary Bifurcation Lesion: Conventional-Jailed Balloon Technique vs Modified-Jailed Balloon Technique. Cardiovasc Revasc Med 2020; 21:1193-9. [PMID: 32169406 DOI: 10.1016/j.carrev.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND In this systematic review, we aim to evaluate the latest evidence on the efficacy and safety of conventional jailed balloon technique and modified jailed balloon technique for bifurcation lesion, and also whether the former or latter is more effective for preventing side branch occlusion during main branch stenting in bifurcation lesions. METHODS We performed comprehensive search on studies assessing the efficacy and safety of conventional jailed balloon and modified jailed balloon technique for bifurcation lesion from several electronic databases. RESULTS There were 908 patients from six studies comprising of 615 in conventional jailed balloon technique group and 293 in modified jailed balloon technique group. Side branch loss was lower in modified jailed balloon technique group, however, the proportion of lesions with TIMI flow <3 in the final percutaneous coronary intervention result was somewhat higher in the modified jailed balloon technique group. The efficacy issue regarding side branch dissection was reported as high as 3.4%, especially at proximal stent edge in conventional jailed balloon technique group, but not quantitatively described in the modified jailed balloon technique group. Zero percent major adverse cardiovascular events at 9-12 months follow up was demonstrated in modified jailed balloon technique group, and 1-5% in the conventional jailed balloon group at a longer observation period up to 2.7 years. CONCLUSION Our study showed that modified jailed balloon technique is potentially better compared to conventional jailed balloon in terms of side branch loss, dissection, and major adverse cardiovascular events. Further controlled studies are warranted for definite conclusion.
Collapse
|
17
|
Daggubati R, Daggubati R, Khaliq A. Get Out of Jail Free! Cardiovasc Revasc Med 2019; 20:1073-4. [PMID: 31870524 DOI: 10.1016/j.carrev.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/21/2022]
|
18
|
Opolski MP, Grodecki K, Staruch AD, Michalowska AM, Kepka C, Wolny R, Knaapen P, Schumacher SP, Pregowski J, Kruk M, Debski M, Debski A, Michalowska I, Witkowski A. Accuracy of RESOLVE score derived from coronary computed tomography versus visual angiography to predict side branch occlusion in percutaneous bifurcation intervention. J Cardiovasc Comput Tomogr 2019; 14:258-265. [PMID: 31806391 DOI: 10.1016/j.jcct.2019.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/31/2019] [Revised: 09/29/2019] [Accepted: 11/20/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Visually estimated angiographic V-RESOLVE score was developed as a simple and accurate prediction tool for side branch (SB) occlusion in patients undergoing coronary bifurcation intervention. Data on the use of coronary computed tomography angiography (coronary CTA) for guiding percutaneous coronary intervention in bifurcation lesions is scarce. OBJECTIVES We aimed to validate the ability of quantitative CTA-derived RESOLVE score for predicting SB occlusion in coronary bifurcation intervention and to compare its predictive value with that of the angiography-based V-RESOLVE score. METHODS We included 363 patients with 400 bifurcation lesions. Angiographic V-RESOLVE score and CTA-derived RESOLVE score were calculated utilizing the weights from the QCA-based RESOLVE score. The scoring systems were divided into quartiles, and classified as the non-high-risk group and the high-risk group. Accuracy was assessed using areas under the receiver-operator characteristic curve (AUC). SB occlusion was defined as any decrease in Thrombolysis in Myocardial Infarction flow grade (including the absence of flow) in the SB after main vessel stenting. RESULTS In total, 28 SB occlusions (7%) occurred. CTA-derived RESOLVE and V-RESOLVE scores achieved comparable predictive accuracy (0.709 vs. 0.752, respectively, p = 0.531) for predicting SB occlusion, and the analysis of AUC for each constituent element of the scores did not show any significant difference between CTA and visual angiography. The total net reclassification index was -18.6% (p = 0.194), and there were no significant differences in the rates of SB occlusion in the non-high-risk group (4.9% vs. 3.8%, p = 0.510) and the high-risk group (13.8% vs. 18.6%, p = 0.384) between CTA-derived RESOLVE and V-RESOLVE scores. CONCLUSIONS The quantitative CTA-derived RESOLVE score is an accurate and reliable alternative to the visually estimated angiographic V-RESOLVE score for prediction of SB occlusion in coronary bifurcation intervention. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03709836.
Collapse
Affiliation(s)
- Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
| | - Kajetan Grodecki
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland; Medical University of Warsaw, Warsaw, Poland
| | - Adam D Staruch
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Anna M Michalowska
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland; Medical University of Warsaw, Warsaw, Poland
| | - Cezary Kepka
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Rafal Wolny
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jerzy Pregowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kruk
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Debski
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Artur Debski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | | | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
19
|
Murasato Y, Mori T, Okamura T, Nagoshi R, Fujimura T, Yamawaki M, Ono S, Serikawa T, Nakao F, Shite J; 3D-OCT Bifurcation Registry Investigators. Efficacy of the proximal optimization technique on crossover stenting in coronary bifurcation lesions in the 3D-OCT bifurcation registry. Int J Cardiovasc Imaging. 2019;35:981-990. [PMID: 30887408 DOI: 10.1007/s10554-019-01581-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/07/2019] [Indexed: 12/13/2022]
Abstract
AIM We sought to investigate the efficacy of the proximal optimization technique (POT) on crossover stenting followed by side branch (SB) dilation under optical coherence tomography guidance in a multicenter registry study. METHODS AND RESULTS A total of 135 bifurcation lesions in 134 patients were divided into POT (n = 52) and non-POT groups (n = 83). The POT was performed before SB dilatation (pre-POT; n = 26), finally (final-POT; n = 12), at both timing (re-POT; n = 13), and uncertain (n = 1). There were no significant intergroup differences in the success rate of guide wire re-crossing (GWR) into the optimal cell (72% vs. 65%), incidence of the link-free type in the configuration of the SB jailed struts (51% vs. 49%), or incomplete strut apposition at the bifurcation (13 ± 11% vs. 10 ± 9%). However, insufficient stent expansion close to the carina in the proximal main vessel (MV) due to inappropriate POT was likely to induce greater incomplete strut apposition (ISA) around the bifurcation. Only re-POT provided more symmetric proximal MV expansion, while pre- and final-POT did not. CONCLUSION The POT did not provide the expected beneficial effects, such as reduction of ISA or more optimal GWR, under the OCT guidance. Wide stent expansion in the proximal MV induced by the POT increased the likelihood of achieving optimal GWR, whereas symmetric stent expansion was provided by re-POT.
Collapse
|
20
|
Zimarino M, Briguori C, Amat-Santos IJ, Radico F, Barbato E, Chieffo A, Cirillo P, Costa RA, Erglis A, Gamra H, Gil RJ, Kanic V, Kedev SA, Maddestra N, Nakamura S, Pellicano M, Petrov I, Strozzi M, Tesorio T, Vukcevic V, De Caterina R, Stankovic G; EuroBifurcation Club. Mid-term outcomes after percutaneous interventions in coronary bifurcations. Int J Cardiol 2019; 283:78-83. [PMID: 30528620 DOI: 10.1016/j.ijcard.2018.11.139] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/07/2018] [Accepted: 11/30/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND The optimal treatment of patients undergoing percutaneous coronary interventions (PCI) for lesions located at coronary bifurcations is still debated. METHODS Data on 5036 consecutive patients who underwent PCI on coronary bifurcation at 17 major coronary intervention centers between January 2012 and December 2014 were collected. RESULTS Follow-up at a median 18 months (IQR 11-28) was available for 4506 patients (89%). Major Adverse Cardiac Events (MACE) occurred in 395 patients (8.8%): cardiac death in 152 (3.4%), myocardial infarction, excluding periprocedural, in 156 (3.5%) and stent thrombosis in 110 cases (2.4%). At multivariable Cox regression, left ventricular ejection fraction ≤30% (P < 0.001), bail-out stenting (beyond a planned strategy of either single or double stenting) (P < 0.001), admission for an acute coronary syndrome (P < 0.001), age >66 years (P < 0.001), multivessel disease (P < 0.001) and diabetes (P < 0.001) were independently associated with MACE. Sensitivity analysis identified premature discontinuation of dual antiplatelet therapy (DAPT) (P < 0.001) and side branch (SB) lesion length ≥9 mm (P < 0.05) as additional independent predictors of MACE. CONCLUSIONS Beyond traditional risk factors, multivessel disease, the length of the SB lesion, "bail-out" stenting and premature DAPT discontinuation are independent predictors of mid-term MACE after PCI of coronary bifurcations. This highlights the importance of a carefully planned PCI strategy and adequate therapy adherence to improve the clinical outcomes in these patients. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01967615.
Collapse
|
21
|
Abstract
Complex bifurcations have been suggested to be better approached by a planned double stent technique; however, recent randomized trials have shown better outcomes of provisional compared to planned two-stent strategy, in terms of both short-term efficacy and safety. In left main (LM) bifurcations, double kissing (DK)-Crush has demonstrated its superiority over Culotte and provisional-T in terms of restenosis and stent thrombosis, gaining respect as one of the most performant techniques for bifurcations stenting. On the other hand, the Nano-Crush technique has recently become part of the repertoire of double stenting techniques, providing evidence that the use of ultrathin strut stents and very minimal crush would be beneficial for both the physiological and rheological properties of the complex bifurcations, even in LM scenario, leading to a lower rate of thrombosis and restenosis at both side branch and true carina. Finally, the newest generation of ultrathin strut stents are gaining a reputation for its safe and effective use in LM treatment thanks to improved design with increased expansion rate capable of LM treatment up to 5-6 mm diameter. The modern crush techniques, such as DK-Crush and Nano-Crush, are providing excellent results on mid and long-term follow up, suggesting that minimal crushing obtained using ultra-thin stents is a good way to obtain surgical-like outcomes in the treatment of complex LM bifurcation disease.
Collapse
Affiliation(s)
- Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo 45100, Italy
| | - Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara 44124, Italy
| | - Debradata Dash
- Interventional Cardiology, Thumbay Hospital, Ajman 415555, United Arab Emirates
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Rampat R, Mayo T, Hildick-Smith D, Cockburn J. A randomized trial comparing two stent sizing strategies in coronary bifurcation treatment with bioresorbable vascular scaffolds - The Absorb Bifurcation Coronary (ABC) trial. Cardiovasc Revasc Med 2018; 20:43-49. [PMID: 30170828 DOI: 10.1016/j.carrev.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/23/2018] [Accepted: 08/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Limited information is available on the use of Bioresorbable Vascular Scaffold (BVS) in bifurcations involving significant side branches. When treating bifurcation disease with metal stents, the recommendation is to choose a stent diameter based on the distal main vessel diameter. Whether this sizing strategy is applicable to BVS is currently unknown. METHODS We randomised 37 patients undergoing elective PCI for 'false' bifurcation disease (Medina 0,1,0; 1,0,0; 1,1,0) to receive BVS based either on proximal or distal reference diameters. Optical Frequency Domain Imaging (OFDI) measurements were performed pre BVS insertion to obtain proximal and distal reference diameters and post implantation. BVS size was chosen according to the proximal or distal reference diameter as per randomisation. Implantation was performed using the PSP technique tailored to bifurcation stenting. OFDI was repeated post implantation to confirm satisfactory expansion and apposition. RESULTS Baseline demographics between the two groups were similar. Patients were aged 62.8 ± 3.3 years; 76% were male. Mean side branch diameter was 2.24 ± 0.13 mm. TIMI III flow in the main vessel was achieved in all cases. Side branch occlusion occurred in 1 case (2.7%). In the distal-sizing arm, there was a greater incidence of significant malapposition (>300 μm) at the proximal end of the scaffold on OCT (2.3% versus 0.8%, p 0.023). The incidence of distal edge dissections was numerically greater in the proximal-sizing group but this was not statistically significant (31.3% vs 11.8%, p 0.17). CONCLUSION Both proximal and distal sizing strategies have similar procedural complication rates when using the ABSORB BVS to treat coronary bifurcations. However a proximal sizing strategy is associated with less malapposition and may be preferable.
Collapse
Affiliation(s)
- Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, BN2 5BE, UK; Brighton and Sussex Medical School, BN1 9PX, UK.
| | - Thomas Mayo
- Brighton and Sussex Medical School, BN1 9PX, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, BN2 5BE, UK
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, BN2 5BE, UK
| |
Collapse
|
24
|
Lynn BS, Hermiller JB. Treatment of Bifurcation Lesions: Has DK Crush"ed" the Competition? Curr Cardiol Rep 2018; 20:101. [PMID: 30173390 DOI: 10.1007/s11886-018-1024-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This paper reviews the double-kiss crush (DK crush) technique in coronary artery bifurcation lesions. The technical aspects of the procedure and the clinical data supporting its use are summarized. RECENT FINDINGS Randomized studies support the adoption of DK technique in complex bifurcation lesions for both left main and non-left-main lesions. For true bifurcation lesions, DK crush may become the default technique for lesions in which the side-branch disease is complex and long. Optimal technique is essential for obtaining the clinical outcomes noted in the DKCRUSH randomized studies.
Collapse
Affiliation(s)
- Bryce S Lynn
- St Vincent Medical Group, St Vincent Heart Center, 10590 N Meridian, Indianapolis, IN, 46290, USA
| | - James B Hermiller
- St Vincent Medical Group, St Vincent Heart Center, 10590 N Meridian, Indianapolis, IN, 46290, USA.
| |
Collapse
|
25
|
Shrestha R, Shrestha A, Kan J, Chen S. A review in enormity of OCT and its enduring understanding of vulnerable plaque in coronary bifurcation lesion. Int J Cardiovasc Imaging 2018; 34:1679-1684. [PMID: 29858960 DOI: 10.1007/s10554-018-1384-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/21/2018] [Accepted: 05/26/2018] [Indexed: 01/03/2023]
Abstract
Optical coherence tomography (OCT) has emerged as one of the most promising tools to assist the optimization of percutaneous coronary intervention (PCI). Its ability to provide unique information on the plaque at high risk for rupture, plaque composition, the thickness of the fibrous cap, the presence of macrophage and thrombi has not only assisted simple PCI but also in many complex bifurcation lesions PCI. OCT has helped to provide valuable anatomic information to optimize stent implantation and adapt PCI strategy in individual patients. This review article summarizes the current role of OCT as an imaging technology and prediction of vulnerable plaque, its site and composition at the coronary bifurcation lesions for supporting the clinical decision.
Collapse
Affiliation(s)
| | | | - Jing Kan
- Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Shaoliang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| |
Collapse
|
26
|
Salinas P, Mejía-Rentería H, Herrera-Nogueira R, Jiménez-Quevedo P, Nombela-Franco L, Núñez-Gil IJ, Gonzalo N, Del Trigo M, Pérez-Vizcayno MJ, Quirós A, Escaned J, Macaya C, Fernández-Ortiz A. Bifurcation Culprit Lesions in ST-segment Elevation Myocardial Infarction: Procedural Success and 5-year Outcome Compared With Nonbifurcation Lesions. ACTA ACUST UNITED AC 2017; 71:801-810. [PMID: 28802533 DOI: 10.1016/j.rec.2017.06.022] [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: 02/19/2017] [Accepted: 06/14/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES We assessed short- and long-term outcomes of primary angioplasty in ST-segment elevation myocardial infarction by comparing bifurcation culprit lesions (BCL) with non-BCL. METHODS Observational study with a propensity score matched control group. Among 2746 consecutive ST-segment elevation myocardial infarction patients, we found 274 (10%) patients with BCL. The primary outcome was a composite endpoint including all-cause death, myocardial infarction, coronary artery bypass grafting or target vessel revascularization, assessed at 30-days and 5-years. RESULTS Baseline characteristics showed no differences after propensity matching (1:1). In the BCL group, the most frequent strategy was provisional stenting of the main branch (84%). Compared with the non-BCL group, the procedures were technically more complex in the BCL group in terms of need for balloon dilatation (71% BCL vs 59% non-BCL; P = .003), longer procedural time (70 ± 29minutes BCL vs 62.8 ± 28.9minutes non-BCL; P = .004) and contrast use (256.2 ± 87.9mL BCL vs 221.1 ± 82.3mL non-BCL; P < .001). Main branch angiographic success was similar (93.4% BCL vs 93.8% non-BCL; P = .86). Thirty-day all-cause mortality was similar between groups: 4.7% BCL vs 5.1% non-BCL; P = .84. At the 5-year follow-up, there were no differences in all-cause death (12% BCL vs 13% non-BCL; P = .95) or the combined event (22% BCL vs 21% non-BCL; P = .43). CONCLUSIONS Primary angioplasty of a BCL was technically more complex; however, main branch angiographic success was similar, and there were no differences in long-term prognosis compared with non-BCL patients.
Collapse
Affiliation(s)
- Pablo Salinas
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.
| | - Hernán Mejía-Rentería
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Raúl Herrera-Nogueira
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Jiménez-Quevedo
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Nombela-Franco
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Iván Javier Núñez-Gil
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Nieves Gonzalo
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - María Del Trigo
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Alicia Quirós
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Escaned
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Macaya
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| |
Collapse
|
27
|
Nakamura D, Attizzani GF, Nishino S, Tanaka K, Soud M, Pereira GT, Leygerman M, Fares A, Schnell A, Costa MA, Erglis A, Bezerra HG. New insight to estimate under-expansion after stent implantation on bifurcation lesions using optical coherence tomography. Int J Cardiovasc Imaging 2017; 33:1677-84. [PMID: 28597125 DOI: 10.1007/s10554-017-1177-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/24/2017] [Indexed: 12/13/2022]
Abstract
Optical coherence tomography (OCT) allows full volumetric segmentation of the lumen. However, for the estimation of stent under-expansion we still rely on the conventional method (CM) of single cross-sectional narrowing compared with reference vessel, likely masking true lesion significance, especially for bifurcations and tapered vessels. We, therefore, suggest a novel concept of volumetric metrics that take into account vessel tapering and major side branches and is capable of obtaining ideal lumen area for every frame of the stent by OCT. Forty-four patients with bifurcation lesions were enrolled. In volumetric metrics, expansion index was calculated as [(actual lumen area/ideal lumen area) × 100] in all frames. While minimum expansion index (MEI) was often located in the proximal segment to the major side branch, minimum stent area (MSA) by CM was frequently located in the distal segment (p < 0.001). Furthermore, the frequency of the under-expansion was significantly greater in newly metrics compared with CM [21 (47.7%) and 11 (25.0%), p = 0.045]. New metrics changed the presence of the under-expansion in 40.9% (18/44) of patients and the locations of MEI and MSA were different in 72.7% (32/44) of cases. Volumetric assessment enables to more accurately assess stent under-expansion.
Collapse
|
28
|
Chiastra C, Gallo D, Tasso P, Iannaccone F, Migliavacca F, Wentzel JJ, Morbiducci U. Healthy and diseased coronary bifurcation geometries influence near-wall and intravascular flow: A computational exploration of the hemodynamic risk. J Biomech 2017; 58:79-88. [PMID: 28457603 DOI: 10.1016/j.jbiomech.2017.04.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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] [Received: 01/25/2017] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 01/09/2023]
Abstract
Local hemodynamics has been identified as one main determinant in the onset and progression of atherosclerotic lesions at coronary bifurcations. Starting from the observation that atherosensitive hemodynamic conditions in arterial bifurcation are majorly determined by the underlying anatomy, the aim of the present study is to investigate how peculiar coronary bifurcation anatomical features influence near-wall and intravascular flow patterns. Different bifurcation angles and cardiac curvatures were varied in population-based, idealized models of both stenosed and unstenosed bifurcations, representing the left anterior descending (LAD) coronary artery with its diagonal branch. Local hemodynamics was analyzed in terms of helical flow and exposure to low/oscillatory shear stress by performing computational fluid dynamics simulations. Results show that bifurcation angle impacts lowly hemodynamics in both stenosed and unstenosed cases. Instead, curvature radius influences the generation and transport of helical flow structures, with smaller cardiac curvature radius associated to higher helicity intensity. Stenosed bifurcation models exhibit helicity intensity values one order of magnitude higher than the corresponding unstenosed cases. Cardiac curvature radius moderately affects near-wall hemodynamics of the stenosed cases, with smaller curvature radius leading to higher exposure to low shear stress and lower exposure to oscillatory shear stress. In conclusion, the proposed controlled benchmark allows investigating the effect of various geometrical features on local hemodynamics at the LAD/diagonal bifurcation, highlighting that cardiac curvature influences near wall and intravascular hemodynamics, while bifurcation angle has a minor effect.
Collapse
Affiliation(s)
- Claudio Chiastra
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands; Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Paola Tasso
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
| |
Collapse
|
29
|
Chiastra C, Iannaccone F, Grundeken MJ, Gijsen FJH, Segers P, De Beule M, Serruys PW, Wykrzykowska JJ, van der Steen AFW, Wentzel JJ. Coronary fractional flow reserve measurements of a stenosed side branch: a computational study investigating the influence of the bifurcation angle. Biomed Eng Online 2016; 15:91. [PMID: 27495804 PMCID: PMC4974683 DOI: 10.1186/s12938-016-0211-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/17/2016] [Accepted: 07/20/2016] [Indexed: 12/31/2022] Open
Abstract
Background Coronary hemodynamics and physiology specific for bifurcation lesions was not well understood. To investigate the influence of the bifurcation angle on the intracoronary hemodynamics of side branch (SB) lesions computational fluid dynamics simulations were performed. Methods A parametric model representing a left anterior descending—first diagonal coronary bifurcation lesion was created according to the literature. Diameters obeyed fractal branching laws. Proximal and distal main branch (DMB) stenoses were both set at 60 %. We varied the distal bifurcation angles (40°, 55°, and 70°), the flow splits to the DMB and SB (55 %:45 %, 65 %:35 %, and 75 %:25 %), and the SB stenoses (40, 60, and 80 %), resulting in 27 simulations. Fractional flow reserve, defined as the ratio between the mean distal stenosis and mean aortic pressure during maximal hyperemia, was calculated for the DMB and SB (FFRSB) for all simulations. Results The largest differences in FFRSB comparing the largest and smallest bifurcation angles were 0.02 (in cases with 40 % SB stenosis, irrespective of the assumed flow split) and 0.05 (in cases with 60 % SB stenosis, flow split 55 %:45 %). When the SB stenosis was 80 %, the difference in FFRSB between the largest and smallest bifurcation angle was 0.33 (flow split 55 %:45 %). By describing the ΔPSB−QSB relationship using a quadratic curve for cases with 80 % SB stenosis, we found that the curve was steeper (i.e. higher flow resistance) when bifurcation angle increases (ΔP = 0.451*Q + 0.010*Q2 and ΔP = 0.687*Q + 0.017*Q2 for 40° and 70° bifurcation angle, respectively). Our analyses revealed complex hemodynamics in all cases with evident counter-rotating helical flow structures. Larger bifurcation angles resulted in more pronounced helical flow structures (i.e. higher helicity intensity), when 60 or 80 % SB stenoses were present. A good correlation (R2 = 0.80) between the SB pressure drop and helicity intensity was also found. Conclusions Our analyses showed that, in bifurcation lesions with 60 % MB stenosis and 80 % SB stenosis, SB pressure drop is higher for larger bifurcation angles suggesting higher flow resistance (i.e. curves describing the ΔPSB−QSB relationship being steeper). When the SB stenosis is mild (40 %) or moderate (60 %), SB resistance is minimally influenced by the bifurcation angle, with differences not being clinically meaningful. Our findings also highlighted the complex interplay between anatomy, pressure drops, and blood flow helicity in bifurcations.
Collapse
Affiliation(s)
- Claudio Chiastra
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.,Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Francesco Iannaccone
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.,IbiTech-bioMMeda, Department of Electronics and Information Systems iMinds Medical IT, Ghent University, Ghent, Belgium
| | - Maik J Grundeken
- The Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank J H Gijsen
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Patrick Segers
- IbiTech-bioMMeda, Department of Electronics and Information Systems iMinds Medical IT, Ghent University, Ghent, Belgium
| | - Matthieu De Beule
- IbiTech-bioMMeda, Department of Electronics and Information Systems iMinds Medical IT, Ghent University, Ghent, Belgium.,FEops bvba, Ghent, Belgium
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Joanna J Wykrzykowska
- The Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.
| |
Collapse
|
30
|
Brindise MC, Chiastra C, Burzotta F, Migliavacca F, Vlachos PP. Hemodynamics of Stent Implantation Procedures in Coronary Bifurcations: An In Vitro Study. Ann Biomed Eng 2016; 45:542-553. [PMID: 27460012 DOI: 10.1007/s10439-016-1699-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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] [Received: 03/05/2016] [Accepted: 07/19/2016] [Indexed: 01/09/2023]
Abstract
Stent implantation in coronary bifurcations presents unique challenges and currently there is no universally accepted stent deployment approach. Despite clinical and computational studies, the effect of each stent implantation method on the coronary artery hemodynamics is not well understood. In this study the hemodynamics of stented coronary bifurcations under pulsatile flow conditions were investigated experimentally. Three implantation methods, provisional side branch (PSB), culotte (CUL), and crush (CRU), were investigated using time-resolved particle image velocimetry to measure the velocity fields. Subsequently, hemodynamic parameters including wall shear stress, oscillatory shear index (OSI), and relative residence time (RRT) were calculated. The pressure field through the vessel was non-invasively quantified and pressure wave speeds were computed. The effects of each stented case were evaluated and compared against an un-stented case. CRU provided the lowest compliance mismatch, but demonstrated detrimental stent interactions. PSB, the clinically preferred method, and CUL maintained many normal flow conditions. However, PSB provided about a 300% increase in both OSI and RRT. CUL yielded a 10 and 85% increase in OSI and RRT, respectively. The results of this study support the concept that different bifurcation stenting techniques result in hemodynamic environments that deviate from that of un-stented bifurcations, to varying degrees.
Collapse
Affiliation(s)
- Melissa C Brindise
- School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN, 47907, USA
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Chemistry, Materials and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Milan, Italy
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Francesco Burzotta
- Department of Cardiovascular Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Chemistry, Materials and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Pavlos P Vlachos
- School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN, 47907, USA.
| |
Collapse
|
31
|
Rigatelli G, Dell'Avvocata F, Zuin M, Vassiliev D, Mazza A, Dinh HD. Complex coronary bifurcation revascularization by means of very minimal crushing and ultrathin biodegradable polymer DES: Feasibility and 1-year outcomes of the "Nano-crush" technique. Cardiovasc Revasc Med 2016; 18:22-27. [PMID: 27566904 DOI: 10.1016/j.carrev.2016.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 05/30/2016] [Revised: 06/26/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023]
Abstract
AIM To assess feasibility and 1-year outcomes of ultrathin biodegradable polymer double stenting using a very minimal crushing (nano-crush technique) in a series of patients with large (≥2.5mm) complex coronary bifurcation. METHODS From January 2015 to June 2016, patients referred for large (≥2.5mm) complex coronary bifurcation percutaneous coronary interventions (PCI) were enrolled to receive Orsiro (Biotronik Inc., Bulack, Switzerland) double stenting using a very minimal crush technique (nano-crush). Per our institutional protocol, follow-up was conducted by physical examination at 1, 6, 12month and yearly whereas angiographic control was eventually scheduled at 6-8months on the basis of symptoms recurrence or/and positive induced ischemia tests. RESULTS Fifty-two patients (15 females mean age 77.2±6.2years) were enrolled. Mean angles between main branch and side branch were 63.6±21.3°. The mean diameter and length of implanted stents were 3.8±0.4mm and 27.1±8.7mm in main branch and 2.8±0.3mm and 22.1±.7.1mm in side branch. Immediate success was 100%. Clinical follow-up was available for 100% of patients: at a mean follow-up of 12.0±2.6months, no patient death, or acute myocardial infarction or target vessel revascularization were observed. Angiographic follow-up was available in 25/52 patients (48%) at a mean time from the procedure of 7.2±0.5months and showed no significant angiographic restenosis. CONCLUSIONS The revascularization of complex large (≥2.5mm) coronary bifurcation disease using the nano-crush technique and the ultrathin polymer biodegradable stent appeared feasible in our small study with promising 1year outcomes.
Collapse
Affiliation(s)
- Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
| | - Fabio Dell'Avvocata
- Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Department of Internal Medicine, Rovigo General Hospital, Rovigo, Italy
| | - Dobrin Vassiliev
- Cardiology Clinic, Alexandroska University Hospital, Sofia, Bulgaria
| | - Alberto Mazza
- Department of Internal Medicine, Rovigo General Hospital, Rovigo, Italy
| | - Huy D Dinh
- Interventional Cardiology Department, Tam Duc Heart Hospital, Ho Chi Minh City, Vietnam
| |
Collapse
|
32
|
Ather S, Bavishi CP, Bhatia V, Bajaj NS, Leesar MA. Comparison of failure rates of crossing side branch with pressure vs. coronary guidewire: a meta-analysis. Eur J Clin Invest 2016; 46:448-59. [PMID: 26990307 DOI: 10.1111/eci.12620] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/11/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The aim of this study was to compare the failure rates of crossing side branch (SB) with pressure guidewire vs. coronary guidewire after main vessel (MV) stenting in coronary bifurcation lesions (CBL). BACKGROUND Percutaneous coronary intervention of CBL is technically difficult. The European Bifurcation Club recommends performing either fractional flow reserve (FFR) estimation of the SB or final kissing balloon inflation (FKBI) after the MV stenting when a significant SB ostial stenosis is present. Even though FFR is recommended in CBL, there is concern about SB crossing with pressure guidewire among interventionists. MATERIALS AND METHODS We undertook a comprehensive literature search to identify all relevant studies reporting the failure rates of SB crossing after MV stenting with either pressure or coronary guidewire. A random effects model was used to compare the failure rates between the two approaches. RESULTS Our search identified six studies that reported failure rates of SB crossing with a pressure guidewire (n = 648) and 11 studies that reported failure rates of SB crossing with a coronary guide-wire (n = 2601). Estimated pooled failure rate was 3·9% (95% CI: 1·5% to 9·6%) for inability to cross SB with pressure guidewire. Estimated pooled failure rate of SB crossing with coronary guidewire was 3·1% (95% CI: 1·5% to 6·2%). There was no significant difference between the failure rates in the two groups (P = 0·70). CONCLUSION The failure rates of SB crossing after MV stenting are low with both pressure and coronary guidewire procedures, with no significant difference between the two approaches.
Collapse
Affiliation(s)
- Sameer Ather
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Chirag P Bavishi
- Department of Medicine, Mount Sinai St Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Vikas Bhatia
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Navkaranbir S Bajaj
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Massoud A Leesar
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
33
|
Takahashi H, Otake H, Shinke T, Murasato Y, Kinoshita Y, Yamawaki M, Takeda Y, Fujii K, Yamada SI, Shimada Y, Yamashita T, Yumoto K, Hirata KI. Impact of final kissing balloon inflation on vessel healing following drug-eluting stent implantation: Insight from the optical coherence tomography sub-study of the J-REVERSE trial. J Cardiol 2016; 68:504-511. [PMID: 26899277 DOI: 10.1016/j.jjcc.2015.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/26/2015] [Revised: 12/15/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND We sought to clarify the impact of final kissing inflation (FKI) after single stenting of bifurcation lesions on vessel healing. METHODS From the J-REVERSE registry enrolling 303 bifurcation lesions treated with provisional single stenting using sirolimus- (SES) or everolimus-eluting stent (EES), 65 lesions treated with (n=30) and without (n=35) FKI underwent 9-month follow-up optical coherence tomography. Average stent eccentricity index (SEI: minimum/maximum stent diameter) and neointimal unevenness score (NUS: maximum/average neointimal thickness of the same cross-section) for the proximal, bifurcation, and distal segments were compared between FKI and non-FKI groups. RESULTS At the proximal segment, the FKI group demonstrated significantly larger average stent area with greater asymmetric stent expansion, and average lumen area remained significantly larger at 9-month follow-up despite a tendency toward greater neointimal proliferation. Jailed strut and thrombus incidence were also significantly lower at the side branch orifice, and NUS was significantly smaller at the bifurcation and proximal segments in the FKI group. CONCLUSIONS Nine months after SES and EES treatment of bifurcation lesions, FKI reduced proximal-segment luminal narrowing. Considering its homogeneous neointimal distribution and fewer jailed struts, FKI may be beneficial for treating bifurcation lesions.
Collapse
Affiliation(s)
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University, Kobe, Japan
| | - Toshiro Shinke
- Department of Cardiovascular Medicine, Kobe University, Kobe, Japan.
| | - Yoshinobu Murasato
- Department of Cardiology, Cardiovascular Center, Kyushu Medical Center, Fukuoka, Japan
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan
| | - Masahiro Yamawaki
- Department of Cardiovascular Medicine, Saiseikai Yokohama-Eastern Hospital, Yokohama, Japan
| | - Yoshihiro Takeda
- Department of Cardiovascular Medicine, Rinku General Medical Center, Izumi-Sano, Japan
| | - Kenichi Fujii
- Department of Cardiovascular Medicine, Hyogo Medical College, Nishinomiya, Japan
| | - Shin-Ichiro Yamada
- Department of Cardiovascular Medicine, Himeji Cardiovascular Center, Himeji, Japan
| | - Yoshihisa Shimada
- Department of Cardiovascular Medicine, Shiroyama Hospital, Habikino, Japan
| | - Takehiro Yamashita
- Department of Cardiovascular Medicine, Cardiovascular Center Hokkaido Ono Hospital, Sapporo, Japan
| | - Kazuhiko Yumoto
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan
| | - Ken-Ichi Hirata
- Department of Cardiovascular Medicine, Kobe University, Kobe, Japan
| |
Collapse
|
34
|
|
35
|
Würtz M, Christiansen EH, Kristensen SD, Holm NR. Accidentally crushed stent during complex bifurcation treatment. A potential cause of very late stent thrombosis. Int J Cardiol 2015; 197:113-5. [PMID: 26142195 DOI: 10.1016/j.ijcard.2015.06.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/18/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Morten Würtz
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Internal Medicine, Regional Hospital West Jutland, Denmark
| | | | | | | |
Collapse
|
36
|
Razavi SE, Omidi AA, Saghafi Zanjani M. Numerical investigation of blood flow in a deformable coronary bifurcation and non-planar branch. Bioimpacts 2015; 4:199-204. [PMID: 25671176 PMCID: PMC4298711 DOI: 10.15171/bi.2014.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 12/20/2014] [Accepted: 12/27/2014] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Among cardiovascular diseases, arterials stenosis is recognized more commonly than the others. Hemodynamic characteristics of blood play a key role in the incidence of stenosis. This paper numerically investigates the pulsatile blood flow in a coronary bifurcation with a non-planar branch. To create a more realistic analysis, the wall is assumed to be compliant. Furthermore, the flow is considered to be three-dimensional, incompressible, and laminar. METHODS The effects of non-Newtonian blood, compliant walls and different angles of bifurcation on hemodynamic characteristics of flow were evaluated. Shear thinning of blood was simulated with the Carreau-Yasuda model. The current research was mainly focused on the flow characteristics in bifurcations since atherosclerosis occurs mostly in bifurcations. Moreover, as the areas with low shear stresses are prone to stenosis, these areas were identified. RESULTS Our findings indicated that the compliant model of the wall, bifurcation's angle, and other physical properties of flow have an impact on hemodynamics of blood flow. Lower wall shear stress was observed in the compliant wall than that in the rigid wall. The outer wall of bifurcation in all models had lower wall shear stress. In bifurcations with larger angles, wall shear stress was higher in outer walls, and lower in inner walls. CONCLUSION The non-Newtonian blood vessels and different angles of bifurcation on hemodynamic characteristics of flow evaluation confirmed a lower wall shear stress in the compliant wall than that in the rigid wall, while the wall shear stress was higher in outer walls but lower in inner walls in the bifurcation regions with larger angles.
Collapse
Affiliation(s)
- Seyed Esmail Razavi
- Faculty of Mechanical Engineering, University of Tabriz, Tabriz, Iran ; Research Center for Pharmaceutical Nanotechnology, Tabriz University of Medical Sciences, Tabriz Iran
| | - Amir Ali Omidi
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz, Iran
| | | |
Collapse
|
37
|
von Birgelen C, Tandjung K, Lam MK. Aspiration of intact coronary bifurcation thrombus in ST-elevation myocardial infarction. Int J Cardiol 2014; 172:e245-6. [PMID: 24461986 DOI: 10.1016/j.ijcard.2013.12.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Clemens von Birgelen
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Kenneth Tandjung
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Ming Kai Lam
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| |
Collapse
|