507 results on '"coronary bifurcation"'
Search Results
2. Comparison of 2-Stenting Strategies Depending on Sequence or Technique for Bifurcation Lesions in the Second-Generation Drug-Eluting Stent Era ― Analysis From the COBIS (Coronary Bifurcation Stenting) III Registry ―
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Do Sun Lim, Woo Jung Chun, Jeehoon Kang, In-Ho Chae, Sang Yeub Lee, Hyun Jae Kang, Joon-Hyung Doh, Kwang Soo Cha, Myeong Ki Hong, Seung Ho Hur, Ki Hong Choi, Soon-Jun Hong, Myung Ho Jeong, Jung Ho Heo, So-Yeon Choi, Jin-Ok Jeong, Doo-Il Kim, Chang-Wook Nam, Hyeon-Cheol Gwon, Jong-Seon Park, Junghan Yoon, Hyo-Soo Kim, Kiyuk Chang, Han-Mo Yang, Seung-Woon Rha, Young Bin Song, Bon-Kwon Koo, Seung Hwan Han, Byung-Hee Hwang, Kyung Woo Park, and Jung-Kyu Han
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Target lesion ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Main vessel ,Restenosis ,Side branch ,Humans ,Medicine ,In patient ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Stent thrombosis ,Coronary bifurcation ,business.industry ,Drug-Eluting Stents ,General Medicine ,equipment and supplies ,medicine.disease ,Treatment Outcome ,surgical procedures, operative ,Drug-eluting stent ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
Background It has not been determined which specific 2-stenting strategy is the best for bifurcation lesions. Our aim was to investigate the clinical outcomes of various 2-stenting strategies in the era of 2nd-generation drug-eluting stents (2G-DES).Methods and Results:We analyzed 454 patients who finally underwent 2-stenting for a bifurcation lesion, from among 2,648 patients enrolled in the COBIS III registry. The primary outcome was target lesion failure (TLF). Patients were analyzed according to stenting sequence (provisional [main vessel stenting first] vs. systemic [side branch stenting first]) and stenting technique (crush vs. T vs. culotte vs. kissing/V stenting). Overall, 4.4 years' TLF after 2-stenting treatment for bifurcation lesion was excellent: TLF 11.2% and stent thrombosis 1.3%. There was no difference in TLF according to 2-stenting strategy (11.1% vs. 10.5%, P=0.990 for provisional and systemic sequence; 8.6% vs. 14.4% vs. 12.9% vs. 12.2%, P=0.326 for crush, T, culotte, kissing/V technique, respectively). Only left main (LM) disease and a shorter duration of dual antiplatelet therapy (DAPT) were associated with TLF. The distribution of DAPT duration differed between patients with and without TLF, and the time-point of intersection was 2.5 years. Also, the side branch was the most common site of restenosis. Conclusions The stenting sequence or technique did not affect clinical outcomes, but LM disease and shorter DAPT were associated with TLF, in patients with bifurcation lesions undergoing 2-stenting with 2G-DES.
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- 2021
3. Incidence and Predictors of Stent Thrombosis in Patients Treated with Stents for Coronary Bifurcation Narrowing (From the BIFURCAT Registry)
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Giuseppe Patti, Luca Franchin, Francesco Bruno, Ovidio De Filippo, Francesco Piroli, Jeehoon Kang, Bon Kwon Koo, Young Bin Song, Hyeon Cheol Gwon, Gaetano M. De Ferrari, Soon Jun Hong, Wojciech Wańha, Pier Paolo Bocchino, Fabrizio D'Ascenzo, and Hyo-Soo Kim
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Male ,medicine.medical_specialty ,Percutaneous ,Coronary Artery Disease ,Coronary Angiography ,Global Health ,Coronary artery disease ,Percutaneous Coronary Intervention ,Risk Factors ,Internal medicine ,Humans ,Medicine ,In patient ,Registries ,Stent thrombosis ,Coronary bifurcation ,Aged ,Retrospective Studies ,business.industry ,Dual Anti-Platelet Therapy ,Incidence ,Incidence (epidemiology) ,Drug-Eluting Stents ,Thrombosis ,Retrospective cohort study ,medicine.disease ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
Percutaneous coronary interventions performed at coronary bifurcations yield high rates of stent thrombosis (ST). The aim of the present study was to investigate the predictors of ST in contemporary coronary bifurcation percutaneous coronary interventions. We retrospectively investigated the BIFURCAT (comBined Insights From the Unified RAIN and COBIS bifurcAtion regisTries) registry on coronary bifurcations to assess the incidence and predictors of definite ST, which were the study primary endpoints. Predictors of ST among patients on dual antiplatelet therapy (DAPT) were also examined. A total of 5330 patients were included. After a mean 2-years follow-up, 64 (1.2%) patients experienced ST. 42 (65.6%) ST patients were on DAPT. At multivariable analysis, age (HR 1.02, CI 1.01 to 1.05, p = 0,027), smoking status (HR 2.57, CI 1.49 to 4.44, p = 0.001), chronic kidney disease (HR 2.26, CI 1.24 to 4.12, p = 0.007) and a 2-stent strategy (HR 2.38, CI 1.37 to 4.14, p = 0.002) were independent predictors of ST, whereas intracoronary imaging (HR 0.42, CI 0.23 to 0.78, p = 0.006) and final kissing balloon (FKB) (HR 0.48, CI 0.29 to 0.82, p = 0.007) were protective against ST. Among patients on DAPT, smoking status and a 2-stent strategy significantly increased the risk of ST, while intracoronary imaging and FKB reduced the risk. In conclusion, age, smoking status, chronic kidney disease and a 2-stent strategy were significant predictors of ST, whereas intracoronary imaging use and FKB had a protective effect. Only smoking status and a 2-stent strategy significantly predicted ST in DAPT subgroup, while intracoronary imaging and FKB had a protective role.
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- 2021
4. Proximal optimisation technique versus final kissing balloon inflation in coronary bifurcation lesions: the randomised, multicentre PROPOT trial
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Kayoko Kozuma, Ken Kozuma, Hiromasa Otake, Munenori Okubo, Yoshinobu Murasato, Yusuke Watanabe, Kazuhiko Yumoto, Jiro Aoki, Yoshihisa Kinoshita, Bernard Chevalier, Thierry Lefèvre, Yves Louvard, Yohei Numasawa, Nobuaki Suzuki, Tatsuya Ito, Kensuke Takagi, Takayuki Okamura, Masahiro Yamawaki, Junya Shite, Gaku Nakazawa, and Naoki Masuda
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Target lesion ,business.industry ,medicine.medical_treatment ,Stent ,law.invention ,Apposition ,Randomized controlled trial ,law ,Side branch ,Kissing balloon ,Clinical endpoint ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Coronary bifurcation - Abstract
BACKGROUND Clinical implications of the proximal optimisation technique (POT) for bifurcation lesions have not been investigated in a randomised controlled trial. AIMS This study aimed to investigate whether POT is superior in terms of stent apposition compared with the conventional kissing balloon technique (KBT) in real-life bifurcation lesions using optical coherence tomography (OCT). METHODS A total of 120 patients from 15 centres were randomised into two groups - POT followed by side branch dilation or KBT. Finally, 57 and 58 patients in the POT and KBT groups, respectively, were analysed. OCT was performed at baseline, immediately after wire recrossing to the side branch, and at the final procedure. RESULTS The primary endpoint was the rate of malapposed struts assessed by the final OCT. The rate of malapposed struts did not differ between the POT and KBT groups (in-stent proximal site: 10.4% vs 7.7%, p=0.33; bifurcation core: 1.4% vs 1.1%, p=0.67; core's distal edge: 6.2% vs 5.3%, p=0.59). More additional treatments were required among the POT group (40.4% vs 6.9%, p
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- 2021
5. Optimal strategy for side branch treatment in patients with left main coronary bifurcation lesions
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Myung Ho Jeong, June-Hong Kim, Jae-Hwan Lee, Hyo-Soo Kim, Jong-Seon Park, Seung-Hyuk Choi, Jihoon Kim, Dong Woon Jeon, Ki Bae Seung, Taek Kyu Park, Seung Ho Hur, Seung Hwan Lee, Joo Myung Lee, Young Bin Song, Jin-Ho Choi, Ju Hyeon Oh, Sang Yeub Lee, Seung-Woon Rha, Woo-Jung Park, Joo-Yong Hahn, Sung Yun Lee, Hyeon-Cheol Gwon, Rak Kyeong Choi, and Jeong Hoon Yang
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Target lesion ,medicine.medical_specialty ,business.industry ,Coronary Artery Disease ,General Medicine ,030204 cardiovascular system & hematology ,Coronary Angiography ,medicine.disease ,Surgery ,03 medical and health sciences ,Dissection ,Percutaneous Coronary Intervention ,Treatment Outcome ,0302 clinical medicine ,Main vessel ,Multicenter trial ,Side branch ,medicine ,Humans ,In patient ,Prospective Studies ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,business ,Coronary bifurcation - Abstract
Introduction and objectives There are no guidelines regarding the most appropriate approach for provisional side branch (SB) intervention in left main (LM) bifurcation lesions. Methods The present prospective, randomized, open-label, multicenter trial compared conservative vs aggressive strategies for provisional SB intervention during LM bifurcation treatment. Although the trial was designed to enroll 700 patients, it was prematurely terminated due to slow enrollment. For 160 non-true bifurcation lesions, a 1-stent technique without kissing balloon inflation was applied in the conservative strategy, whereas a 1-stent technique with mandatory kissing balloon inflation was applied in the aggressive strategy. For 46 true bifurcation lesions, a stepwise approach was applied in the conservative strategy (after main vessel stenting, SB ballooning when residual stenosis > 75%; then, SB stenting if residual stenosis > 50% or there was a dissection). An elective 2-stent technique was applied in the aggressive strategy. The primary outcome was a 1-year target lesion failure (TLF) composite of cardiac death, myocardial infarction, or target lesion revascularization . Results Among non-true bifurcation lesions, the conservative strategy group used a smaller amount of contrast dye than the aggressive strategy group. There were no significant differences in 1-year TLF between the 2 strategies among non-true bifurcation lesions (6.5% vs 4.9%; HR, 1.31; 95%CI, 0.35-4.88; P = .687) and true bifurcation lesions (17.6% vs 21.7%; HR, 0.76; 95%CI, 0.20-2.83; P = .683). Conclusions In patients with a LM bifurcation lesion, conservative and aggressive strategies for a provisional SB approach have similar 1-year TLF rates.
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- 2021
6. Double kissing crush bifurcation stenting: step-by-step troubleshooting
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Mario Gössl, Santiago Garcia, Iosif Xenogiannis, Emmanouil S. Brilakis, Yiannis S. Chatzizisis, Yale Wang, Ivan Chavez, Allison B. Hall, Paul Sorajja, Anil Poulose, Yves Louvard, Subhash Banerjee, and M. Nicholas Burke
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medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Coronary Artery Disease ,Troubleshooting ,030204 cardiovascular system & hematology ,Coronary Angiography ,Article ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Angioplasty, Balloon, Coronary ,Coronary bifurcation ,Bifurcation ,integumentary system ,business.industry ,musculoskeletal, neural, and ocular physiology ,Drug-Eluting Stents ,body regions ,Treatment Outcome ,surgical procedures, operative ,nervous system ,Drug-eluting stent ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The double kissing crush (DK crush) is the most studied two-stent coronary bifurcation stenting strategy. While published data support its use, DK crush can be challenging to perform. In this review we provide a detailed step-by-step description and troubleshooting for each stage of the DK crush technique.
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- 2021
7. Koroner bifurkasyon lezyonlarında ‘jailed semi-inflated balloon’ tekniği ile yan dal açıklığının değerlendirilmesi
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Hakan Uçar, Mustafa Gür, Selami Demirelli, Murat Çaylı, Emrah Ermis, Emrah Ipek, Biruni Üniversitesi, and Tıp Fakültesi
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Coronary Angiography ,Balloon ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,Angioplasty ,Occlusion ,Jailed Semi-Inflated Balloon Technique ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Acute Coronary Syndrome ,Angioplasty, Balloon, Coronary ,Prospective cohort study ,Jailed Semi-Inflated Balloon ,Akut Koroner Sendrom ,business.industry ,Percutaneous coronary intervention ,Coronary Bifurcation ,Coronary Bifurcation Lesion ,Middle Aged ,medicine.disease ,Coronary Vessels ,Dissection ,Treatment Outcome ,Conventional PCI ,Cardiology ,Female ,Stents ,Koroner Bifurkasyon ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective: Many interventional cardiologists are concerned about the risk of side branch (SB) loss during main vessel (MV) stenting in complex bifurcation lesions. Therefore, novel techniques are required to reduce the risk of SB occlusion. The jailed semi-inflated balloon technique (JSBT) is one of these techniques. This article is a description of clinical experience with SB patency assessment using the JSBT. Methods: A total of 64 patients with 82 distinct coronary bifurcation lesions underwent percutaneous coronary intervention (PCI) via JSBT at this institution. In the majority of patients, the SB balloon was inflated with a greater pressure (4.8 +/- 2.0 atm) than in the standard JSBT. Procedural and immediate clinical outcomes were reviewed via baseline and post-procedural quantitative coronary angiography analysis. Results: The majority of the patients had acute coronary syndrome (60.9%) and almost one-third of the patients were Medina class 1.1.1. (32.8%). A jailed-balloon or wire was not entrapped during any PCI. SB ostial dissection was seen in only 2 patients. The minimal lumen diameter was improved in the MV and SB following PCI. There were no adverse cardiac events during in-hospital stay or at 1-month follow-up. Conclusion: JSBT provides maximum SB protection with bifurcation lesions and requires less time than a complex technique. There was no significant SB occlusion risk even though the SB balloon was inflated with a slightly higher pressure. The immediate clinical outcomes and procedural success of this study may encourage interventional cardiologists to use this technique safely with reliable preservation of SB patency., Amaç: Birçok girişimsel kardiyolog kompleks bifurkasyon lezyonlarında ana damara stent yerleştirme sırasında yan dalın tıkanma riski nedeniyle kaygılıdırlar. Bu yüzden yan dalın tıkanma riskini azaltmak için yeni teknikler gereklidir. ‘Jailed semi-inflated balloon’ (JSB) tekniği bunun için geliştirilmiş tekniklerden biridir. Bu yazıda JSB tekniği ile yan dal açıklığını değerlendirdiğimiz klinik deneyimimizi açıklamaktayız. Yöntemler: Kliniğimizde toplam 82 koroner bifurkasyon lezyonu bulunan ve JSB tekniği ile perkütan koroner girişim (PKG) uygulanan 64 hasta alındı. Hastaların çoğunluğunda yan dal balonu JSB tekniğinden farklı olarak daha yüksek basınçla şişirildi (4.8±2.0 atm). İşlemsel ve erken klinik sonuçlar, başlangıç ve işlem sonrası kantitatif koroner anjiyografi analizi ile değerlendirildi. Bulgular: Hastaların çoğunluğu akut koroner sendrom olup (%60.9) yaklaşık üçte biri Medina sınıf 1.1.1 idi (%32.8). Jailed balonu yada teli hiçbir PKG işlemi sırasında sıkışmadı. Yan dal ağzı diseksiyonu yalnızca iki hastada meydana geldi. PKG sonrası minimal lümen çapının ana dalda ve yan dalda düzeldiği görüldü. Hastanede yatış sırasında ve birinci ay kontrollerinde ise hiçbir ciddi kardiyak istenmeyen olay görülmedi. Sonuç: Jailed semi-inflated balloon tekniği bifurkasyon lezyonlarında maksimum yan dal koruması sağlamakla beraber aynı zamanda kompleks bir tekniğe göre daha kısa sürmektedir. Yan dal balonu daha fazla basınçla şişirilmesine rağmen anlamlı yan dal tıkanması görülmedi. Erken klinik sonuçlar ve işlemsel başarı, girişimsel kardiyologları yan dal akımını korumadaki güvenilirliği ile bu tekniği rahatlıkla kullanma konusunda cesaretlendirebilir.
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- 2021
8. Primary percutaneous coronary intervention of left-main bifurcation in a centenarian ˗ a hard nut to crack
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Parvathy Anilkumar, Biju Ramabhadran Potty, Mangalanandan Paramu, Pradeep Prabhakar, and Sreeja Sreekantan Nair
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Acute kidney injury ,Percutaneous coronary intervention ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Hemoglobin drop ,Internal medicine ,Conventional PCI ,medicine ,Cardiology ,030212 general & internal medicine ,Centenarian ,Adverse effect ,business ,Coronary bifurcation - Abstract
We report a case of 102-year-old independent male, with no co-morbidities, who underwent successful percutaneous coronary intervention (PCI) of left main coronary bifurcation. During PCI, he developed hypotension, acute kidney injury and hemoglobin drop but was managed successfully. The patient's condition was stabilized and is doing well without any adverse events.
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- 2021
9. Treating Bifurcation Lesions
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Antonio Colombo and Pier Pasquale Leone
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business.industry ,Applied mathematics ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Coronary bifurcation ,Bifurcation - Published
- 2021
10. Determination of Predictors of Acute Kidney Injury in Patients with Coronary Bifurcation Lesions Revascularized with the Two-Stent Strategy
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Ali Kemal Kalkan, Serkan Aslan, Ali Rıza Demir, Mehmet Erturk, Begum Uygur, Gokhan Demirci, and Yalcin Avci
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,Cardiology ,Acute kidney injury ,Medicine ,Stent ,In patient ,business ,medicine.disease ,Coronary bifurcation - Published
- 2021
11. Coronary bifurcations – anatomy, physiology and treatment with selected aspects of left main stem bifurcation
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Wojciech Milejski, Damian Kawecki, Beata Morawiec, Ewa Nowalany-Kozielska, Marek Gierlotka, and Jerzy Sacha
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03 medical and health sciences ,0302 clinical medicine ,030212 general & internal medicine ,General Medicine ,Anatomy ,030204 cardiovascular system & hematology ,Biology ,Coronary bifurcation ,Bifurcation ,Main stem - Abstract
Bifurkacja wieńcowa jest miejscem szczególnym w obrębie krążenia wieńcowego. Charakterystyczna anatomia oraz cechy przepływu krwi w złożony sposób wiążą się z rozmieszczeniem blaszek miażdżycowych. Wybór strategii leczenia zmian bifurkacji wieńcowych wymaga szczególnej uwagi, gdyż wszelkie powikłania w tym rejonie narażają na niedokrwienie istotnie większy obszar miokardium niż w przypadku pojedynczego naczynia. Niniejsza publikacja stanowi przegląd podstawowych informacji o anatomii, klasyfikacji oraz kolejnych krokach aktualnie zalecanych technik leczenia przezskórnego zmian bifurkacji wieńcowych, poczynając od kwalifikacji, przygotowania, poprzez wybór stentu, po optymalizację efektu zabiegu. Podkreśla kliniczną złożoność problemu leczenia zmian bifurkacji wieńcowych, która wymusza stały rozwój technik zabiegowych. Przedstawione zostały strategie leczenia, wskazania do wyboru techniki z użyciem pojedynczego stentu oraz zamierzonego zastosowania dwóch stentów. Zaprezentowano również zalecane metody obrazowej oraz czynnościowej oceny istotności zmian w obrębie rozwidlenia tętnic wieńcowych. Szczególną uwagę poświęcono odrębnościom bifurkacji pnia lewej tętnicy wieńcowej.
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- 2021
12. Angioplasty in coronary bifurcation: provisional stent technique
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Fábio Augusto Pinton, Giancarlo Gonçalves, Roberto Abdalla Filho, and Ricardo Alves da Costa
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medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Angioplasty ,medicine ,Stent ,Radiology ,Treatment results ,business ,Coronary bifurcation ,Bifurcation - Abstract
Bifurcation lesions are present in one out of every five percutaneous coronary interventions. Despite the progress of techniques, materials, and imaging technologies, the bifurcation approach remains challenging, and its percutaneous treatment results in higher rates of adverse cardiac events when compared to treatment of lesions with no bifurcation involvement. The best technique to treat bifurcation lesions is still a subject of debate. For most cases, the provisional technique is preferred, since it is simpler, easier, faster, less expensive, and presents better clinical results in several studies analyzed. The two-stent technique, especially the double kissing crush, has shown better results than the provisional method in complex coronary anatomies. This review aimed to discuss the rationale for using the provisional approach, describing the planning of its various stages, and establishing its main indications.
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- 2021
13. Optimal Duration of Dual Antiplatelet Therapy After Two-Stent Treatment in Coronary Bifurcation Lesions
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Yoshinobu Murasato
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medicine.medical_specialty ,business.industry ,Dual Anti-Platelet Therapy ,medicine.medical_treatment ,Stent ,Drug-Eluting Stents ,General Medicine ,DUAL (cognitive architecture) ,Percutaneous Coronary Intervention ,Text mining ,Internal medicine ,medicine ,Cardiology ,Humans ,Duration (project management) ,Cardiology and Cardiovascular Medicine ,business ,Coronary bifurcation ,Platelet Aggregation Inhibitors - Published
- 2021
14. Efficacy of coronary imaging on bifurcation intervention
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Junya Shite, Yutaka Hikichi, Yoshinobu Murasato, Young Bin Song, Ryoji Nagoshi, Chang-Wook Nam, Bon Kwon Koo, Kensuke Takagi, Woong Kim, Byeong Keuk Kim, Yoshihisa Kinoshita, and Soo Joong Kim
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medicine.medical_specialty ,Coronary imaging ,Consensus ,medicine.medical_treatment ,Review Article ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Optical coherence tomography ,Intervention (counseling) ,Intravascular ultrasound ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Coronary bifurcation ,Ultrasonography, Interventional ,Bifurcation ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Interventional radiology ,General Medicine ,Coronary Vessels ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence - 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.
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- 2020
15. Double kissing crush: technical aspects and current considerations
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Alcides José Zago, Gabriel Zago, Rafael Coimbra Ferreira Beltrame, and Alexandre do Canto Zago
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medicine.medical_specialty ,Percutaneous ,business.industry ,New materials ,equipment and supplies ,medicine.disease ,surgical procedures, operative ,Restenosis ,medicine ,cardiovascular diseases ,Radiology ,Stent thrombosis ,business ,Coronary bifurcation ,Therapeutic strategy - Abstract
Percutaneous treatment of coronary bifurcation lesions remains a challenge, even with all advances in technique and materials available, such as hydrophilic guidewires, lower profile balloons and drug-eluting stents with new materials, thinner struts and less thrombogenic polymers. Despite these advances, little progress has been made in dedicated bifurcation stenting. The degree of technical difficulty and the lack of dedicated material result in higher rates of restenosis and stent thrombosis, especially in true bifurcation lesions, in which the therapeutic strategy [...]
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- 2020
16. Percutaneous management of coronary bifurcation lesions: current perspective
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Shuangbo Liu, Anthony W A Wassef, Subodh Verma, Asim N. Cheema, and Bobby Yanagawa
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medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Main branch ,Lesion ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Side branch ,Humans ,Medicine ,030212 general & internal medicine ,Coronary bifurcation ,business.industry ,Coronary Stenosis ,Percutaneous coronary intervention ,Stent ,medicine.disease ,Treatment Outcome ,Stents ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose of review Coronary artery disease affecting bifurcations poses a challenge for percutaneous intervention. Several techniques and strategies for percutaneous management of bifurcation lesions have been described in the literature with variable data available for outcomes. In this review, we provide an overview of the strategies and techniques used for percutaneous intervention of bifurcation lesions with an update of recent technical developments and clinical evidence. Recent findings The coronary bifurcation lesions of both left main and other coronary segments are best treated with a provisional stenting strategy where main branch is treated with a stent placement and side branch intervention reserved for angiographically or physiologically determined hemodynamically significant residual stenosis despite application of a proximal stent optimization technique. When a provisional stent strategy is not likely to be successful due to anatomic or morphologic lesion characteristics and a large side branch or distal left main bifurcation is involved, an upfront bifurcation stenting strategy with double kissing crush technique may provide the optimum results. Coronary imaging and fractional flow determination may guide lesion specific management, facilitate device selection and improve clinical outcomes for percutaneous therapy for bifurcation lesions. Summary Despite advances in technology and procedural techniques, percutaneous intervention of coronary bifurcation lesions remains challenging and associated with higher adverse outcomes compared to non bifurcation lesions. Among the several bifurcation strategies, a provisional stenting approach is preferred for technical simplicity and better long term outcomes. Double kissing crush technique provides superior clinical results and should be preferred when a two stent strategy is indicated. Use of coronary imaging and physiology assessment should be incorporated in the algorithm of bifurcation interventions for greater technical and clinical success.
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- 2020
17. Optimal Site for Proximal Optimization Technique in Complex Coronary Bifurcation Stenting: A Computational Fluid Dynamics Study
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Marco Zuin, Gianluca Rigatelli, and Claudio Chiastra
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Male ,Patient-Specific Modeling ,Computed Tomography Angiography ,Clinical Decision-Making ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Computational fluid dynamics ,Coronary Angiography ,Balloon ,Bench test ,Wall shear stress ,03 medical and health sciences ,0302 clinical medicine ,Coronary Circulation ,Multidetector Computed Tomography ,Left main ,Humans ,Medicine ,In patient ,030212 general & internal medicine ,Angioplasty, Balloon, Coronary ,Coronary bifurcation ,Hemodynamic effects ,Bifurcation ,Aged ,Retrospective Studies ,Aged, 80 and over ,Myocardial infarction ,business.industry ,Models, Cardiovascular ,Coronary computed tomography angiography ,General Medicine ,Middle Aged ,Hydrodynamics ,Female ,Stents ,Stress, Mechanical ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
Background/purpose The optimal position of the balloon distal radio-opaque marker during the post optimization technique (POT) remains debated. We analyzed three potential different balloon positions for the final POT in two different two-stenting techniques, to compare the hemodynamic effects in terms of wall shear stress (WSS) in patients with complex left main (LM) coronary bifurcation. Methods/materials We reconstructed the patient-specific coronary bifurcation anatomy using the coronary computed tomography angiography (CCTA) data of 8 consecutive patients (6 males, mean age 68.2± 18.6 years) affected by complex LM bifurcation disease. Subsequently a virtual bench test was performed in each patient using two different double stenting techniques represented by the DK and Nano crush using the reconstruction of Orsiro stents (Biotronik IC, Bulack, Switzerland). Results A significant reduction in the mean WSS values in all the lesion's sites was observed when the final POT was performed 1 mm distally the carina cut plane in both techniques. Moreover, a significant improvement in the mean WSS values of the entire SB (e.g. LCX) was obtained performing the POT 1 mm distally to the carina cut plane. The proximal POT resulted in larger area of lower WSS values at the carina using both the Nano crush and the DK crush techniques. Conclusions In patients with complex LM bifurcation disease the use of a final POT performed 1 mm distally to the carina cut plane might results in more favorable WSS patterns (i.e. higher WSS values) along all stented segments and, especially, along the entire LCX lesions.
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- 2020
18. A case of very late stent thrombosis on the protruded struts at the left main coronary bifurcation
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Kyohei Meno, Yoshinobu Murasato, Katsuhiko Takenaka, and Kodai Shibao
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Acute coronary syndrome ,medicine.medical_specialty ,business.industry ,Hemodynamics ,030204 cardiovascular system & hematology ,medicine.disease ,Chest pain ,Article ,03 medical and health sciences ,Ostium ,surgical procedures, operative ,0302 clinical medicine ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Stent thrombosis ,medicine.symptom ,Thrombus ,Cardiology and Cardiovascular Medicine ,business ,Coronary bifurcation - 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.
- Published
- 2020
19. A Short Term Clinical Outcome of Provisional versus Routine Kissing Balloon Technique after Main Vessel Crossover Stenting for Coronary Bifurcation Lesions
- Author
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Fatehia Ahmed Elsheshtawy, Medhat Mohamed Ashmawy, Mohamed Ahmed Khalil, Ayman Mohamed Elsaeed, and Samiah Mahmoud Sharaf El-Din
- Subjects
medicine.medical_specialty ,Main vessel ,business.industry ,Internal medicine ,Crossover ,Cardiology ,Kissing balloon ,Medicine ,General Medicine ,business ,Coronary bifurcation ,Outcome (game theory) ,Term (time) - Abstract
Background: Kissing Balloon Inflation (KBI) technique was the first technique for percutaneous intervention in bifurcation lesions. It's the standard strategy in the two-stent procedure. Its benefit in one-stent approach remains uncertain. Several trials comparing KBI strategy with the No-KBI strategy in one-stent technique did not show any advantages in the clinical outcome. Clinical outcome and the follow up of ischemic symptoms is a useful method to compare the effectiveness of both strategies. Aims: To study the short-term clinical outcome (3and 6 months) of provisional versus routine kissing‑balloon technique after main vessel stenting for coronary bifurcation lesions. Patients and Methods: The study included sixty consecutive patients. They were randomized to receive different side branch (SB) intervention strategies: group I (provisional final kissing balloon inflation group - PFKBI) (FKBI only when SB Flow less than TIMI 3) and group II (routine final kissing balloon inflation group – RFKBI). Results: 1- Dissection of side branch and conversion to two stent strategy was significantly higher in PFKBI group (14,3%) than in RFKBI group (0) 2-The amount of dye, total procedure time and time of admission was significantly higher in RFKBI group. 3-Chest pain immediately after the procedure was significantly higher in PFKBI group while at 3 and 6 months follow up no significant difference between both groups was noticed. 4- MACE, target lesion revascularization (TLR) and stent thrombosis were similar between both groups at 3 and 6 months. Conclusions: Main vessel stenting with and without final kissing balloon dilatation was associated with favorable and similar 3 and 6-month clinical outcomes.
- Published
- 2020
20. Coronary Bifurcation Lesion–Management
- Author
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Maddury Jyotsna
- Subjects
medicine.medical_specialty ,business.industry ,percutaneous coronary intervention ,Immunology ,lcsh:Surgery ,lcsh:RD1-811 ,030204 cardiovascular system & hematology ,equipment and supplies ,culotte ,proximal optimization ,Lesion ,03 medical and health sciences ,angles ,0302 clinical medicine ,Internal medicine ,bifurcation ,medicine ,Cardiology ,cardiovascular diseases ,030212 general & internal medicine ,medicine.symptom ,business ,Coronary bifurcation - Abstract
Coronary bifurcation lesion management is challenging even in this modern era of drug-eluting stents (DES). A debate always exists as to what mode of treatment is better–one-stent or two-stent strategy. As in hospital and major adverse cardiac events (MACE) are more in the follow-up, what improvements in management strategy are required in relation to bifurcation lesions? We have more questions than answers for this type of lesion. In this article, we try to analyze these issues.
- Published
- 2020
21. 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
- Author
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Anna M. Michalowska, Mariusz Debski, Ilona Michałowska, Jerzy Pręgowski, Adam Witkowski, Artur Debski, Rafał Wolny, Adam D. Staruch, Cezary Kępka, Damini Dey, Piotr J. Slomka, Maksymilian P. Opolski, Kajetan Grodecki, Sebastien Cadet, and Mariusz Kruk
- Subjects
Male ,medicine.medical_specialty ,Computed Tomography Angiography ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Coronary Angiography ,Coronary artery disease ,Percutaneous coronary intervention ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Main vessel ,Internal medicine ,Occlusion ,medicine ,Humans ,Coronary computed tomography angiography ,Registries ,Retrospective Studies ,Computed tomography angiography ,Original Paper ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Area under the curve ,General Medicine ,Middle Aged ,medicine.disease ,Coronary Vessels ,Plaque, Atherosclerotic ,Stenosis ,Coronary Occlusion ,Coronary bifurcation ,Plaque burden ,Cardiology ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Follow-Up Studies - 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.
- Published
- 2020
22. Twelve-month clinical results from the new cobalt-chromium sirolimus-eluting dedicated bifurcation stent BiOSS LIM C Registry
- Author
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Jacek Bil, Adam Kern, Robert J. Gil, and Tomasz Pawłowski
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,chemistry.chemical_element ,Stent ,General Medicine ,Surgery ,Chromium ,chemistry ,Drug-eluting stent ,Sirolimus ,medicine ,business ,Coronary bifurcation ,Cobalt ,medicine.drug - Abstract
IntroductionPercutaneous coronary interventions (PCI) in bifurcations are still challenging and are associated with higher risks of periprocedural complications as well as restenosis and stent thrombosis. The aim of this paper was to summarize 12 months of clinical results of the prospective, first-in-man registry assessing the BiOSS LIM C stent (Balton, Poland).Material and methodsIn the prospective two-center registry we enrolled patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and stable coronary artery disease. Provisional T-stenting was the default treatment strategy. The primary endpoint was defined as the rate of cardiac death, myocardial infarction (MI) and clinically driven target lesion revascularization (TLR) in 12-month follow-up.ResultsThe study population consisted of 95 patients (mean age: 66.8 ±9.8 years, 17.9% were females). A BiOSS LIM C stent was implanted in the left main (LM) in 53 (55.8%) cases. There were 25.2% of patients with NSTE-ACS, 33.7% with diabetes, 90.5% with hypertension, and 53.7% had previous MI. The device success rate was 100%. An additional regular drug-eluting stent was deployed in the side branch in 18.9% of cases. Proximal optimization technique and final kissing balloon (FKB) technique were used in 53.7% and 30.5% of cases, respectively. MI type 4a was registered in 4 (4.2%) cases. At 12 months the MACE rate was 9.5%, cardiac death 1.1%, MI 2.1% and clinically driven TLR 6.3%. All incidents, apart from one TLR, appeared in the LM subgroup.ConclusionsOur registry might suggest that PCI using the BiOSS LIM C in coronary bifurcations is feasible and might be an option for percutaneous revascularization.
- Published
- 2020
23. Evolving coronary bifurcation intervention techniques. Can 'double kiss' change our routine?
- Author
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Attila Thury, Róbert Sepp, Attila Nemes, Viktor Sasi, András Katona, Imre Imre, and Gyula Szántó
- Subjects
medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,Internal medicine ,Intervention (counseling) ,Kiss ,Cardiology ,Medicine ,General Medicine ,business ,Coronary bifurcation ,media_common - Published
- 2020
24. Calcific lesion preparation for coronary bifurcation stenting
- Author
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Matteo Perfetti, Antonio Procopio, Marco Zimarino, Alessandro Toro, Francesco Radico, Nicola Maddestra, and Fabio Fulgenzi
- Subjects
Atherectomy, Coronary ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Orbital atherectomy ,Lesion ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Lithotripsy ,Internal medicine ,medicine ,Practical algorithm ,Humans ,Side branch occlusion ,Vascular Calcification ,Coronary bifurcation ,Interventional cardiology ,business.industry ,Stent ,General Medicine ,Interventional Cardiology ,Clinical trial ,Treatment Outcome ,Cardiology ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Bifurcating coronary lesions are a very common challenge in interventional cardiology because of the technical complexity in their treatment, the risk of side branch occlusion and an overall worse outcome when compared to non-bifurcating lesions. The presence of calcifications represents further complexity due to the difficulty in device delivery and stent expansion as well as enhanced risk of side branch occlusion. Rotational and orbital atherectomy, scoring and cutting balloons, coronary lithoplasty are available tools which have been introduced over the last three decades to overcome such issue. Nevertheless, their application in different contexts of bifurcations presents specific caveats and the studies directed at comparing such techniques have never been expressly oriented in the subset of the bifurcating lesion. In this paper, we review these devices and their usefulness in bifurcations by analyzing consistent data from clinical trials, and we propose a practical algorithm for the treatment of severely calcified bifurcating lesions according to their anatomical features.
- Published
- 2019
25. Comparative analysis of sequential pot-side-pot and kissing balloon techniques in patients with coronary bifurcation lesions treated with single stent strategy: propensity score analysis
- Author
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B Balaban Kocas, Süleyman Sezai Yıldız, Hakan Kilci, Ozgur Selim Ser, Serhat Sığırcı, Ahmet Gürdal, Gokhan Cetinkal, M C Sumerkan, Kudret Keskin, and Kadriye Orta Kilickesmez
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Propensity score matching ,Kissing balloon ,Medicine ,Stent ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Coronary bifurcation ,Surgery - Abstract
Objectives It is unknown whether the novel re-POT technique is more effective than commonly preferred kissing balloon inflation (KBI) in patients with non-complex coronary bifurcation lesions (CBL) treated with single-stent strategy. Our aim was to compare the efficacy of re-POT and KBI techniques in one-stent strategy of non-complex CBL. Methods 283 patients were retrospectively analyzed (re-POT group, n=149; KBI group, n=134). Primary end-points of the study were defined as; in-hospital and 30-day mortality, contrast induced acute kidney injury (CI-AKI), stent thrombosis (ST), side branch (SB) dissection and need for SB stenting. Characteristics of patients at baseline were balanced by using propensity score inverse probability weighting (IPW). Results Procedure time (minute, 30.6±8.5 vs 34.3±11.6; p=0.003) and contrast volume (mL, 153.7±42.4 vs 171.1±58.2; p=0.004) were significantly lower in re-POT group. Besides, SB residual stenosis and number of patients with >50% SB residual stenosis remained significantly higher in re-POT group both in general and true bifurcation subgroup analysis (20.3±19.8% vs 16.5±16.4%, p=0.02; 11.9% vs 5.7%, p=0.01 and 24.1±23.2% vs 18.8±18.7%, p=0.03; 17.6% vs 6.6%, p=0.005; respectively). Combined clinical adverse outcomes were similar between groups. (Figure 1) SB dissection (10.2% vs 20.1%, p=0.001) and need for SB stenting (12.6% vs 19%, p=0.04) were reached statistically significance in KBI group after adjustment. (Figure 2) Conclusions Re-POT may be a simple and safe technique with a shorter procedure time and lower incidence of adverse events in non-complex CBL treated with single-stent strategy. Funding Acknowledgement Type of funding sources: None. Adverse clinical outcomes; weighted
- Published
- 2021
26. Baseline troponin-T is powerful predictor of mortality after coronary bifurcation stenting
- Author
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Robert J. Gil, Carlos Collet, Gianluca Rigatelli, P Nikolov, Dobrin Vassilev, K. Karamfiloff, N Mileva, and K Sokolova
- Subjects
medicine.medical_specialty ,Troponin T ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Revascularization ,Cardiovascular death ,Internal medicine ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Baseline (configuration management) ,Coronary bifurcation - Abstract
Introduction Considerable progress has been made in the treatment of coronary bifurcation stenosis. Anatomical characteristics of the lesion, however, fail to give information about the functional significance of the bifurcation stenosis. There is no study that systematically establishes the baseline functional significance of coronary stenosis and its effect on procedural and clinical outcomes. Methods Patients with significant angiographically bifurcation lesions defined as diameter stenosis >50% in main vessel and/or side branch were included. FFR was performed in main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI). If FFR was ≤0.80 the lesion was considered functionally significant, and patients underwent PCI. For the group with FFR >0.80 – intervention was deferred. All patients were followed-up for vital status every 3 months. Cox regression analysis was performed to identify independent predictors of all-cause and cardiovascular death. The local ethics committee approved the study and patients signed informed consent for participation into registry. Results For mean follow-up of 38±18 months (median 40, IQR 23–55 months) all-cause mortality was numerically lower: 8.5% (n=7/82) in deferred group and 12.6% in stented group (n=11/76, p=0.387). The cardiac mortality was also numerically lower, but statistically not significant (9.8%, n=8/82 vs. 11.5%, n=10/88, p=0.714). On multivariate model, independent predictors were mitral regurgitation >1st degree – HR=1.778 (CI 1.100–2.874, p=0.019); dyslipidemia HR=0.765 (CI 0.594–0.985, p=0.038); hemoglobin concentration – HR=0.976 (CI 0.964–0.988, p Conclusion Baseline high-sensitive troponin T value is a strong predictor for both all cause and cardiac mortality in patients undergoing coronary bifurcation lesion PCI. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Alexandrovska University Hospital
- Published
- 2021
27. Double kissing – crush technique to treat coronary bifurcation lesions: analysis of success rate, procedural times and device usage
- Author
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P Ferstl, L. Gaede, Mohamed Marwan, M Troebs, F Weidinger, S. Achenbach, and N Schacher
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Coronary bifurcation ,Device Usage - Abstract
Background The Double Kissing Crush (“DK Crush”) technique is one of the recommended planned 2-stent techniques to treat true coronary bifurcation lesions (Medina 1–1-1, Medina 0–1-1). While some trials demonstrated superiority to other techniques, DK Crush requires a sequence of specific and potentially technically challenging steps. No data exists on the procedural difficulty of the various steps required for DK Crush. We therefore analyzed procedural times and device usage in a systematic fashion. Methods and results 54 patients (42 male, mean age 67±12 years) intended for treatment with DK Crush were enrolled. Detailed procedural characteristics including exact times and device usage for each step of DK Crush were prospectively measured and analyzed. DK Crush was successful in 48/54 patients (89%). In two patients stenting technique was changed to T- or TAP-stenting due to anatomical reasons at the moment of positioning of the SB stent. In one patient no balloon could cross the lesion and in another the procedure had to be modified due to coronary perforation directly after pre-dilatation. True failure of DK Crush was observed in two cases: In one case, the first rewiring of the SB, in the other, placement of a balloon for first kissing balloon (KB) maneuver in the SB was not possible. These 6 patients were excluded from further analysis. Median times for each step were: 1:21min (IQR 0:52min-1:50min) for wiring SB, 1:18min (IQR 0:47min-1:42min) for wiring MV, 1:30min (IQR 0:54min-2:15min) for stent placement in the SB, 0:40min (IQR 0:29min-1:21min) for balloon placement in the MV. First rewiring of the SB after SB stent crush required 1:30min (IQR 0:37min-2:05min), 1st KB placement in the SB took 1:42min (IQR 1:00min-3:13min) and 1st KB placement in the MV required 0:45min (IQR 0:27min-1:19min). Stent placement in the MV required 1:34min (IQR 1:09min-2:40min) and 2nd rewiring of the SB 1:21min (IQR 0:55min-2:04min), 2nd KB placement of the SB 2:08min (IQR 1:01min-3:36min) and 2nd KB placement of the MV 0:50min (IQR 0:34min-1:01min). Final POT was performed in all cases. Median total procedure time was 52:35 min (IQR 00:42:54h-1:01:37h). Additional devices were needed in 10% (3x1, 2x2 balloons) for stent placement in the SB; in 46% (20x1, 1x4 wires) for the first rewiring of the SB and in 49% (20x1, 3x2 balloons) for 1st KB placement in the SB. The 2nd rewiring of the SB required additional wires in 32% (13x1, 2x2 wires) and 54% of the patients required additional balloons for the 2nd KB placement in the SB (20x1, 2x2, 1x3, 2x5 balloons). Final TIMI flow was III in 97.9%. Complications occurred in 6% (n=3), each showing coronary dissection with TIMI III flow in 2 patients and TIMI I flow in 1 patient after placement of additional stents. Conclusion DKMC has a high success rate but is a time-consuming and material-intensive technique. The placement of the 2nd KB in the SB requires most of the procedural time and resources. Funding Acknowledgement Type of funding sources: None.
- Published
- 2021
28. Reply: When is the optimal time point for detecting malapposition in coronary bifurcation trials?
- Author
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Nobuaki Suzuki, Ken Kozuma, Yusuke Watanabe, and Yoshinobu Murasato
- Subjects
medicine.medical_specialty ,business.industry ,MEDLINE ,Time optimal ,Coronary Vessels ,Internal medicine ,Cardiology ,medicine ,Humans ,Point (geometry) ,Angioplasty, Balloon, Coronary ,Cardiology and Cardiovascular Medicine ,business ,Coronary bifurcation ,Letter to the Editor - Published
- 2021
29. Computation Prediction of the Therapeutic Effect of Metal Stent Implantation for Coronary Bifurcation
- Author
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Xinxin Zhang, Xiaotong Yan, and Kai Yue
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Therapeutic effect ,Stent ,Hemodynamics ,Blood flow ,medicine.disease ,Peripheral ,Stenosis ,medicine.anatomical_structure ,Internal medicine ,medicine ,Cardiology ,business ,Coronary bifurcation ,Artery - Abstract
A good understanding of the characteristics behavior of blood flow is significant for exploring the formation mechanism and process of atherosclerosis (AS), grasping the pathogenesis of AS, and providing effective theoretical guidance for clinical treatment of AS. To predict the influence of plaque on hemodynamics and the therapeutic effect of stent interventional treatment on stenosis artery, the coronary bifurcation models with/without stenosis and with stent implantation were constructed to analyze the hemodynamic characteristics in three cases using fluid-solid interaction method based on COMSOL software. The dynamic velocity, streamline, pressure, Von Mises stress, and displacement distributions in the coronary artery were obtained in these studies. Results show that the velocity of the plaque increased sharply, and the peripheral tissues of the plaque are more prone to the risk of injury because of the higher stress. The blood flow velocity tends to be stable in the stented artery and the velocity distribution is uniform, indicating that the blood supply of branch vessels is further improved, which is conducive to the normal blood supply and stable blood flow.
- Published
- 2021
30. Consensus statements, guidelines and definition: will they actually improve our treatment of coronary bifurcation lesions?
- Author
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Adrian P. Banning
- Subjects
medicine.medical_specialty ,Consensus ,Treatment Outcome ,business.industry ,medicine ,MEDLINE ,Humans ,Coronary Artery Disease ,Coronary Angiography ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Coronary bifurcation - Published
- 2020
31. Dedicated Bifurcation Stents vs. Conventional Stenting Strategy for Coronary Bifurcation Lesions: Insights from Randomized Clinical Trials
- Author
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Mohamad Alkhouli and Wasiq Faraz Rawasia
- Subjects
medicine.medical_specialty ,Time Factors ,Treatment outcome ,MEDLINE ,Coronary Artery Disease ,Prosthesis Design ,law.invention ,Percutaneous Coronary Intervention ,Randomized controlled trial ,Risk Factors ,law ,Humans ,Medicine ,Prosthesis design ,Coronary bifurcation ,Bifurcation ,Randomized Controlled Trials as Topic ,Evidence-Based Medicine ,business.industry ,General Medicine ,Evidence-based medicine ,Surgery ,Treatment Outcome ,Meta-analysis ,Stents ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
32. Assessment of Coronary Bifurcation Stenting using Optical Coherence Tomography
- Author
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Ganesh Paramasivam and Rajesh Vijayvergiya
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Stent ,Percutaneous coronary intervention ,Dissection (medical) ,equipment and supplies ,medicine.disease ,surgical procedures, operative ,Main vessel ,Optical coherence tomography ,Conventional PCI ,medicine ,Distal segment ,cardiovascular diseases ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Coronary bifurcation - Abstract
Introduction: Percutaneous coronary intervention (PCI) in coronary bifurcation lesions (CBL) is challenging and has poorer outcomes compared to non-bifurcation lesions. Conventional angiography alone is insufficient to assess procedural results because of poor resolution and complex anatomy involving bifurcations. We evaluate the use of optical coherence tomography (OCT) during bifurcation PCI to evaluate procedural results. Methods: This single-center, prospective, observational study included 13 patients with 14 CBLs undergoing PCI (one-stent or two-stent strategy) who were evaluated with OCT. After stent placement, OCT was used to assess acute stent malapposition, underexpansion, stent edge dissection, tissue protrusion, and microthrombi. To study malapposition in detail, bifurcation region was divided into four segments (proximal, distal and bifurcation segments of main vessel and side-branch segment). Results: The overall incidence of stent malapposition was 64%. It was more common with two-stent strategy compared to one-stent strategy (83% vs 50%). The incidence of malapposition was highest in side-branch and least in distal segment of main vessel. Stent underexpansion was seen in 21% of cases. Stent edge dissection,microthrombi, tissue prolapse were noted in 21% of cases. OCT findings led to additional interventional steps in 38% of cases.Conclusions: OCT can be used to comprehensively assess procedural results after bifurcation stenting. The incidence of acute stent malapposition is high after stenting at bifurcation sites and is more common when the two-stent techniques are used compared to the one-stent technique. Whether long-term clinical outcomes are affected by findings uncovered on OCT needs to be studied in prospective trials
- Published
- 2019
33. Efficacy of the proximal optimization technique on crossover stenting in coronary bifurcation lesions in the 3D-OCT bifurcation registry
- Author
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Tatsuhiro Fujimura, Junya Shite, Takahiro Mori, Ryoji Nagoshi, D-Oct Bifurcation Registry Investigators, Shiro Ono, Masahiro Yamawaki, Takayuki Okamura, Takeshi Serikawa, Yoshinobu Murasato, and Fumiaki Nakao
- Subjects
Male ,Time Factors ,Registry study ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,03 medical and health sciences ,Imaging, Three-Dimensional ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Main vessel ,Japan ,Predictive Value of Tests ,Side branch ,Image Interpretation, Computer-Assisted ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Registries ,030212 general & internal medicine ,Coronary bifurcation ,Beneficial effects ,Bifurcation ,Aged ,Aged, 80 and over ,business.industry ,Coronary Stenosis ,Stent ,Middle Aged ,Coronary Vessels ,Apposition ,Treatment Outcome ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Tomography, Optical Coherence - Abstract
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. 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. 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.
- Published
- 2019
34. V-scaffolding of coronary bifurcation lesions using bioresorbable vascular scaffolds: Technical challenges
- Author
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Ashok Seth and Babu Ezhumalai
- Subjects
03 medical and health sciences ,Scaffold ,0302 clinical medicine ,business.industry ,Metallic drug ,fungi ,Medicine ,Guiding catheter ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,business ,Coronary bifurcation ,Biomedical engineering - Abstract
The larger profile of Absorb™ BioResorbable vascular Scaffolds (A-BRS) renders V-scaffolding using A-BRS technically different from V-stenting using metallic drug eluting stents. Hence, A-BRS of certain sizes need to be delivered and deployed sequentially rather than simultaneously while performing V-scaffolding through 7F guiding catheter.
- Published
- 2019
35. Primary stenosis progression versus secondary stenosis formation in the left coronary bifurcation: A mechanical point of view
- Author
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Bahar Firoozabadi, Mohammad Said Saidi, Reza Jahromi, and Hossein Ali Pakravan
- Subjects
medicine.medical_specialty ,business.industry ,0206 medical engineering ,Biomedical Engineering ,Hemodynamics ,02 engineering and technology ,Blood flow ,medicine.disease ,020601 biomedical engineering ,Compliance (physiology) ,Stenosis ,medicine.anatomical_structure ,Left coronary artery ,Internal medicine ,medicine.artery ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Cardiology ,020201 artificial intelligence & image processing ,Circumflex ,business ,Coronary bifurcation ,Artery - Abstract
Biomechanical forces and hemodynamic factors influence the blood flow and the endothelial cells (ECs) morphology. These factors behave differently beyond the coronary artery stenosis. In the present study, unsteady blood flow in the left coronary artery (LCA) and its atherosclerotic bifurcating vessels, left anterior descending (LAD) and left circumflex (LCX) arteries, were numerically simulated to investigate the risk of plaque length development and secondary plaque formation in the post-stenotic areas. Using fluid–structure interaction (FSI) model, compliance of arterial wall and vessel curvature variations due to cardiac motion were considered. The arteries included plaques at the beginning of the bifurcation. Stenosis degree varied from 40% to 70% based on diameter reduction. Healthy coronary artery was also reconstructed to compare with the atherosclerotic arteries. Circumferential and longitudinal strains of ECs as well as wall shear stress (WSS) were computed in different locations downstream of the stenosis. It was concluded that the most critical regions experiencing low circumferential strain and low WSS were located proximal to the plaque throat, and the effects of these parameters intensified by stenosis degree. The results proposed that primary plaque length progression is more probable than secondary plaque formation distal to the stenosis when the stenosis degree increases.
- Published
- 2019
36. Treatment strategies for coronary bifurcation lesions made easy in the current era by introduction of the BIFURCAID app
- Author
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Annapoorna Kini, Jeffrey C Selan, Samin K. Sharma, Takahiro Yoshimura, and Samit Bhatheja
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Prosthesis Design ,Revascularization ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Coronary bifurcation ,business.industry ,Stent ,Drug-Eluting Stents ,Coronary Vessels ,Practice Guidelines as Topic ,Molecular Medicine ,Treatment strategy ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Coronary bifurcation lesions account for 15–20% of all percutaneous coronary interventions. Percutaneous revascularization of these lesions is technically challenging and results in lower success rates than nonbifurcation lesions. There are unique procedural considerations and techniques that are employed in the percutaneous revascularization of these lesions. Our objective is to define the procedural complexities of treating coronary bifurcation lesions and describe the leading provisional and dedicated two stent techniques used to optimize procedural and clinical results, as described in the BIFURCAID app.
- Published
- 2019
37. Effect of left coronary bifurcation angle and left main coronary artery length on coronary artherosclerotic plaque burden
- Author
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Zafer Buyukterzi and Murat Ziyrek
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Internal medicine ,Cardiology ,medicine ,business ,Coronary bifurcation ,Artery - Published
- 2019
38. Prediction of All-Cause Mortality Following Percutaneous Coronary Intervention in Bifurcation Lesions Using Machine Learning Algorithms
- Author
-
Jacopo Burrello, Guglielmo Gallone, Alessio Burrello, Daniele Jahier Pagliari, Eline H. Ploumen, Mario Iannaccone, Leonardo De Luca, Paolo Zocca, Giuseppe Patti, Enrico Cerrato, Wojciech Wojakowski, Giuseppe Venuti, Ovidio De Filippo, Alessio Mattesini, Nicola Ryan, Gérard Helft, Saverio Muscoli, Jing Kan, Imad Sheiban, Radoslaw Parma, Daniela Trabattoni, Massimo Giammaria, Alessandra Truffa, Francesco Piroli, Yoichi Imori, Bernardo Cortese, Pierluigi Omedè, Federico Conrotto, Shao-Liang Chen, Javier Escaned, Rosaly A. Buiten, Clemens Von Birgelen, Paolo Mulatero, Gaetano Maria De Ferrari, Silvia Monticone, Fabrizio D’Ascenzo, Università degli studi di Torino = University of Turin (UNITO), University of Bologna/Università di Bologna, Polytechnic University of Turin, Thorax Centrum Twente [Enschede, The Netherlands] (TCT), Ospedale San Giovanni Bosco [Turin, Italy] (OSGB), Ospedale San Giovanni Evangelista [Rome, Italy] (OSGE), University Hospital 'Maggiore della Carità' [Novara, Italy], Azienda Ospedaliero-Universitaria San Luigi Gonzaga/San Luigi Gonzaga University Hospital (SLGUH), Medical University of Silesia (SUM), AOU Policlinico Vittorio-Emanuele [Catania, Italia], Careggi University Hospital [Florence, Italie], Aberdeen Royal Infirmary [Aberdeen, UK] (ARI), Institut de cardiologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Università degli Studi di Roma Tor Vergata [Roma], Nanjing Medical University, Clinica Pederzoli [Peschiera del Garda, Italy] (CP), Medical University of Warsaw - Poland, Centro Cardiologico Monzino [Milano], Dpt di Scienze Cliniche e di Comunità [Milano] (DISCCO), Università degli Studi di Milano = University of Milan (UNIMI)-Università degli Studi di Milano = University of Milan (UNIMI)-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Maria Vittoria Hospital [Turin], Ospedale Civile Cardinal Massaia, Nippon Medical School [Tokyo, Japon], Clinica San Carlo [Milan, Italy] (CSC), Nanjing First Hospital (NFH), Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), and Lesnik, Philippe
- Subjects
[SDV] Life Sciences [q-bio] ,percutaneous coronary intervention ,coronary bifurcation ,machine learning ,prognosis ,[SDV]Life Sciences [q-bio] ,Medicine (miscellaneous) - Abstract
International audience; Stratifying prognosis following coronary bifurcation percutaneous coronary intervention (PCI) is an unmet clinical need that may be fulfilled through the adoption of machine learning (ML) algorithms to refine outcome predictions. We sought to develop an ML-based risk stratification model built on clinical, anatomical, and procedural features to predict all-cause mortality following contemporary bifurcation PCI. Multiple ML models to predict all-cause mortality were tested on a cohort of 2393 patients (training, n = 1795; internal validation, n = 598) undergoing bifurcation PCI with contemporary stents from the real-world RAIN registry. Twenty-five commonly available patient-/lesion-related features were selected to train ML models. The best model was validated in an external cohort of 1701 patients undergoing bifurcation PCI from the DUTCH PEERS and BIO-RESORT trial cohorts. At ROC curves, the AUC for the prediction of 2-year mortality was 0.79 (0.74–0.83) in the overall population, 0.74 (0.62–0.85) at internal validation and 0.71 (0.62–0.79) at external validation. Performance at risk ranking analysis, k-center cross-validation, and continual learning confirmed the generalizability of the models, also available as an online interface. The RAIN-ML prediction model represents the first tool combining clinical, anatomical, and procedural features to predict all-cause mortality among patients undergoing contemporary bifurcation PCI with reliable performance.
- Published
- 2022
39. Angiographic and Midterm Outcomes of Bioresorbable Vascular Scaffold for Coronary Bifurcation Lesions
- Author
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Kees-Jan Royaards, Valeria Paradies, Georgios J. Vlachojannis, Jochem Wassing, Martin van der Ent, and Pieter C. Smits
- Subjects
Male ,Target lesion ,medicine.medical_specialty ,Time Factors ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Prosthesis Design ,Lesion ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Text mining ,Side branch ,Internal medicine ,Absorbable Implants ,medicine ,Humans ,030212 general & internal medicine ,Coronary bifurcation ,Retrospective Studies ,Bioresorbable vascular scaffold ,Tissue Scaffolds ,business.industry ,Retrospective cohort study ,Middle Aged ,Coronary Vessels ,Treatment Outcome ,Conventional PCI ,Cardiology ,Female ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence ,Follow-Up Studies - Abstract
Data on the angiographic and clinical performance of bioresorbable vascular scaffolds (BVS) for bifurcation lesions treatment are still limited. Data were examined of 107 patients with at least 1 coronary bifurcation lesion involving a side branch ≥2mm. Angiographic and clinical outcomes were collected. Optical coherence tomography analysis was performed in a subgroup of patients. Between July 2009 and December 2015, 423 patients underwent PCI with Absorb BVS. A total of 110 lesions were identified as bifurcations, of which 24.5% were classified as true bifurcation lesions. Lesion complexity B2/C was 68.1%. Ninety-five out of 110 lesions were treated by provisional stenting technique while 2 stenting strategy was the final approach in 15 lesions. Procedural success of main branch was 100% whereas side-branch impairment at the end of the procedure was 4.5%. The mean follow-up was 21 months with one-third of the patients followed up for at least 2 years. The overall target lesion failure and scaffold/stent thrombosis rate at 1 year was 7.8% and 3.9%, respectively. In conclusion the results of the present analysis suggest the BVS implanted in bifurcations lesions are associated with procedural safety and angiographic success as well as acceptable target lesion failure rate at 1 year.
- Published
- 2018
40. Thin and crush: The new mantra in left main stenting?
- Author
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Gianluca Rigatelli, Debradata Dash, and Marco Zuin
- Subjects
medicine.medical_specialty ,Expansion rate ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Percutaneous coronary intervention ,03 medical and health sciences ,0302 clinical medicine ,Restenosis ,Side branch ,Stent ,medicine ,030212 general & internal medicine ,Stent thrombosis ,Coronary bifurcation ,Crush ,business.industry ,equipment and supplies ,medicine.disease ,Editorial ,surgical procedures, operative ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Interventional cardiology - 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.
- Published
- 2018
41. Developing a Mobile Application for Global Cardiovascular Education
- Author
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Ashish Atreja, Samin K. Sharma, Jason Rogers, Surbhi Chamaria, Valentin Fuster, Emamuzo Otobo, Sarthak Kakkar, Samit Bhatheja, Rivelle Zlatopolsky, and Annapoorna Kini
- Subjects
Medical education ,Internationality ,business.industry ,Field (Bourdieu) ,medicine.medical_treatment ,Cardiology ,Percutaneous coronary intervention ,030204 cardiovascular system & hematology ,Mobile Applications ,ComputingMilieux_GENERAL ,03 medical and health sciences ,Software portability ,0302 clinical medicine ,Expression (architecture) ,medicine ,Humans ,Smartphone ,030212 general & internal medicine ,Program Development ,Cardiology and Cardiovascular Medicine ,business ,Coronary bifurcation - Abstract
Technological revolution in the field of medical education is here, and it is time to embrace it. Adoption of on-the-go learning style, portability of smartphones, and expression of concepts with interactive illustrations and their global reach have made application (app)-based learning an effective medium. An educational mobile app, BIFURCAID, was developed to simplify and teach complex coronary bifurcation intervention. This app has been downloaded worldwide. The survey results revealed its widespread acceptance and success. The authors believe that educational apps can have a significant impact on shaping the future of cardiovascular education in the 21st century. This experience with developing and testing the app could work as a template for other medical educators.
- Published
- 2018
42. Influence of balloon location during proximal optimization technique (POT): A finite element analysis
- Author
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Meng Li, Changyan Lin, and Heng Wu
- Subjects
Materials science ,Plane (geometry) ,medicine.medical_treatment ,Rehabilitation ,Finite Element Analysis ,Biomedical Engineering ,Biophysics ,Stent ,Coronary Artery Disease ,equipment and supplies ,Balloon ,Coronary Angiography ,Coronary Vessels ,Finite element method ,Apposition ,Wall stress ,Treatment Outcome ,Vessel morphology ,medicine ,Humans ,Orthopedics and Sports Medicine ,Stents ,Angioplasty, Balloon, Coronary ,Coronary bifurcation ,Biomedical engineering - Abstract
Proximal Optimization Technique (POT) is a post-expansion technique that must be completed after single-stent implantation for the coronary bifurcation. The optimal location for the distal balloon shoulder during POT remains debatable. In the present study, the finite element method is applied to simulate POT after single-stent implantation in the coronary bifurcation. Three different balloon locations based on the distal shoulder relative to the carina cut plane were analyzed: 1) “proximal”:1mm before carina cut plane; 2) “standard”: at the carina cut plane; and 3) “distal”: 1 mm after the carina cut plane. The computational results showed differences in stent, vessel morphology, and vessel wall stress due to the different balloon locations. However, when distal balloon shoulder was located between two adjacent stent rings, it formed the distal cell of the stent, the best stent apposition, least stent structs obstruction at SB ostial. Moreover, best opening effect of distal cell of the stent can be achieved, with the least damage to the vessel wall.
- Published
- 2021
43. Comparison of Different Stenting Techniques of Coronary Bifurcation Lesions: A Network Meta-Analysis of 7601 Patients
- Author
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Miri Merkin, Gabriel Rosenstein, Lital Hadad, Orit Barrett, Hector M. Garcia-Garcia, Aref El Nasasra, Yigal Abramowitz, Carlos Cafri, Romain Didier, Edward Koifman, Doron Zahger, and Ala Abu Dogosh
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Meta-analysis ,Cardiology ,medicine ,General Medicine ,business ,Coronary bifurcation - Abstract
IntroductionIntervention on coronary bifurcations lesions (CBL) is challenging. While provisional side branch (PS) stenting is the recommended method in most cases, there is no consensus on the preferred 2-stent technique.Material and methodsWe performed a network meta-analysis including randomized controlled trials (RCT) and observational studies comparing stenting techniques in CBL with reported clinical outcomes. A mixed treatment comparison model generation was performed to compare culotte, T and protrusion (TAP), crush and provisional techniques.ResultsWe included 14 RCT and 14 observational studies comprising 7,601 patients among whom 2,516 were treated with PS, 792 with TAP, 1,493 with culotte and 2,808 with crush. A Bayesian network meta-analysis showed a significant rate reduction of major adverse cardiovascular events (OR=0.73; 95%CI 0.52-0.99) and a trend for reduction in lesion revascularization (OR=0.72; 95%CI 0.48-1.11) and myocardial infarction (OR=0.62; 95%CI 0.3-1.08) with the crush technique, mainly driven by the double kissing (DK) crush, compared with all other stenting techniques. Other clinical outcomes, including mortality and stent thrombosis (ST) did not differ significantly between methods.ConclusionsThe crush technique, and especially DKcrush, is associated with improved outcomes compared to culotte, T and protrusion (TAP) and provisional techniques for CBL treatment. Further research is required to determine the optimal stenting technique for CBL.
- Published
- 2021
44. 6-year results of BiOSS stents in coronary bifurcation treatment
- Author
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Robert J. Gil, Adam Kern, Sławomir Dobrzycki, Luis A Iñigo Garcia, Dobrin Vassilev, Radoslaw Formuszewicz, and Jacek Bil
- Subjects
Male ,medicine.medical_specialty ,Heart Diseases ,medicine.medical_treatment ,Clinical Biochemistry ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Biochemistry ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Absorbable Implants ,medicine ,Clinical endpoint ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Coronary bifurcation ,Aged ,Heart Failure ,Sirolimus ,business.industry ,Clinical events ,Stent ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,medicine.disease ,Coronary Vessels ,Cardiology ,Population study ,Female ,business ,Mace ,medicine.drug - Abstract
Background The wide variation in bifurcation anatomy has generated an ongoing search for stents explicitly designed for coronary bifurcations, and to date, results have been underachieved. Methods The POLBOS I and POLBOS II were international, multicentre, randomized, open-label, controlled trials. Patients were randomly assigned to BiOSS Expert (in POLBOS I, biodegradable polymer eluting paclitaxel)/BiOSS LIM (in POLBOS II, biodegradable polymer eluting sirolimus) stent implantation or regular drug-eluting stent (rDES) deployment. A provisional T-stenting strategy was the default treatment option. The primary endpoint of this pooled data study was the cumulative rate of major adverse cardiovascular events (MACE) consisting of cardiac death, myocardial infarction (MI) and target lesion revascularization (TLR). Telephone follow-up was performed annually up to 72 months. (ClinicalTrials.gov Identifier: POLBOS I-NCT02192840, POLBOS II-NCT02198300). Results The total study population consisted of 445 patients, 222 patients in the BiOSS group and 223 patients in the rDES group. The follow-up rate was 93.7% in the BiOSS group and 91.9% in the rDES group. At 72 months, there was no significant difference between BiOSS and rDES groups regarding MACE (25.7% vs 25.1%, HR 1.06, 95% CI 0.73-1.52), cardiac death (3.1% vs 4.0%, HR 0.94, 95% CI 0.43-2.34), MI (3.6% vs 4.9%, HR 0.76, 95% CI 0.32-2.89), TLR (18.9% vs 16.1%, HR 1.17, 95% CI 0.75-1.83) and stent thrombosis rates (0.9% vs 0.5%, HR 1.21, 95CI 0.75-2.09). Conclusions At the 6-year follow-up, clinically significant clinical events did not differ between BiOSS stents and rDES.
- Published
- 2021
45. 5-Year Outcome of Simple Crossover Stenting in Coronary Bifurcation Lesions Compared With Side Branch Opening
- Author
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Myung Ho Jeong, Ki Hong Choi, Byung-Hee Hwang, Jong-Seon Park, Kwang Soo Cha, Do Sun Lim, Seung Ho Hur, Jang-Whan Bae, Woo Jung Chun, Cheol Hyun Lee, Hyo-Soo Kim, Sung Yun Lee, Kwon-Bae Kim, Yun-Kyeong Cho, In-Ho Chae, Soon-Jun Hong, Jin-Ok Jeong, So-Yeon Choi, Jung Ho Heo, Kiyuk Chang, Doo-Il Kim, Chang-Wook Nam, Bon-Kwon Koo, Young Bin Song, Hyeon-Cheol Gwon, Hyuck-Jun Yoon, Seung-Woon Rha, Myeong Ki Hong, Junghan Yoon, Seung Hwan Han, and Joon-Hyung Doh
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,percutaneous coronary intervention ,Crossover ,clinical outcome ,Percutaneous coronary intervention ,Outcome (game theory) ,Simple (abstract algebra) ,RC666-701 ,Internal medicine ,Side branch ,medicine ,Cardiology ,bifurcation disease ,Diseases of the circulatory (Cardiovascular) system ,Treatment strategy ,business ,Coronary bifurcation ,Bifurcation - Abstract
Background: The optimal side branch (SB) treatment strategy after simple crossover stenting in bifurcation lesions is still controversial. Objectives: The purpose of this study was to compare the long-term outcomes of a 1-stent strategy with simple crossover alone versus with an additional SB–opening procedure in patients with left main (LM) and non-LM coronary bifurcation lesions. Methods: Patients who underwent percutaneous coronary intervention with a 1-stent strategy for bifurcation lesions including LM were selected from the COBIS (Coronary Bifurcation Stenting) III registry and divided into the simple crossover–alone group and SB-opening group. Clinical outcomes were assessed by the 5-year rate of target lesion failure (a composite of cardiac death, target vessel myocardial infarction, and target lesion repeat revascularization). Results: Among 2,194 patients who underwent the 1-stent strategy, 1,685 (76.8%) patients were treated with simple crossover alone, and 509 (23.2%) patients were treated with an additional SB-opening procedure. Although the baseline SB angiographic disease was more severe in the SB-opening group, the final lumen diameter of the SB was larger. The 5-year observed target lesion failure rate was similar between the 2 groups (7.0% in the simple crossover vs. 6.7% in SB-opening group; hazard ratio: 0.99; 95% confidence interval: 0.66 to 1.48; p = 0.947), even in the subgroup analyses including LM (9.5% vs. 11.3%; p = 0.442) and true bifurcation (5.3% vs. 7.8%; p = 0.362). The results were not changed after an inverse probability of treatment weighting adjustment. There was no difference in the overall and SB-related target lesion revascularization rate in both groups. Conclusions: The long-term clinical outcome of the 1-stent strategy with simple crossover alone for coronary bifurcation lesions was acceptable compared to those of additional SB-opening procedures. (Korean Coronary Bifurcation Stenting [COBIS] Registry III [COBIS III]; NCT03068494)
- Published
- 2021
46. Antegrade and retrograde in‐stent tibial artery chronic total occlusion recanalization with double kiss crush (DK crush) stenting of previous stent
- Author
-
Sehrish Memon, Jon C. George, Sanjog Kalra, and Sean Janzer
- Subjects
medicine.medical_specialty ,Time Factors ,Arterial disease ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Total occlusion ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,medicine ,Extensive data ,Humans ,Radiology, Nuclear Medicine and imaging ,Tibial artery ,030212 general & internal medicine ,Coronary bifurcation ,business.industry ,Stent ,Drug-Eluting Stents ,General Medicine ,Critical limb ischemia ,equipment and supplies ,Surgery ,Tibial Arteries ,body regions ,Treatment Outcome ,surgical procedures, operative ,Drug-eluting stent ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Below the knee (BTK) peripheral arterial disease often presents with critical limb ischemia (CLI) clinically with involvement of more than one tibial vessels. Drug eluting stent (DES) technology for treatment of BTK disease has shown promising long-term durable results; however, currently only coronary DESs are available for application in the United States. Although coronary bifurcation stenting techniques are backed by extensive data in literature, there is a scarcity of data for the treatment of tibial bifurcation disease. Bifurcation angles in the tibials are similar to those in the coronaries and therefore the same two stent bifurcation technique can be applied in BTK disease. Double Kiss crush (DK crush) stenting has superior outcomes when compared to provisional or culotte stenting in randomized coronary trials (based on Medina classification). We present a case of BTK CLI with tibial bifurcation chronic total occlusion treated with two stent DK crush technique using coronary DES.
- Published
- 2021
47. Letter: When is the optimal time point for detecting malapposition in coronary bifurcation trials?
- Author
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Lene Nyhus Andreasen and Emil Holck
- Subjects
business.industry ,Humans ,Medicine ,Applied mathematics ,Point (geometry) ,Angioplasty, Balloon, Coronary ,Cardiology and Cardiovascular Medicine ,business ,Time optimal ,Coronary Vessels ,Reply to the Letter to the Editor ,Coronary bifurcation - Published
- 2021
48. SIDE BRANCH PLAQUE SHIFT IN BIFURCATION LESIONS IN CORONARY ARTERIES AND LOW DENSITY LIPOPROTEIN AS ITS MARKER
- Author
-
Betul Ozdemir
- Subjects
medicine.medical_specialty ,Triglyceride ,medicine.diagnostic_test ,business.industry ,Coronary arteries ,Lesion ,chemistry.chemical_compound ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Low-density lipoprotein ,Side branch ,Internal medicine ,medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Lipid profile ,Coronary bifurcation ,Shift length - Abstract
Objective: In this study, the effect of lipid profile on plaque shift was investigated considering the known effect of atherosclerosis. Methodology: A total of 660 patients, 457 males and 203 females, participated in the study. Average age is 60.3 ± 12 years. Two study groups included this study one was no plaque shift, the other one was plaque shift group. Results: In laboratory parameters of all groups triglyceride mean 164.7± 132.3 mg/dl, HDL mean 40± 11.1 mg/dl and LDL mean 129.1± 43.3 mg/dl were calculated. In lipid profile TG and HDL has no differences in two groups. Mean of HDL 40.6±11.2 mg/dl in no plaque shift group and 39.4±11.0 mg/dl in plaque shift group. And also mean of TG 167.8±145.5 mg/dl and 161.1±115.6 mg/dl consecutively. LDL mean was 123.9±43 mg/dl in no plaque shift group, 135.1±42.9 mg/dl in plaque shift group. Only high LDL levels correlated with plaque shift degree, plaque shift length and shift lesion percentage difference before and after the procedure. Conclusion: There is a correlation between LDL levels and plaque shift in coronary bifurcation lesions due to the volume of lipid core in plaque formation. The benefit is to predict the plaque shift that may occur in coronary bifurcation interventions with an easily measured parameter before the procedure.
- Published
- 2021
49. Hemodynamic disturbance due to serial stenosis in human coronary bifurcations: a computational fluid dynamics study
- Author
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Gérard Finet, Ricardo Coppel, Manuel Lagache, M. Malvè, Jacques Ohayon, and Roderic I. Pettigrew
- Subjects
medicine.medical_specialty ,business.industry ,Hemodynamics ,Fractional flow reserve ,Blood flow ,Computational fluid dynamics ,medicine.disease ,Clinical Practice ,Stenosis ,Internal medicine ,Cardiology ,Medicine ,business ,Surgical treatment ,Coronary bifurcation - Abstract
Surgical treatment of coronary bifurcation in presence of two lesions is problematic due to postclinical complications. In recent years, fractional flow reserve has emerged as a valuable tool for assessing the functional severity of coronary stenosis in clinical practice. Numerical studies have facilitated prediction by idealized patient-specific biomechanical models. However, overall bifurcation hemodynamics in presence of stenotic lesions still needs to be better understood, to improve clinical intervention and reduce associated risks. In this chapter, we study the influence of serial stenotic coronary lesions on coronary blood flow, using a parametric model. Computational fluid dynamics simulations were carried out to characterize hemodynamic changes and fractional flow reserve according to various stenosis configurations and degrees of severity.
- Published
- 2021
50. Sequential technique for the stenting of a coronary bifurcation: the re-proximal optimizing technique strategy
- Author
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Gérard Finet, Gilles Rioufol, and François Derimay
- Subjects
Mathematical optimization ,Computer science ,medicine.medical_treatment ,technology, industry, and agriculture ,medicine ,Kissing balloon ,food and beverages ,Balloon ,Revascularization ,Coronary bifurcation ,humanities ,Bifurcation - Abstract
Coronary bifurcation revascularization needs to take account of the systematic stepwise relation between the three diameters and to minimize final side-branch (SB) ostial obstruction. Historically, kissing balloon inflation (KBI) was recommended in this indication, but never in fact demonstrated clinical benefit in bifurcation provisional stenting. Thanks to better knowledge of bifurcation pathophysiology and the development of new bench models, a novel sequential technique, without balloon juxtaposition, was developed: the re-proximal optimizing technique (re-POT) strategy. Re-POT consists of a succession of three steps: (1) initial “POT, (2) SB opening, and (3) final POT. Unlike in the case of KBI, the re-POT sequence was assessed progressively, from experimental to clinical studies. The experiments confirmed all the expected benefits of re-POT concerning correction of expected malapposition and SB optimization without deleterious parietal deformation. Thanks to this demonstration, re-POT is now recommended in the European guidelines.
- Published
- 2021
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