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1
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Qiu J, Li L, Wang W, Li X, Zhang Z, Shao S, Tse G, Li G, Liu T. Jailed high-pressure balloon technique is superior to jailed wire technique in protecting side branch of coronary bifurcation lesions. SCAND CARDIOVASC J 2024; 58:2347295. [PMID: 38706409 DOI: 10.1080/14017431.2024.2347295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
Objectives. This study investigated the influence of higher pressure protection with a small diameter balloon of side branch (SB) on bifurcation lesions. Background. Of the different coronary stent implantation techniques, the modified jailed balloon technique has become a viable option for bifurcation lesions. However, there was no detailed study on the relationship between the balloon inflation pressure of the main vessel (MV) and SB. Methods. In this study, we collected information of patients who underwent percutaneous coronary intervention (PCI) for bifurcated lesions between March 2019 and December 2022. They were divided into two groups according to the operation way: active jailed balloon technique (A-JBT) group and jailed wire technique (JWT) group. Results. A total of 216 patients were enrolled. The A-JBT group had a larger SB stenosis diameter (1.53 ± 0.69 vs. 0.95 ± 0.52, p < .001), the lower degree of stenosis (44.34 ± 18.30 vs. 63.69 ± 17.34, p < .001) compared to the JWT group. However, the JWT group had a higher incidence of SB occlusion (18.0% vs. 1.9%, p < .001) compared to the A-JBT group. Nevertheless, the success rate for both groups was 100%. Conclusions. This novel high inflation pressure and small diameter balloon approach we propose has significant advantages. There is a lower rate of SB occlusion and SB dissection, which is more cost-effective and provides better clinical outcomes for the patient. This method should be considered in the future for treating bifurcation lesions.
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Affiliation(s)
- Jiuchun Qiu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Longyan Li
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Weiding Wang
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Xinjian Li
- Department of Cardiovascular Medicine, Shanxi Bethune Hospital, Taiyuan, China
| | - Zizhao Zhang
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Shuai Shao
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Gary Tse
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Guangping Li
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Tong Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
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Burzotta F, Louvard Y, Lassen JF, Lefèvre T, Finet G, Collet C, Legutko J, Lesiak M, Hikichi Y, Albiero R, Pan M, Chatzizisis YS, Hildick-Smith D, Ferenc M, Johnson TW, Chieffo A, Darremont O, Banning A, Serruys PW, Stankovic G. Percutaneous coronary intervention for bifurcation coronary lesions using optimised angiographic guidance: the 18th consensus document from the European Bifurcation Club. EUROINTERVENTION 2024; 20:e915-e926. [PMID: 38752714 PMCID: PMC11285041 DOI: 10.4244/eij-d-24-00160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/25/2024] [Indexed: 08/06/2024]
Abstract
The 2023 European Bifurcation Club (EBC) meeting took place in Warsaw in October, and the latest evidence for the use of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) to optimise percutaneous coronary interventions (PCI) on coronary bifurcation lesions (CBLs) was a major focus. The topic generated deep discussions and general appraisal on the potential benefits of IVUS and OCT in PCI procedures. Nevertheless, despite an increasing recognition of IVUS and OCT capabilities and their recognised central role for guidance in complex CBL and left main PCI, it is expected that angiography will continue to be the primary guidance modality for CBL PCI, principally due to educational and economic barriers. Mindful of the restricted access/adoption of intracoronary imaging for CBL PCI, the EBC board decided to review and describe a series of tips and tricks which can help to optimise angiography-guided PCI for CBLs. The identified key points for achieving an optimal angiography-guided PCI include a thorough analysis of pre-PCI images (computed tomography angiography, multiple angiographic views, quantitative coronary angiography vessel estimation), a systematic application of the technical steps suggested for a given selected technique, an intraprocedural or post-PCI use of stent enhancement and a low threshold for bailout use of intravascular imaging.
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Affiliation(s)
- Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yves Louvard
- Ramsay Générale de Santé - Institut cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Jens Flensted Lassen
- Department of Cardiology B, Odense Universitets Hospital & University of Southern Denmark, Odense, Denmark
| | - Thierry Lefèvre
- Ramsay Générale de Santé - Institut cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Gérard Finet
- Department of Interventional Cardiology, Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France and INSERM U1060, CarMeN Laboratory, Université de Lyon, Lyon, France
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland and Clinical Department of Interventional Cardiology, Saint John Paul II Hospital, Kraków, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Yutaka Hikichi
- Heart Centre, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Remo Albiero
- Interventional Cardiology Unit, Ospedale Civile Sondrio, Sondrio, Italy
| | - Manuel Pan
- Department of Cardiology, Reina Sofía Hospital, University of Córdoba (IMIBIC), Córdoba, Spain
| | - Yiannis S Chatzizisis
- Division of Cardiovascular Medicine, Center for Digital Cardiovascular Innovations, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol & Weston NHSFT, Bristol, United Kingdom and University of Bristol, Bristol, United Kingdom
| | - Alaide Chieffo
- Vita-Salute San Raffaele University, Milan, Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Adrian Banning
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland and CORRIB Research Centre for Advanced Imaging and Core Laboratory, Galway, Ireland
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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3
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Okamura T, Iwasaki K, Lu H, Zhu X, Fujimura T, Kitaba N, Murakami K, Nakamura R, Mitsui H, Tsuboko Y, Miyazaki Y, Matsuyama T. Importance of optimal rewiring guided by 3-dimensional optical frequency domain imaging during double-kissing culotte stenting demonstrated through a novel bench model. Sci Rep 2023; 13:13511. [PMID: 37598246 PMCID: PMC10439901 DOI: 10.1038/s41598-023-40606-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/14/2023] [Indexed: 08/21/2023] Open
Abstract
The usefulness of optical frequency domain imaging (OFDI) guidance on two-stenting at left main bifurcation has not been evaluated. Here, we used a novel bench model to investigate whether pre-defined optimal rewiring with OFDI-guidance decreases acute incomplete stent apposition (ISA) at the left main bifurcation segment. A novel bench simulation system was developed to simulate the foreshortening and overlapping of daughter vessels as well as left main bifurcation motion under fluoroscopy. Double-kissing (DK) culotte stenting was performed using the novel bench model under fluoroscopy with or without OFDI-guidance. In the OFDI-guidance group, if the guidewire did not pass through the pre-defined optimal cell according to the 3-dimensional OFDI, additional attempts of rewiring into the jailed side branch were performed. The success rate of optimal jailed side branch rewiring after implantation of the first and second stent under OFDI-guidance was significantly higher than that under only angio-guidance. After completion of the DK-culotte stenting, the incidence and volume of ISA at the bifurcation segment in the OFDI-guidance group was significantly lower than that in the angio-guidance group. Online 3-dimensional OFDI-guided DK-culotte stenting according to a pre-defined optimal rewiring point might be superior to only angio-guided rewiring for reducing ISA at the bifurcation.
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Affiliation(s)
- Takayuki Okamura
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, Japan
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi Ube, Japan
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, Japan.
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University, Tokyo, Japan.
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, Japan.
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering,, Waseda University, Tokyo, Japan.
- Institute for Medical Regulatory Science, Comprehensive Research Organization, Waseda University, Shinjuku, Tokyo, Japan.
| | - Hongze Lu
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Xiaodong Zhu
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
- Institute for Medical Regulatory Science, Comprehensive Research Organization, Waseda University, Shinjuku, Tokyo, Japan
| | - Tatsuhiro Fujimura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi Ube, Japan
| | - Norika Kitaba
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Keisuke Murakami
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Ryota Nakamura
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Haruki Mitsui
- Department of Modern Mechanical Engineering, School of Creative Science and Engineering, Waseda University, Tokyo, Japan
| | - Yusuke Tsuboko
- Waseda Research Institute for Science and Engineering, Waseda University, Tokyo, Japan
- Institute for Medical Regulatory Science, Comprehensive Research Organization, Waseda University, Shinjuku, Tokyo, Japan
| | - Yousuke Miyazaki
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi Ube, Japan
| | - Tetsuya Matsuyama
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi Ube, Japan
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Cangemi S, Burzotta F, Bianchini F, DeVos A, Valenzuela T, Trani C, Aurigemma C, Romagnoli E, Lassen JF, Stankovic G, Iaizzo PA. Configuration of two-stent coronary bifurcation techniques in explanted beating hearts: the MOBBEM study. EUROINTERVENTION 2023; 19:e423-e431. [PMID: 37171514 PMCID: PMC10397672 DOI: 10.4244/eij-d-23-00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/03/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND In patients with complex coronary bifurcation lesions undergoing percutaneous coronary intervention (PCI), various 2-stent techniques might be utilised. The Visible Heart Laboratories (VHL) offer an experimental environment where PCI results can be assessed by multimodality imaging. AIMS We aimed to assess the post-PCI stent configuration achieved by 2-stent techniques in the VHL and to evaluate the procedural factors associated with suboptimal results. METHODS Bifurcation PCI with 2-stent techniques, performed by expert operators in the VHL on explanted beating swine hearts, was studied. The adopted bifurcation PCI strategy and the specific procedural steps applied in each procedure were classified according to Main, Across, Distal, Side (MADS)-2 and to their adherence to the European Bifurcation Club (EBC) recommendations. Microcomputed tomography (micro-CT) was used to assess the post-PCI stent configuration. The primary endpoint was "suboptimal stent implantation", defined as a composite of stent underexpansion (<90%), side branch ostial area stenosis >50% and the gap between stents. RESULTS A total of 82 PCI with bifurcation stenting were assessed, comprised of 29 crush, 25 culotte, 28 T/T and small protrusion (TAP) techniques. Suboptimal stent implantation was observed in as many as 53.7% of the cases, regardless of baseline anatomy or the stenting strategy. However, less frequent use of the proximal optimisation technique (POT; p=0.015) and kissing balloon inflations (KBI; p=0.027) and no adherence to EBC recommendations (p=0.004, p multivariate=0.006) were significantly associated with the primary endpoint. CONCLUSIONS Commonly practised bifurcation 2-stent techniques may result in imperfect stent configurations. More frequent use of POT/KBI and adherence to expert recommendations might reduce the occurrence of post-PCI suboptimal stent configurations.
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Affiliation(s)
- Stefano Cangemi
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amanda DeVos
- Visible Heart Laboratories, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Thomas Valenzuela
- Visible Heart Laboratories, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jens Flested Lassen
- Department of Cardiology B, Odense University Hospital & University of Southern Denmark, Odense C, Denmark
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Paul Anthony Iaizzo
- Visible Heart Laboratories, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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5
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Pan M, Lassen JF, Burzotta F, Ojeda S, Albiero R, Lefèvre T, Hildick-Smith D, Johnson TW, Chieffo A, Banning AP, Ferenc M, Darremont O, Chatzizisis YS, Louvard Y, Stankovic G. The 17th expert consensus document of the European Bifurcation Club - techniques to preserve access to the side branch during stepwise provisional stenting. EUROINTERVENTION 2023; 19:26-36. [PMID: 37170568 PMCID: PMC10173756 DOI: 10.4244/eij-d-23-00124] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/28/2023] [Indexed: 05/13/2023]
Abstract
Provisional stenting has become the default technique for the treatment of most coronary bifurcation lesions. However, the side branch (SB) can become compromised after main vessel (MV) stenting and restoring SB patency can be difficult in challenging anatomies. Angiographic and intracoronary imaging criteria can predict the risk of side branch closure and may encourage use of side branch protection strategies. These protective approaches provide strategies to avoid SB closure or overcome compromise following MV stenting, minimising periprocedural injury. In this article, we analyse the strategies of SB preservation discussed and developed during the most recent European Bifurcation Club (EBC) meetings.
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Affiliation(s)
- Manuel Pan
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba (IMIBIC), Cordoba, Spain
| | - Jens Flensted Lassen
- Department of Cardiology B, Odense University Hospital & University of Southern Denmark, Odense C, Denmark
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Soledad Ojeda
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba (IMIBIC), Cordoba, Spain
| | - Remo Albiero
- Interventional Cardiology Unit, Ospedale Civile di Sondrio, Sondrio, Italy
| | - Thierry Lefèvre
- Ramsay Générale de Santé - Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - David Hildick-Smith
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton and Sussex University Hospitals Trust, Brighton, UK
| | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol and Weston NHSFT & University of Bristol, Bristol, UK
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Adrian P Banning
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, UK
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | | | - Yves Louvard
- Ramsay Générale de Santé - Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Vijayvergiya R, Batta A, Kasinadhuni G, Gupta A, Gawalkar AA. A side branch balloon block and support technique for difficult distal main branch access during percutaneous coronary intervention. ASIAINTERVENTION 2023; 9:52-55. [PMID: 36936100 PMCID: PMC10015480 DOI: 10.4244/aij-d-22-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/02/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Akash Batta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankush Gupta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Atit A Gawalkar
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Nagoshi R, Kijima Y, Kozuki A, Fujiwara R, Shibata H, Suzuki A, Soga F, Asada H, Higuchi K, Shite J. Success rate and influencing factors of a balloon-push technique: A new technique to remove side branch-jailed struts under three-dimensional optical coherence tomography guidance. Catheter Cardiovasc Interv 2023; 101:528-535. [PMID: 36617385 DOI: 10.1002/ccd.30548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/21/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Kissing balloon inflation with distal guide wire recross can cause severe stent deformation depending on the stent link location with respect to the carina. The balloon-push technique, by which an inflated balloon is forced into the SB from the proximal main vessel (MV), is a feasible way to remove jailed struts without causing severe stent deformation. AIMS We investigated the procedural success rate, patterns of jailed strut removal at side branch (SB) orifices, factors related to failure of jailed strut removal, and follow-up angiogram results of the balloon-push technique. METHODS Between September 2015 and December 2020, 51 bifurcation stenting cases in which the balloon-push technique was used were enrolled. Based on three-dimensional optical coherence tomography images, strut removal with 1 stent crown length was defined as successful. Strut removal patterns were classified into two types: parallel-slide type (stent struts shifted distally into the MV lumen without inversion) and under-carina type (stent struts shifted distally under the carina with strut inversion or strut slide). RESULTS Procedural success was attained in 39 cases (success rate: 76.5%). Parallel-slide type and under-carina type occurred in 43% and 33% of cases, respectively. Factors related to failure were trifurcation lesions and a smaller pushed balloon-SB artery ratio compared with those in success cases (0.95 ± 0.18 vs. 1.10 ± 0.22, p = 0.032). Follow-up angiography was performed in 37 cases, and 2 cases had binary in-stent restenosis. CONCLUSIONS Removal of jailed struts with the balloon-push technique was feasible, without severe stent deformation, in bifurcation stentings.
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Affiliation(s)
- Ryoji Nagoshi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Yoichi Kijima
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Amane Kozuki
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Ryudo Fujiwara
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Hiroyuki Shibata
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Fumitaka Soga
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Hiroyuki Asada
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Kotaro Higuchi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
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8
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Albiero R, Burzotta F, Lassen JF, Lefèvre T, Banning AP, Chatzizisis YS, Johnson TW, Ferenc M, Pan M, Daremont O, Hildick-Smith D, Chieffo A, Louvard Y, Stankovic G. Treatment of coronary bifurcation lesions, part I: implanting the first stent in the provisional pathway. The 16th expert consensus document of the European Bifurcation Club. EUROINTERVENTION 2022; 18:e362-e376. [PMID: 35570748 PMCID: PMC10259243 DOI: 10.4244/eij-d-22-00165] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Stepwise layered provisional stenting (PS) is the most commonly used strategy to treat coronary bifurcation lesions (CBL). The term 'stepwise layered' emphasises the versatility of this approach that allows the adjustment of the procedure plan according to the CBL complexity, starting with stent implantation in one branch and implantation of a second stent in the other branch only when required. A series of refinements have been implemented over the years to facilitate the achievement of predictable procedural results using this approach. However, despite its simplicity and versatility, operators using this technique require full knowledge of the pitfalls of each procedural step. Part I of this 16th European Bifurcation Club consensus paper provides a detailed step-by-step overview of the pitfalls and technical troubleshooting during the implantation of the first stent using the PS strategy for the treatment of CBL.
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Affiliation(s)
- Remo Albiero
- Interventional Cardiology Unit, Ospedale Civile di Sondrio, Sondrio, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jens Flensted Lassen
- Department of Cardiology B, Odense Universitates Hospital & University of Southern Denmark, Odense C, Denmark
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Adrian P Banning
- Cardiovascular Medicine Division, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol and Weston NHSFT & University of Bristol, Bristol, United Kingdom
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital. University of Cordoba (IMIBIC), Cordoba, Spain
| | | | - David Hildick-Smith
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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9
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Wang J, Li C, Ding D, Zhang M, Wu Y, Xu R, Lu H, Chen Z, Chang S, Dai Y, Qian J, Zhang F, Tu S, Ge J. Functional comparison of different jailed balloon techniques in treating non-left main coronary bifurcation lesions. Int J Cardiol 2022; 364:20-26. [PMID: 35597490 DOI: 10.1016/j.ijcard.2022.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a paucity of data comparing functional difference between active jailed balloon technique (A-JBT) and conventional jailed balloon technique (C-JBT) in treating non-left main coronary bifurcation lesions (CBLs). METHODS In this retrospective cohort study, we consecutively enrolled 232 patients with non-left main CBLs who underwent percutaneous coronary intervention (PCI) using JBTs between January 2018 and March 2019. Among them, 191 patients entered the final analysis with 12-months angiographic follow-up. We stratified patients into A-JBT group (130 patients) and C-JBT group (61 patients). The functional analysis by Murray law-based quantitative flow ratio (μQFR) and Seattleanginaquestionnaire (SAQ) were performed to compare the two techniques. RESULTS Compared with C-JBT group, A-JBT group observed a lower abrupt (0.8% vs. 11.1%, p = 0.002) and final SB occlusion (0 vs. 7.9%, p = 0.005). Meanwhile, A-JBT group had a significantly higher μQFR of side branch (SB) both post-PCI and 12-months follow-up (median [interquartile range (IQR)]: 0.91 (0.86-0.96) vs. 0.82 (0.69-0.92), p < 0.001; median [IQR]: 0.95 (0.89-0.98) vs. 0.85 (0.74-0.93), p < 0.001) than C-JBT group. Besides, A-JBT group gained a μQFR improvement at follow-up period compared with post-PCI data (median [IQR]: 0.95 [0.89-0.98] vs. 0.91[0.86-0.96] of SB, p < 0.001) and a higher SAQ scores at 12-months follow-up compared with C-JBT group (p < 0.001). CONCLUSIONS Compared with C-JBT, A-JBT provided excellent SB protection during MV stenting and improved the SB functional blood flow as well as the angina relief even after 12 months.
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Affiliation(s)
- Jingpu Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chenguang Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Daixin Ding
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
| | - Mingyou Zhang
- Department of Cardiology, The first hospital of Jilin university, Changchun, China
| | - Yizhe Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Rende Xu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hao Lu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhangwei Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shufu Chang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuxiang Dai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China..
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
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10
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Kırat T. Fundamentals of percutaneous coronary bifurcation interventions. World J Cardiol 2022; 14:108-138. [PMID: 35432773 PMCID: PMC8968454 DOI: 10.4330/wjc.v14.i3.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/22/2021] [Accepted: 02/22/2022] [Indexed: 02/06/2023] Open
Abstract
Coronary bifurcation lesions (CBLs) account for 15%-20% of all percutaneous coronary interventions. The complex nature of these lesions is responsible for poorer procedural, early and late outcomes. This complex lesion subset has received great attention in the interventional cardiac community, and multiple stenting techniques have been developed. Of these, the provisional stenting technique is most often the default strategy; however, the elective double stenting (EDS) technique is preferred in certain subsets of complex CBLs. The double kissing crush technique may be the preferred EDS technique because of its efficacy and safety in comparative trials; however, this technique consists of many steps and requires training. Many new methods have recently been added to the EDS techniques to provide better stent scaffolding and to reduce early and late adverse outcomes. Intravascular imaging is necessary to determine the interventional strategy and postinterventional results. This review discusses the basic concepts, contemporary percutaneous interventional technical approaches, new methods, and controversial treatment issues of CBLs.
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Affiliation(s)
- Tamer Kırat
- Department of Cardiology, Yücelen Hospital, Muğla 48000, Turkey.
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11
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Suzuki Y, Kinoshita Y, Maekawa Y, Suzuki T. Rewiring to the dissected branch along the jailed balloon (Real JAB technique)-A novel rewiring technique for the dissected branch in bifurcation lesion-case report. J Cardiol Cases 2022; 25:156-158. [DOI: 10.1016/j.jccase.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/06/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022] Open
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12
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Nomura T, Ota I, Ono K, Sakaue Y, Shoji K, Wada N, Keira N, Tatsumi T. Practical use of dual-lumen catheter-facilitated reverse wire technique for nonhighly angulated side branch. Res Cardiovasc Med 2022. [DOI: 10.4103/rcm.rcm_29_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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13
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Valenzuela TF, Burzotta F, Iles TL, Lassen JF, Iaizzo PA. Assessment of single and double coronary bifurcation stenting techniques using multimodal imaging and 3D modeling in reanimated swine hearts using Visible Heart® methodologies. Int J Cardiovasc Imaging 2021; 37:2591-2601. [PMID: 33993420 PMCID: PMC8390408 DOI: 10.1007/s10554-021-02240-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
Stent implantation in bifurcated coronary lesions is technically challenging so that procedural refinements are continuously investigated. Novel procedure modeling and intracoronary imaging techniques may offer critical insights on stent deformations and stent-wall interactions during bifurcation stenting procedures. Thus, we assessed coronary bifurcation stenting techniques using multimodal imaging and 3D modeling in reanimated swine hearts. Harvested swine hearts were reanimated using Visible Heart® methodologies and (under standard fluoroscopic guidance) used to test 1-stent (provisional and inverted provisional) and 2-stent (culotte, TAP and DK-crush) techniques on bifurcations within various coronary vessels using commercially available devices. Intracoronary angioscopy and frequency-domain optical-coherence-tomography (OCT) were obtained during the procedures. 3D OCT reconstruction and micro-computed tomography 3D modeling (post heart fixations) were used to assess stent deformations and stent-wall interactions. We conducted multiple stenting procedures and collected unique endoscopic and OCT images (and subsequent computational models from micro-CT) to assess stent deformations and device/wall interactions during different steps of bifurcation stenting procedures. Endoscopy, micro-CT and virtual reality processing documented that different 1- and 2-stent techniques, practiced according to experts’ recommended steps, achieve optimal post-intervention stent conformation. As compared with intra-procedural endoscopy, software-generated 3D OCT images accurately depicted stent deformations during 1-stent techniques. On the opposite, during more complex 2-stent techniques, some defects were appreciated at 3D OCT reconstruction despite optimal 2D OCT images. This study provided unique insights regarding both stent deformations occurring in the course of bifurcation stenting and the efficacy of OCT to visualize them.
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Affiliation(s)
- Thomas F Valenzuela
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA.,Department of Surgery, University of Minnesota, Minneapolis, MN, USA.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli 1, 00168, Rome, Italy. .,Università Cattolica del Sacro Cuore, Milan, Italy.
| | - Tinen L Iles
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, USA.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jens F Lassen
- Department of Cardiology, University of Copenhagen, Copenhagen, Denmark
| | - Paul A Iaizzo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA.,Department of Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, USA.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
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14
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Agarwal S, Agarwal SK. STEMI with flush occlusion of a coronary artery: An interventional dilemma. J Cardiol Cases 2021; 23:108-111. [PMID: 33717373 DOI: 10.1016/j.jccase.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/10/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022] Open
Abstract
Flush occlusions of coronary arteries present with multiple challenges during primary percutaneous coronary intervention (PPCI). We describe a case of anterior ST-elevation myocardial infarction in cardiogenic shock, where it was not possible to identify the origin of left anterior descending artery (LAD) as it was flush occluded and initial attempts to place a coronary guidewire in the LAD during PPCI were unsuccessful. After failed attempts with multiple guidewires, a combined pharmacological-mechanical approach resulted in successful timely revascularization and subsequent recovery of the patient. <Learning objective: Acute flush occlusion of a major coronary artery is a challenge to interventionists as there may not be any clue of occluded coronary artery. In this difficult scenario, when the wire placement is not possible, the intracoronary infusion of a thrombolytic agent helps in visualization of stump of an occluded artery, facilitating its quick wiring and procedure.>.
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Affiliation(s)
- Shubham Agarwal
- Department of Internal Medicine, Rosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, IL, USA
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15
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Burzotta F, Lassen JF, Louvard Y, Lefèvre T, Banning AP, Daremont O, Pan M, Hildick-Smith D, Chieffo A, Chatzizisis YS, Džavík V, Gwon HC, Hikichi Y, Murasato Y, Koo BK, Chen SL, Serruys P, Stankovic G. European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions. Catheter Cardiovasc Interv 2020; 96:1067-1079. [PMID: 32579300 PMCID: PMC8915133 DOI: 10.1002/ccd.29071] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/26/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Defining the optimal conduction of percutaneous-coronary-intervention (PCI) to treat bifurcation lesions has been the subject of many clinical studies showing that the applied stenting technique may influence clinical outcome. Accordingly, bifurcation stenting classifications and technical sequences should be standardized to allow proper reporting and comparison. METHODS The European Bifurcation Club (EBC) is a multidisciplinary group dedicated to optimize the treatment of bifurcations and previously created a classification of bifurcation stenting techniques that is based on the first stent implantation site. Since some techniques have been abandoned, others have been refined and dedicated devices became available, EBC promoted an international task force aimed at updating the classification of bifurcation stenting techniques as well as at highlighting the best practices for most popular techniques. Original descriptive images obtained by drawings, bench tests and micro-computed-tomographic reconstructions have been created in order to serve as tutorials in both procedure reporting and clinical practice. RESULTS An updated Main-Across-Distal-Side (MADS)-2, classification of bifurcation stenting techniques has been realized and is reported in the present article allowing standardized procedure reporting in both clinical practice and scientific studies. The EBC-promoted task force deeply discussed, agreed on and described (using original drawings and bench tests) the optimal steps for the following major bifurcation stenting techniques: (a) 1-stent techniques ("provisional" and "inverted provisional") and (b) 2-stent techniques ("T/TAP," "culotte," and "DK-crush"). CONCLUSIONS The present EBC-promoted paper is intended to facilitate technique selection, reporting and performance for PCI on bifurcated lesions during daily clinical practice.
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Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jens Flensted Lassen
- Department of Cardiology B, Odense Universitetshospital and University of Southern Denmark, Odense, Denmark
| | - Yves Louvard
- Ramsay Générale de Santé–Institut cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Thierry Lefèvre
- Ramsay Générale de Santé–Institut cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Adrian P. Banning
- Cardiovascular Medicine Division, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, UK
| | | | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba (IMIBIC), Cordoba, Spain
| | | | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Vladimìr Džavík
- Interventional Cardiology Program, Division of Cardiology, Toronto General Hospital, Toronto, Ontario, Canada
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yutaka Hikichi
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Yoshinobu Murasato
- Department of Cardiology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Bon Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital and Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaboratory Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Patrick Serruys
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Goran Stankovic
- Medical Faculty, Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
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16
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Kočka V, Thériault-Lauzier P, Xiong TY, Ben-Shoshan J, Petr R, Laboš M, Buithieu J, Mousavi N, Pilgrim T, Praz F, Overtchouk P, Beaudry JP, Spaziano M, Pelletier JP, Martucci G, Dandona S, Rinfret S, Windecker S, Leipsic J, Piazza N. Optimal Fluoroscopic Projections of Coronary Ostia and Bifurcations Defined by Computed Tomographic Coronary Angiography. JACC Cardiovasc Interv 2020; 13:2560-2570. [PMID: 33153569 DOI: 10.1016/j.jcin.2020.06.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to define the optimal fluoroscopic viewing angles of both coronary ostia and important coronary bifurcations by using 3-dimensional multislice computed tomographic data. BACKGROUND Optimal fluoroscopic projections are crucial for coronary imaging and interventions. Historically, coronary fluoroscopic viewing angles were derived empirically from experienced operators. METHODS In this analysis, 100 consecutive patients who underwent computed tomographic coronary angiography (CTCA) for suspected coronary artery disease were studied. A CTCA-based method is described to define optimal viewing angles of both coronary ostia and important coronary bifurcations to guide percutaneous coronary interventions. RESULTS The average optimal viewing angle for ostial left main stenting was left anterior oblique (LAO) 37°, cranial (CRA) 22° (95% confidence interval [CI]: LAO 33° to 40°, CRA 19° to 25°) and for ostial right coronary stenting was LAO 79°, CRA 41° (95% CI: LAO 74° to 84°, CRA 37° to 45°). Estimated mean optimal viewing angles for bifurcation stenting were as follows: left main: LAO 0°, caudal (CAU) 49° (95% CI: right anterior oblique [RAO] 8° to LAO 8°, CAU 43° to 54°); left anterior descending with first diagonal branch: LAO 11°, CRA 71° (95% CI: RAO 6° to LAO 27°, CRA 66° to 77°); left circumflex bifurcation with first marginal branch: LAO 24°, CAU 33° (95% CI: LAO 15° to 33°, CAU 25° to 41°); and posterior descending artery and posterolateral branch: LAO 44°, CRA 34° (95% CI: LAO 35° to 52°, CRA 27° to 41°). CONCLUSIONS CTCA can suggest optimal fluoroscopic viewing angles of coronary artery ostia and bifurcations. As the frequency of use of diagnostic CTCA increases in the future, it has the potential to provide additional information for planning and guiding percutaneous coronary intervention procedures.
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Affiliation(s)
- Viktor Kočka
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Third Faculty of Medicine, Charles University, Prague, Czech Republic; Cardiocenter, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Pascal Thériault-Lauzier
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tian-Yuan Xiong
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jeremy Ben-Shoshan
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada; Tel-Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Róbert Petr
- Third Faculty of Medicine, Charles University, Prague, Czech Republic; Cardiocenter, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Marek Laboš
- Cardiocenter, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Jean Buithieu
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Negareh Mousavi
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Swiss Cardiovascular Center, Bern, Switzerland
| | - Pavel Overtchouk
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Pierre Beaudry
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marco Spaziano
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Philippe Pelletier
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Giuseppe Martucci
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sonny Dandona
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stéphane Rinfret
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Bern, Switzerland
| | - Jonathon Leipsic
- Department of Radiology, St. Paul Hospital, Vancouver, British Columbia, Canada
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
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17
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The Effective and Safe Way to Use Crusade Microcatheter-Facilitated Reverse Wire Technique to Solve Bifurcated Lesions with Markedly Angulated Target Vessel. J Interv Cardiol 2019; 2019:2579526. [PMID: 31772518 PMCID: PMC6739779 DOI: 10.1155/2019/2579526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/04/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives We aim to present a new way to introduce reverse wire in crusade microcatheter-facilitated reverse wire technique to solve markedly angulated bifurcated lesions. Background Markedly angulated coronary bifurcation lesions are still one of the considerable challenges of treatment with percutaneous coronary intervention especially with severe proximal stenosis. Microcatheter-facilitated reverse wire technique improved the efficacy of crossing a guide wire to such an extremely angulated complex targeted vessel. However, there has been a debate regarding what kind of curve was the best to introduce reverse guide wire in this technique. Methods We analyzed 7 patients who were admitted to Fuwai Hospital and underwent antegrade wiring which failed. Crusade microcatheter-facilitated reverse wire technique with simple short tip one round curve was used successfully to solve in all 7 bifurcation lesions. We investigated the bifurcation lesion's characteristics and details of the reverse wire technique procedures. Results All 7 bifurcations exhibit both a smaller take-off angle and a larger carina angle and severe proximal significant stenosis. After having suitable size of balloon predilation, reverse wire with simple short distal one curve was delivered to distal segment of targeted vessel successfully. We performed all PCI procedures without any complications and no major adverse cardiac event was observed during hospitalization. Conclusions In solving markedly angulated bifurcated lesions, especially with severe proximal stenosis, crusade microcatheter-facilitated reverse wire technique with simple short tip one curve is an effective and safe way of wiring.
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18
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Landolff Q, Veugeois A, Godin M, Boussaada MM, Dibie A, Caussin C, Amabile N. [Hot issues in bifurcation lesions PCI in 2019]. Ann Cardiol Angeiol (Paris) 2019; 68:325-332. [PMID: 31542202 DOI: 10.1016/j.ancard.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/28/2019] [Indexed: 11/27/2022]
Abstract
Coronary bifurcations are involved in 15-20% of all percutaneous coronary interventions (PCI) and remain one of the most challenging lesions in interventional cardiology in terms of procedural success rate as well as long-term cardiac events. The optimal management of bifurcation lesions is still debated but involves careful assessment, planning and a sequential provisional approach. The preferential strategy for PCI of bifurcation lesions remains to use main vessel (MV) stenting with a proximal optimisation technique (POT) and provisional side branch (SB) stenting as a preferred approach. Final kissing balloon inflation is not recommended in all cases. In the minority of lesions where two stents are required, careful deployment and optimal expansion are essential to achieve a long-term result. Intracoronary imaging techniques (IVUS, OCT) and FFR are useful endovascular tools to achieve optimal results.
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Affiliation(s)
- Q Landolff
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - A Veugeois
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - M Godin
- Service de cardiologie, clinique St-Hilaire, Rouen, France
| | - M M Boussaada
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - A Dibie
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - C Caussin
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - N Amabile
- Service de cardiologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
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19
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Watanabe M, Okura H, Okamura A, Iwai S, Keshi A, Kamon D, Isojima T, Ueda T, Soeda T, Saito Y. Usefulness of longitudinal reconstructed optical coherence tomography images for predicting the need for the reverse wire technique during coronary bifurcation interventions. Catheter Cardiovasc Interv 2019; 94:E54-E60. [PMID: 30474184 DOI: 10.1002/ccd.27981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/02/2018] [Accepted: 10/23/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim is to investigate the usefulness of longitudinal reconstructed optical coherence tomography (OCT) images in selecting the reverse wire (RW) technique for inserting a guidewire into a side branch (SB). BACKGROUND It is sometimes necessary to protect the SB with a guidewire to prevent SB complications in PCI for bifurcation lesions. The RW is a novel method for guidewire insertion into an extremely angulated SB when the standard antegrade wire (AW) approach is difficult. METHODS This retrospective study included 46 consecutive patients who underwent OCT-guided PCI in bifurcation lesions with significant SB stenosis. Patients were divided into two groups: 36 patients with successful guidewire crossing using the AW (AW group) and 10 patients with unsuccessful AW but successful RW guidewire crossing (RW group). SB angle and branch point (BP) slope, defined as the angle between the line connecting the proximal and distal BPs and the vertical, were measured using longitudinal reconstructed OCT images. RESULTS The RW group had a significantly larger SB angle and higher BP slope than the AW group (108.7 ± 11.4° vs. 76.2 ± 14.9°; P < 0.0001, 128.7 ± 31.6° vs. 82.9 ± 33.6°; P = 0.0004, respectively). Receiver operating characteristic curve analysis indicated that SB angle ≥ 100° and BP slope ≥ 120° are optimal cutoff values for predicting the need for RW (area under the curve 0.97, sensitivity 90.0%, specificity 91.7%; area under the curve 0.83, sensitivity 80.0%, specificity 86.1%, respectively). CONCLUSIONS Longitudinal reconstructed OCT is useful for selecting the wiring technique for bifurcation lesions.
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Affiliation(s)
- Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Hiroyuki Okura
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Akihiko Okamura
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Saki Iwai
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Ayaka Keshi
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Daisuke Kamon
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Takuya Isojima
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
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Iannaccone M, Colangelo S, Di Mario C, Garbo R. Double wire rotational atherectomy technique in a heavily calcified coronary bifurcation. EUROINTERVENTION 2019; 14:204-205. [PMID: 29437038 DOI: 10.4244/eij-d-18-00001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mario Iannaccone
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
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21
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Protected Rotational Atherectomy With Double–Guiding Catheter Technique for Unprotected Distal Left Main. JACC Cardiovasc Interv 2019; 12:e27-e29. [DOI: 10.1016/j.jcin.2018.10.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/20/2022]
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22
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Burzotta F, Lassen JF, Banning AP, Lefèvre T, Hildick-Smith D, Chieffo A, Darremont O, Pan M, Chatzizisis YS, Albiero R, Louvard Y, Stankovic G. Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club. EUROINTERVENTION 2018; 14:112-120. [PMID: 29786539 DOI: 10.4244/eij-d-18-00357] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The 2017 European Bifurcation Club (EBC) meeting was held in Porto (Portugal) and allowed a multidisciplinary international faculty to review and discuss the latest data collected in the field of coronary bifurcation interventions. In particular, the topic of percutaneous coronary intervention (PCI) on left main coronary artery (LM) disease was highlighted as a contemporary priority. Herein, we summarise the key LM anatomy features, the diagnostic modalities and available data that are relevant for a patient's procedural management. Since the clinical outcomes of patients undergoing PCI on LM disease may depend on both PCI team organisation and PCI performance, the optimal catheterisation laboratory set-up and the rationales for device and technique selection are critically reviewed. The best lesion preparation modalities, the different DES implantation technique choices and the strategies to be considered during PCI on unprotected LM for optimal PCI results are reviewed step by step.
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Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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23
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Lassen J, Burzotta F, Banning A, Lefèvre T, Darremont O, Hildick-Smith D, Chieffo A, Pan M, Holm N, Louvard Y, Stankovic G. Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. EUROINTERVENTION 2018; 13:1540-1553. [DOI: 10.4244/eij-d-17-00622] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Li L, Liu J, Jin Q, Chen S. Case report of a novel maneuver to facilitate wire access to the side branch in bifurcation intervention-balloon block and support technique. Medicine (Baltimore) 2018; 97:e9673. [PMID: 29505012 PMCID: PMC5779781 DOI: 10.1097/md.0000000000009673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite advancements in the devices and techniques used for percutaneous coronary intervention, side branch (SB) wiring remains highly challenging in certain complex bifurcation intervention cases. METHODS AND RESULTS In this report, we demonstrate the efficacy and safety of the balloon block and support technique (BBST), which comprises inflation of an appropriately sized balloon 1-2 mm distal from the carina in the distal main branch to facilitate wire access to the SB. Between June 2012 and July 2017, we utilized the BBST as a bail-out strategy for six bifurcation cases with difficult SB wiring. In this report, we present in detail the oldest and the most recent of those cases to illustrate the use of the BBST. As a bail-out strategy, the BBST successfully facilitated SB wiring. No BBST-related complications were observed. CONCLUSIONS The BBST may be an efficient and safe method for facilitating SB wiring in complex bifurcation intervention cases and could be used as a bail-out technique.
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Affiliation(s)
- Li Li
- Cardiovascular Medical Department of Guangzhou Red Cross Hospital, Guangzhou, Guangdong
| | - Jia Liu
- Cardiovascular Medical Department of Guangzhou Red Cross Hospital, Guangzhou, Guangdong
| | - Qinhua Jin
- Department of Cardiology, Chinese PLA General Hospital, Beijing
| | - Shaoliang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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25
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Foley JRJ, Kidambi A, Biglands JD, Maredia N, Dickinson CJ, Plein S, Greenwood JP. A comparison of cardiovascular magnetic resonance and single photon emission computed tomography (SPECT) perfusion imaging in left main stem or equivalent coronary artery disease: a CE-MARC substudy. J Cardiovasc Magn Reson 2017; 19:84. [PMID: 29110669 PMCID: PMC5674685 DOI: 10.1186/s12968-017-0398-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Assessment of left main stem (LMS) stenosis has prognostic and therapeutic implications. Data on assessment of LMS disease by cardiovascular magnetic resonance (CMR) and single photon emission computed tomography (SPECT) are limited. CE-MARC is the largest prospective comparison of CMR and SPECT against quantitative invasive coronary angiography (QCA) for detection of coronary artery disease (CAD), and provided the framework for this evaluation. The aims of this study were to compare diagnostic accuracy of visual and quantitative perfusion CMR to SPECT in patients with LMS stable CAD. METHODS Fifty-four patients from the CE-MARC study were included: 27 (4%) with significant LMS or LMS-equivalent disease on QCA, and 27 age/sex-matched patients with no flow-limiting CAD. All patients underwent multi-parametric CMR, SPECT and QCA. Performance of visual and quantitative perfusion CMR by Fermi-constrained deconvolution to detect LMS disease was compared with SPECT. RESULTS Of 27 patients in the LMS group, 22 (81%) had abnormal CMR and 16 (59%) had abnormal SPECT. All patients with abnormal CMR had abnormal perfusion by visual analysis. CMR demonstrated significantly higher area under the curve (AUC) for detection of disease (0.95; 0.85-0.99) over SPECT (0.63; 0.49-0.76) (p = 0.0001). Global mean stress myocardial blood flow (MBF) by CMR in LMS patients was significantly lower than controls (1.77 ± 0.72 ml/g/min vs. 3.28 ± 1.20 ml/g/min, p < 0.001). MBF of <2.08 ml/g/min had sensitivity of 78% and specificity of 85% for diagnosis of LMS disease, with an AUC (0.87; 0.75-0.94) not significantly different to visual CMR analysis (p = 0.18), and more accurate than SPECT (p = 0.003). CONCLUSION Visual stress perfusion CMR had higher diagnostic accuracy than SPECT to detect LMS disease. Quantitative perfusion CMR had similar performance to visual CMR perfusion analysis.
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Affiliation(s)
- James R. J. Foley
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - John D. Biglands
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Neil Maredia
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
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Nagoshi R, Okamura T, Murasato Y, Fujimura T, Yamawaki M, Ono S, Serikawa T, Hikichi Y, Nakao F, Sakamoto T, Shinke T, Kijima Y, Kozuki A, Shibata H, Shite J. Feasibility and usefulness of three-dimensional optical coherence tomography guidance for optimal side branch treatment in coronary bifurcation stenting. Int J Cardiol 2017; 250:270-274. [PMID: 29030141 DOI: 10.1016/j.ijcard.2017.09.197] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/10/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND For the treatment of coronary bifurcation lesions, optimal guidewire (GW) recrossing after main vessel stenting is important for good stent apposition at the side branch (SB) orifice in kissing balloon inflation (KBI). METHODS We analyzed 150 bifurcation lesions treated with single stenting following KBI in the three-dimensional optical coherence tomography (3D-OCT) bifurcation registry study (2015-16) and a single center experience (2012-16). OCT examination was performed after GW recrossing to the SB and after KBI. Patients were divided into two-dimensional (2D, n=78) and 3D groups (n=72) according to 2D- or 3D-OCT guidance. GW recrossing position, jailing configuration of the stent over the SB (divided into Link-connecting type: stent link connecting to the carina and Link-free type: no stent link at the carina) and stent apposition were compared between the groups. RESULTS Distal GW recrossing was achieved in 75.6% and 91.7% in the 2D and 3D groups, respectively (P=0.004). Compared with the 2D group, the incidence of incomplete stent apposition (ISA) toward the SB in the 3D group tended to be lower in the whole cohort (14.5±13.6% vs 10.0±9.0%, P=0.077), and was significantly lower in left main trunk bifurcations (18.7±12.8% vs 10.3±8.9%, P=0.014). Independent contributors to ISA were the Link-connecting type (β 0.089, P<0.001), distal GW recrossing (β -0.078, P=0.001), and age (β -0.0020, P=0.012). CONCLUSION Optimal GW recrossing under 3D-OCT guidance is feasible and improves stent apposition, which may lead to a better clinical outcome in the treatment of bifurcation lesions.
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Affiliation(s)
- Ryoji Nagoshi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan
| | - Takayuki Okamura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Japan
| | | | - Tatsuhiro Fujimura
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama Eastern Hospital, Japan
| | - Shiro Ono
- Department of Cardiology, Saiseikai Yamaguchi General Hospital, Japan
| | - Takeshi Serikawa
- Department of Cardiology, Saiseikai Fukuoka General Hospital, Japan
| | | | - Fumiaki Nakao
- Department of Cardiology, Yamaguchi Central General Hospital, Japan
| | - Tomohiro Sakamoto
- Department of Cardiology, Saiseikai Kumamoto General Hospital, Japan
| | - Toshiro Shinke
- Department of Cardiology, Kobe University Graduate School of Medicine, Japan
| | - Yoichi Kijima
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan
| | - Amane Kozuki
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan
| | - Hiroyuki Shibata
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Japan.
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Burzotta F, Trani C. In bifurcation PCI, as in everyday life, the consequences of kissing may not always be the same. EUROINTERVENTION 2016; 11:e1209-13. [PMID: 26865437 DOI: 10.4244/eijv11i11a240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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28
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Zhou Y, Xiao H, Wang YQ, Liu HY, Bao P, Song YM, Azzalini L, Huang L, Zhao XH. In-stent Anchoring Facilitating Side-branch Balloon Delivery for Final Kissing: A Prospective, Single-center Registry Study. Chin Med J (Engl) 2016; 129:2666-2669. [PMID: 27823997 PMCID: PMC5126156 DOI: 10.4103/0366-6999.193439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Recrossing the compromised side branch (SB) with a balloon is sometimes technically challenging. The aim of this study was to evaluate whether in-stent anchoring (ISA) is safe and effective to facilitate SB balloon delivery for final kissing. Methods: One hundred and fifty-nine consecutive patients were included (166 bifurcation lesions) in this prospective, single-center registry. ISA was used as a bailout method after unsuccessful SB crossing using conventional techniques, including low-profile balloons. Technique success was defined as SB balloon delivery and final kissing. Results: Kissing-balloon delivery was successfully performed with conventional strategies in 149 of 166 lesions (89.8%). In the remaining 17 lesions (10.2%), recrossing of the main vessel stent strut was not successful; therefore, ISA was attempted. The balloon successfully crossed the stent struts, and final kissing was achieved in 15 of 17 lesions (88.2%). Total final kissing was achieved in 164 of 166 lesions (98.8%), with success rates of 100% in the single-stent group and 97.6% in the two-stent group. Two cases without balloon delivery had complex bifurcation lesions with severe calcification. There was no vessel dissection in the anchoring zone. Conclusions: ISA is safe and effective for recrossing stent struts when conventional low-profile balloons have failed. However, large-scale trials are warranted for further evaluation.
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Affiliation(s)
- Yu Zhou
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Han Xiao
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Yu-Qing Wang
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Huan-Yun Liu
- Department of Cardiovascular, First People's Hospital of Chongqing New North Zone, Chongqing 401120, China
| | - Pang Bao
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Yao-Ming Song
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Lorenzo Azzalini
- Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Lan Huang
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Xiao-Hui Zhao
- Institution of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
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Impact of Operator Experience and Volume on Outcomes After Left Main Coronary Artery Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2016; 9:2086-2093. [DOI: 10.1016/j.jcin.2016.08.011] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/19/2016] [Accepted: 08/11/2016] [Indexed: 12/28/2022]
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Nomura T, Higuchi Y, Kubota H, Miyawaki D, Urata R, Sugimoto T, Kato T, Keira N, Tatsumi T. Practical Usefulness of Dual Lumen Catheter-Facilitated Reverse Wire Technique for Markedly Angulated Bifurcated Lesions. J Interv Cardiol 2016; 28:544-50. [PMID: 26643002 DOI: 10.1111/joic.12253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the practical usefulness of dual lumen catheter-facilitated reverse wire technique. BACKGROUND We sometimes encounter difficulty in introducing a guidewire to the highly angulated side branch. In those cases, the reverse wire technique is considered as a last resort to overcome the situation. METHODS Between January 2013 and June 2015, we performed the reverse wire technique for guidewire crossing into an extremely angulated side branch in consecutive seven cases with true bifurcated lesions. We retrospectively evaluated patients' backgrounds, lesion characteristics, and details of the percutaneous coronary intervention (PCI) procedures. RESULTS Three interventional cardiologists with various levels of experience in coronary intervention performed this technique. A polymer-jacket hydrophilic-coated guidewire was used for the reverse wire system excluding in one case, and we adopted a sharp curve for the tip shape in all cases. After crossing the reverse wire into a highly angulated side branch, we usually deliver a flexible micro catheter over the guidewire for the purpose of guidewire exchange. We deployed a stent in the side branch in three cases. We successfully performed all PCI procedures without any complications and no major adverse cardiac event was observed during hospitalization. CONCLUSIONS We could safely and effectively perform the reverse wire technique for guidewire crossing into a markedly angulated side branch. We recommend a polymer-jacket hydrophilic-coated guidewire with a sharp curve in the tip shape for this technique. All interventional cardiologists should acquire knowledge and skills regarding this guidewire manipulation technique.
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Affiliation(s)
- Tetsuya Nomura
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan, Japan
| | - Yusuke Higuchi
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan, Japan
| | - Hiroshi Kubota
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan, Japan
| | - Daisuke Miyawaki
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan, Japan
| | - Ryota Urata
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan, Japan
| | - Takeshi Sugimoto
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan, Japan
| | - Taku Kato
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan, Japan
| | - Natsuya Keira
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan, Japan
| | - Tetsuya Tatsumi
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan, Japan
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Lassen JF, Holm NR, Banning A, Burzotta F, Lefèvre T, Chieffo A, Hildick-Smith D, Louvard Y, Stankovic G. Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. EUROINTERVENTION 2016; 12:38-46. [PMID: 27173860 DOI: 10.4244/eijv12i1a7] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Coronary bifurcations are involved in 15-20% of all percutaneous coronary interventions (PCI) and remain one of the most challenging lesions in interventional cardiology in terms of procedural success rate as well as long-term cardiac events. The optimal management of bifurcation lesions is, despite a fast growing body of scientific literature, the subject of considerable debate. The European Bifurcation Club (EBC) was initiated in 2004 to support a continuous overview of the field, and aims to facilitate a scientific discussion and an exchange of ideas on the management of bifurcation disease. The EBC hosts an annual, compact meeting, dedicated to bifurcations, which brings together physicians, engineers, biologists, physicists, epidemiologists and statisticians for detailed discussions. Every meeting is finalised with a consensus statement which reflects the unique opportunity of combining the opinions of interventional cardiologists with the opinions of a large variety of other scientists on bifurcation management. The present 11th EBC consensus document represents the summary of the up-to-date EBC consensus and recommendations. It points to the fact that there is a multitude of strategies and approaches to bifurcation stenting within the provisional strategy and in the different two-stent strategies. The main EBC recommendation for PCI of bifurcation lesions remains to use main vessel (MV) stenting with a proximal optimisation technique (POT) and provisional side branch (SB) stenting as a preferred approach. The consensus document covers a moving target. Much more scientific work is needed in non-left main (LM) and LM bifurcation lesions for continuous improvement of the outcome of our patients.
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Affiliation(s)
- Jens Flensted Lassen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Sabbah M, Kadota K, Fuku Y, Mitsudo K. Correction of Stent Distortion and Overhanging Stent Struts during Left Main Bifurcation Stenting by Selective Distal Stent Cell Re-Wiring: A Novel Guidewire Approach. ACTA CARDIOLOGICA SINICA 2016; 31:453-6. [PMID: 27122906 DOI: 10.6515/acs20150120a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Stent malapposition and overhanging stent struts in front of the side branch (SB) ostium are not uncommon following bifurcation stenting that might lead to stent thrombosis. We herein present 2 cases, in which optical frequency domain imaging and intravascular ultrasound effectively revealed stent malapposition and overhanging struts inside the ostium of the SB following left main coronary artery stenting. Therefore, we introduced a novel technique for rectification of these incidental findings by selective SB re-wiring through the most distal stent cell with the adjunctive help of a double lumen microcatheter. KEY WORDS Distal stent strut; Left main bifurcation; Overhanging struts; Side branch re-crossing; Stent optimization.
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Affiliation(s)
- Mahmoud Sabbah
- Department of Cardiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; ; Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazuaki Mitsudo
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
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33
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Paraggio L, Burzotta F, Aurigemma C, Trani C. Update on Provisional Technique for Bifurcation Interventions. Curr Cardiol Rep 2016; 18:27. [DOI: 10.1007/s11886-016-0704-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lee JM, Park KW, Koo BK, Kim HS. Stenting of coronary bifurcation lesions: a literature and technical review. Curr Cardiol Rep 2016; 17:45. [PMID: 25929543 DOI: 10.1007/s11886-015-0595-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Newer generation drug-eluting stents have improved outcomes in various subsets of coronary lesions including bifurcation lesions. This article reviews the current literature on various issues in bifurcation percutaneous coronary intervention (PCI). Generally, the provisional approach of placing one stent in the main vessel is the preferred first-line treatment for most bifurcation lesions. However, some lesions require 2-stenting. It is unknown whether 2nd-generation DES have improved outcomes with 2-stenting. The use of fractional flow reserve (FFR) for the assessment of functional significance of the jailed side branch can help avoid unnecessary stenting in complex lesions. Skilled techniques in every step of the 2-stenting process and meticulous use of imaging techniques including IVUS or OCT are warranted to obtain optimal angiographic and clinical results. Dedicated bifurcation stents are feasible treatment options and may change future concepts in bifurcation PCI, although larger trials with control groups are required in order to widely apply these techniques into daily routine practice.
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Affiliation(s)
- Joo Myung Lee
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 DaeHak-Ro, JongRo-Gu, Seoul, 110-744, South Korea
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35
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Roh JH, Kim YH. Percutaneous treatment of left main and non-left main bifurcation coronary lesions using drug-eluting stents. Expert Rev Cardiovasc Ther 2015; 14:229-43. [DOI: 10.1586/14779072.2016.1120158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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36
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Nomura T, Higuchi Y, Kato T. Successful percutaneous coronary intervention for complex bifurcated lesions with combination of "Reverse wire technique" and "Reverse bent wiring with the crusade catheter" novel wire manipulation technique. Catheter Cardiovasc Interv 2015; 87:920-5. [PMID: 26490073 DOI: 10.1002/ccd.26267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/28/2015] [Accepted: 09/19/2015] [Indexed: 11/07/2022]
Abstract
We encountered a case of percutaneous coronary intervention for complex bifurcated lesions in the mid portion of the left anterior descending (LAD) artery. The diagonal artery branched from the LAD artery with a markedly angulated pattern and there was severe stenosis from just proximal to this diagonal artery. The "reverse wire technique facilitated with the Crusade catheter" enabled us to cross a guidewire through to the markedly angulated diagonal side branch (SB). Next, we adopted a mini-crushing stent strategy for this true bifurcated lesion. Thereafter, we adopted "reverse bent wiring with the Crusade catheter" for wire re-crossing to the incarcerated side branch, and successfully completed all procedures. This technique for successful wire re-crossing is simple but can be very effective in specific situations in practical percutaneous coronary intervention (PCI). Many PCI operators may empirically adopt this kind of wire manipulation technique. However, this case is the first report in the world describing the application of a "reverse bent wiring with the Crusade catheter" for wire re-crossing through a double-folded stent strut to a SB at the optimal point of the bifurcation. In this case, we made the most of the Crusade catheter. This catheter is a very useful device for multifactorial use in practical PCI. It can help us to perform complex PCI procedures successfully.
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Affiliation(s)
- Tetsuya Nomura
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan City, Kyoto, Japan
| | | | - Taku Kato
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan City, Kyoto, Japan
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37
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ZHANG DONG, DOU KEFEI. Coronary Bifurcation Intervention: What Role Do Bifurcation Angles Play? J Interv Cardiol 2015; 28:236-48. [DOI: 10.1111/joic.12203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- DONG ZHANG
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute; Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 China
| | - KEFEI DOU
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute; Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 China
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Burzotta F, Džavík V, Ferenc M, Trani C, Stankovic G. Technical aspects of the T And small Protrusion (TAP) technique. EUROINTERVENTION 2015; 11 Suppl V:V91-5. [DOI: 10.4244/eijv11sva20] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Darremont O, Leymarie JL, Lefèvre T, Albiero R, Mortier P, Louvard Y. Technical aspects of the provisional side branch stenting strategy. EUROINTERVENTION 2015; 11 Suppl V:V86-90. [DOI: 10.4244/eijv11sva19] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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He X, Gao B, Liu Y, Li Z, Zeng H. Side-branch technique for difficult guidewire placement in coronary bifurcation lesion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 17:59-62. [PMID: 25842349 DOI: 10.1016/j.carrev.2015.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/07/2015] [Accepted: 03/17/2015] [Indexed: 12/31/2022]
Abstract
Despite tremendous advances in technology and skills, percutaneous coronary intervention (PCI) of bifurcation lesion (BL) remains a particular challenge for the interventionalist. During bifurcation PCI, safe guidewire placement in the main branch (MB) and the side branch (SB) is the first step for successful procedure. However, in certain cases, the complex pattern of vessel anatomy and the mix of plaque distribution may make target vessel wiring highly challenging. Therefore, specific techniques are required for solving this problem. Hereby, we describe a new use of side-branch technique for difficult guidewire placement in BL.
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Affiliation(s)
- Xingwei He
- Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Gao
- Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yujian Liu
- Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuxi Li
- Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hesong Zeng
- Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Burzotta F, Mortier P, Trani C. Characteristics of drug-eluting stent platforms potentially influencing bifurcated lesion provisional stenting procedure. EUROINTERVENTION 2015; 10:124-32. [PMID: 24832640 DOI: 10.4244/eijv10i1a19] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to review the technical characteristics of DES platforms which have been documented to influence bifurcation stenting procedures conducted according to the provisional approach. METHODS AND RESULTS DES platforms have remarkable technical differences (side cell diameter, shape, deformability, etc.). We reviewed the literature data and performed original virtual bench tests to highlight the characteristics of DES platforms which influence the following phases of bifurcation stenting conducted according to the provisional approach: stent implantation in the main vessel across side-branch take-off ("crossover" stenting), proximal optimisation technique, rewiring and kissing balloon inflation. Available data show that the response of different DES platforms to the various procedural steps of provisional stenting is different. CONCLUSIONS When treating bifurcated lesions according to the provisional stenting approach, the search for an ideal matching between individual bifurcated anatomy and DES selection should take into account an articulated series of technical parameters.
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Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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Lassen JF, Holm NR, Stankovic G, Lefèvre T, Chieffo A, Hildick-Smith D, Pan M, Darremont O, Albiero R, Ferenc M, Louvard Y. Percutaneous coronary intervention for coronary bifurcation disease: consensus from the first 10 years of the European Bifurcation Club meetings. EUROINTERVENTION 2014; 10:545-60. [PMID: 25256198 DOI: 10.4244/eijv10i5a97] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The European Bifurcation Club (EBC) is an independent, non-political and informal "think tank" of scientists with a particular interest in clinical, technical and fundamental aspects of the management of coronary artery bifurcation disease. Bifurcations account for 15-20% of all percutaneous coronary interventions (PCI) and remain one of the most challenging lesions in interventional cardiology in terms of procedural success rate as well as long-term cardiac events. The optimal management is, despite a fast growing scientific literature, still the subject of considerable debate, one of the main concerns being the potential increased risk of late stent thrombosis associated with treatment complexity. The EBC was initiated in 2004 and aims to facilitate an exchange of ideas on management of bifurcation disease. The EBC hosts an annual, compact meeting dedicated to bifurcations which brings together physicians, engineers, biologists, physicists, epidemiologists and statisticians for detailed discussions. Every meeting is finalised with a consensus statement which reflects the unique opportunity of combining the opinion of interventional cardiologists with the opinion of a large variety of other scientists on bifurcation management. This year the EBC celebrates its 10-year anniversary. This consensus document represents the summary of the consensus from the last ten years of the annual EBC meetings.
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Yokota S, Ottervanger JP, Mouden M, Timmer JR, Knollema S, Jager PL. Prevalence, location, and extent of significant coronary artery disease in patients with normal myocardial perfusion imaging. J Nucl Cardiol 2014; 21:284-90. [PMID: 24469846 DOI: 10.1007/s12350-013-9837-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND False-negative myocardial perfusion imaging (MPI) can by due to left main (LM) or three-vessel disease causing "balanced ischemia". However, so far prevalence of LM or three-vessel-disease in patients with normal MPI is unclear. We assessed prevalence, location, and extent of significant coronary artery disease (CAD) in patients with normal MPI. METHODS Between 2006 and 2010, 256 patients with normal MPI who had invasive angiography because of persisting or worsening of the same initial symptoms were studied. Significant CAD was defined as stenosis > 70% or LM > 50%. RESULTS A total of 93 patients (36%) had significant CAD. Significant CAD was observed more frequently in males, higher age and those with typical angina complaints. Significant LM disease was present in 7%, three-vessel disease in 10%, two-vessel disease in 22%, and single vessel disease (not left main) in 61%. In those with single vessel disease, the location was the LAD in 40%, the RCA in 30%, and the LCX in 30%. CONCLUSIONS In selected patients with normal MPI, one-third had significant CAD. The majority of these patients had single vessel disease (not left main). LM or three vessel disease, causing "balanced ischemia", is a less common cause of false-negative MPI.
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Affiliation(s)
- Shu Yokota
- Department of Cardiology, Isala Klinieken, Dokter Van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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Burzotta F, Talarico GP, Trani C, De Maria GL, Pirozzolo G, Niccoli G, Leone AM, Saffioti S, Porto I, Crea F. Frequency-domain optical coherence tomography findings in patients with bifurcated lesions undergoing provisional stenting. Eur Heart J Cardiovasc Imaging 2013; 15:547-55. [PMID: 24255135 DOI: 10.1093/ehjci/jet231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Bifurcations represent challenging lesions which may benefit from improved understanding of stent-related vessel complications. Since optical coherence tomography (OCT) allows us to detect post-stenting vessel injuries, we sought to assess the geographic pattern of stent-related complications occurring during provisional stenting of bifurcated lesions. METHODS AND RESULTS Fifty-one patients with bifurcated lesions treated by provisional stenting and undergoing intra-procedural OCT assessment were enrolled. OCT images were acquired with the aim of guiding the percutaneous coronary intervention but were re-analysed off-line for the present study. The stented bifurcation was divided into four segments [three in the main vessel (MV) and one in the side branch (SB)]. The following acute post-stenting vessel injuries/complications at the different bifurcation segments were evaluated: (i) stent under-expansion, (ii) stent malapposition, (iii) stent edge dissection, (iv) side-branch ostium dissection, (v) tissue prolapse, (vi) intracoronary thrombus, and (vii) in-stent dissection. A total of 55 bifurcation lesions undergoing provisional stenting were analysed. At least one OCT complication was detectable in all cases. Across different bifurcation sites, significant differences in the occurrence of stent complications were observed. In particular, stent malapposition was more common at the proximal MV segment (P < 0.001), while tissue prolapse was more common at the distal MV segment (P < 0.001). CONCLUSION In bifurcated interventions, OCT often detects vessel injuries/stent complications, which tend to have a specific geographical distribution. In particular, stent malapposition is more common at the proximal MV and tissue prolapse at the distal MV segment.
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Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, L.go Gemelli 8, Rome 00168, Italy
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Watanabe S, Saito N, Bao B, Tokushige A, Watanabe H, Yamamoto E, Kawase Y, Kimura T. Microcatheter-facilitated reverse wire technique for side branch wiring in bifurcated vessels: an in vitro evaluation. EUROINTERVENTION 2013; 9:870-7. [DOI: 10.4244/eijv9i7a141] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wang A, Eggermont J, Dekker N, de Koning PJH, Reiber JHC, Dijkstra J. 3D assessment of stent cell size and side branch access in intravascular optical coherence tomographic pullback runs. Comput Med Imaging Graph 2013; 38:113-22. [PMID: 24070672 DOI: 10.1016/j.compmedimag.2013.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 11/28/2022]
Abstract
We present a semi-automatic approach to assess the maximum circular unsupported surface area (MCUSA) of selected stent cells and the side branch access through stent cells in intravascular optical coherence tomography (IVOCT) pullback runs. Such 3D information may influence coronary interventions, stent design, blood flow analysis or prognostic evaluation. First, the stent struts are detected automatically and stent cells are reconstructed with users' assistance. Using cylinder fitting, a 2D approximation of the stent cell is generated for MCUSA detection and measurement. Next, a stent surface is reconstructed and stent-covered side branches are detected. Both the stent cell contours and side branch lumen contours are projected onto the stent surface to indicate their areas, and the overlapping regions are measured as the side branch access through these stent cells. The method was evaluated on phantom data sets and the accuracy of the MCUSA and side branch access was found to be 95% and 91%, respectively. The usability of this approach for clinical research was proved on 12 in vivo IVOCT pullback runs.
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Affiliation(s)
- Ancong Wang
- Department of Radiology, Leiden University Medical Center, Postbox 9600, 2300 RC Leiden, Netherlands(1).
| | - Jeroen Eggermont
- Department of Radiology, Leiden University Medical Center, Postbox 9600, 2300 RC Leiden, Netherlands(1).
| | - Niels Dekker
- Department of Radiology, Leiden University Medical Center, Postbox 9600, 2300 RC Leiden, Netherlands(1).
| | - Patrick J H de Koning
- Department of Radiology, Leiden University Medical Center, Postbox 9600, 2300 RC Leiden, Netherlands(1).
| | - Johan H C Reiber
- Department of Radiology, Leiden University Medical Center, Postbox 9600, 2300 RC Leiden, Netherlands(1).
| | - Jouke Dijkstra
- Department of Radiology, Leiden University Medical Center, Postbox 9600, 2300 RC Leiden, Netherlands(1).
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Burzotta F, Trani C. Technical Aspects of Provisional Stenting in Percutaneous Treatment of Complex Bifurcation Lesions. Interv Cardiol 2013; 8:96-99. [PMID: 29588759 DOI: 10.15420/icr.2013.8.2.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Drug-eluting stent (DES) implantation using the 'provisional' approach is the gold standard for percutaneous treatment of patients with unselected bifurcated lesions. Nevertheless, many operators still consider the provisional approach unsuitable for coronary patients with complex bifurcation anatomies. Yet, the provisional approach may be so differently carried out that its procedural outcome is often unpredictable. Some technical refinements may help to anticipate or manage procedural difficulties, which may occur during the management of complex patients. We sought to overview the issues related with DES selection as well as some technical points, which may increase the effectiveness of provisional stenting. In particular, the DES characteristics influencing bifurcation interventions and the technical refinements, which may be considered during a provisional stenting procedure are discussed. Indeed, main vessel stent sizing, proximal optimisation, side branch protection modality, side branch rewiring, kissing balloon and side branch rescue techniques are all pivotal to increase the safety and efficacy of the provisional strategy especially in the setting of complex anatomies and patients.
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Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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Depta JP, Patel Y, Patel JS, Novak E, Yeung M, Zajarias A, Kurz HI, Lasala JM, Bach RG, Singh J. Long-term clinical outcomes with the use of a modified provisional Jailed-Balloon stenting technique for the treatment of nonleft main coronary bifurcation lesions. Catheter Cardiovasc Interv 2013; 82:E637-46. [DOI: 10.1002/ccd.24778] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 10/29/2012] [Accepted: 12/07/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Jeremiah P. Depta
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Yogesh Patel
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Jayendrakumar S. Patel
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Eric Novak
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Michael Yeung
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Alan Zajarias
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Howard I. Kurz
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - John M. Lasala
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Richard G. Bach
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
| | - Jasvindar Singh
- Department of Medicine, Division of Cardiology; Washington University School of Medicine; St. Louis Missouri
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Stankovic G, Lefèvre T, Chieffo A, Hildick-Smith D, Lassen JF, Pan M, Darremont O, Albiero R, Ferenc M, Finet G, Adriaenssens T, Koo BK, Burzotta F, Louvard Y. Consensus from the 7th European Bifurcation Club meeting. EUROINTERVENTION 2013; 9:36-45. [DOI: 10.4244/eijv9i1a7] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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50
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Sgueglia GA, Chevalier B. Kissing Balloon Inflation in Percutaneous Coronary Interventions. JACC Cardiovasc Interv 2012; 5:803-11. [DOI: 10.1016/j.jcin.2012.06.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/08/2012] [Accepted: 06/07/2012] [Indexed: 02/07/2023]
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