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coronary, bifurcation, Left main

Q-H Li, Q Zhang, X-L Li, J-F Yin, H-G Ji
OBJECTIVE: To evaluate the plaque distribution and composition pattern in the left main coronary artery (LMCA) disease using intracoronary ultrasound. PATIENTS AND METHODS: Intravascular ultrasound data of 50 patients from the January 2010 to December 2015 with significant LMCA bifurcation lesions, with angiographic diameter stenosis >50%, and requiring revascularization, were evaluated. Plaque burden and percentage of necrotic core (% NC) at the minimal lumen area site and maximal % NC site were measured in different segments...
February 2018: European Review for Medical and Pharmacological Sciences
Jaya Chandrasekhar, Usman Baber, Samantha Sartori, Melissa Aquino, Annapoorna S Kini, Sunil Rao, William Weintraub, Timothy D Henry, Serdar Farhan, Birgit Vogel, Sabato Sorrentino, Zhen Ge, Samir Kapadia, Joseph B Muhlestein, Sandra Weiss, Craig Strauss, Catalin Toma, Anthony DeFranco, Mark B Effron, Stuart Keller, Brian A Baker, Stuart Pocock, George Dangas, Roxana Mehran
BACKGROUND: Potent P2Y12 inhibitors might offer enhanced benefit against thrombotic events in complex percutaneous coronary intervention (PCI). We examined prasugrel use and outcomes according to PCI complexity, as well as analyzing treatment effects according to thienopyridine type. METHODS: PROMETHEUS was a multicentre observational study that compared clopidogrel vs prasugrel in acute coronary syndrome patients who underwent PCI (n = 19,914). Complex PCI was defined as PCI of the left main, bifurcation lesion, moderate-severely calcified lesion, or total stent length ≥ 30 mm...
March 2018: Canadian Journal of Cardiology
Gianluca Rigatelli, Marco Zuin, Fabio Dell'Avvocata, Dobrin Vassilev, Ramesh Daggubati, Thach Nguyen, Minh Trí Nhân Nguyễn, Nicolas Foin
OBJECTIVES: We assess the mid-term outcomes of ultrathin biodegradable polymer double stenting using a very minimal crushing (Nano-Crush) technique in large complex coronary bifurcation. BACKGROUND: Complex bifurcations have been suggested to be better approached by a planned double stent technique. METHODS: Two hundred and five consecutive patients (107 males and 98 females) referred for large complex coronary bifurcation percutaneous coronary interventions were enrolled...
January 25, 2018: Catheterization and Cardiovascular Interventions
Keisuke Hirai, Kenichi Sakakura, Yusuke Watanabe, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-Ichi Momomura, Hideo Fujita
BACKGROUND: Percutaneous coronary interventions (PCI), especially medical devices, consume large amounts of medical resources. It is important to know which type of lesions requires high device costs among current PCI. The purpose of this study was to investigate the association between lesion characteristics and medical device costs in current PCI. METHODS: We identified 593 coronary artery lesions in our PCI database between January 1, 2015 and December 31, 2015...
December 23, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Mariama Akodad, Marie-Claude Morice
Though infrequent, left main stenosis has a major prognostic impact. The management of left main disease has evolved over the last few decades with the growing evidence of the efficacy and safety of percutaneous interventions, as attested by the most recent trials. However, mastery of the technical aspects of left main bifurcation stenting is essential in ensuring optimal results. This review focuses on recent data concerning left main angioplasty results as well as the current technical approaches.
January 5, 2018: Trends in Cardiovascular Medicine
Daniel W Nelson, Abdulla A Damluji, Nish Patel, Marco Valgimigli, Stephan Windecker, Robert Byrne, James Nolan, Tejas Patel, Emmanouil Brilakis, Subhash Banerjee, Jorge Mayol, Warren J Cantor, Carlos E Alfonso, Sunil V Rao, Mauro Moscucci, Mauricio G Cohen
INTRODUCTION: Transfemoral access (TFA) is widely used for coronary angiography and percutaneous coronary intervention (PCI). The influence of operator age, gender, experience, and procedural volume on performance of femoral arterial access has not been studied. METHODS: A survey instrument was developed and distributed via e-mail from professional societies to interventional cardiologists worldwide from March to December 2016. RESULTS: A total of 988 physicians from 88 countries responded to the survey...
December 27, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Pil Hyung Lee, Jong-Young Lee, Cheol Whan Lee, Seon-Ok Kim, Jung-Min Ahn, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Seong-Wook Park, Seung-Jung Park
BACKGROUND: The applicability of Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery scores to left main coronary artery disease (CAD) has been questioned. A simplified alternative is needed for guiding decision making. METHODS AND RESULTS: We evaluated the prognostic value of a simplified angiographic classification in comparison with a Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score-based approach for patients with left main CAD undergoing drug-eluting stent implantation...
January 2018: Circulation. Cardiovascular Interventions
Eun-Seok Shin, Cheol Whan Lee, Jung-Min Ahn, Pil Hyung Lee, Mineok Chang, Min-Ju Kim, Sung-Han Yoon, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Seong-Wook Park, Seung-Jung Park
BACKGROUND: The clinical outcomes for women compared with men undergoing left main PCI were sparse. We compared the characteristics and long-term outcomes in women versus men after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main CAD. METHODS: We identified 2328 patients (545 women; 1783 men) with unprotected left main CAD who received PCI with DES between January 2007 and December 2013 in the Interventional Cardiology Research In-cooperation Society-left MAIN revascularization (IRIS-MAIN) registry...
February 15, 2018: International Journal of Cardiology
Andreas S Triantafyllis, Johan Bennett, Efstathios Pagourelias, Keir McCutcheon, Tom Adriaenssens, Peter R Sinnaeve, Walter Desmet, Christophe Dubois
BACKGROUND: To evaluate long-term clinical outcomes after treatment of complex bifurcation lesions with the AXXESS dedicated self-expanding biolimus A9-eluting bifurcation stent. METHODS: Between 2004 and 2013, 123 patients with complex bifurcation lesions were treated in a single center with the AXXESS stent in the proximal main vessel (MV) and additional drug-eluting stents in branches when required. Median follow-up was 5 years. Primary endpoint was the rate of major adverse cardiac events (MACE)...
December 14, 2017: Cardiology Journal
Shigeru Saito, Koki Shishido, Noriaki Moriyama, Tomoki Ochiai, Shingo Mizuno, Futoshi Yamanaka, Kazuya Sugitatsu, Kazuki Tobita, Junya Matsumi, Yutaka Tanaka, Masato Murakami
OBJECTIVES: We propose a new systematic approach in bifurcation lesions, modified jailed balloon technique (M-JBT), and report the first clinical experience. BACKGROUND: Side branch occlusion brings with a serious complication and occurs in more than 7.0% of cases during bifurcation stenting. METHODS: A jailed balloon (JB) is introduced into the side branch (SB), while a stent is placed in the main branch (MB) as crossing SB. The size of the JB is half of the MB stent size...
December 4, 2017: Catheterization and Cardiovascular Interventions
Robert J Gil, Jacek Bil, Adam Kern, Tomasz Pawłowski
BACKGROUND: The optimal approach to coronary bifurcation treatment by percutaneous coronary intervention (PCI) is still a subject of debate, and dedicated bifurcation stents are one of the proposed solutions. AIM: The aim of this report was to assess the effectiveness and safety profile of a new dedicated bifurcation stent - sirolimus-eluting BiOSS LIM C® (Balton, Poland) at the first three months of a 12-month registry. METHODS: This is a two-centre registry, which enrolled patients with non-ST elevation acute coronary syndrome (NSTE-ACS) and stable angina...
2018: Kardiologia Polska
Jonathan Yap, Gagan D Singh, Jung-Sun Kim, Krishan Soni, Kelvin Chua, Alvin Neo, Choong Hou Koh, Ehrin J Armstrong, Stephen W Waldo, Kendrick A Shunk, Reginald I Low, Myeong-Ki Hong, Yangsoo Jang, Khung Keong Yeo
INTRODUCTION: Prior studies of ULM STEMI have been confined to small cohorts. Recent registry data with larger patient cohorts have shown contrasting results. We aim to study the outcomes of patients with unprotected left main (ULM) ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS: The Asia-pacific left main ST-Elevation Registry (ASTER) is a multicenter retrospective registry involving 4 sites in Singapore, South Korea, and the United States...
November 16, 2017: Journal of Interventional Cardiology
Tae-Min Rhee, Kyung Woo Park, Joo Myung Lee, Michael S Lee, Ki-Hyun Jeon, Hyun-Jae Kang, Bon-Kwon Koo, Jay Young Rhew, Kwang Soo Cha, Jang-Ho Bae, Kyoo-Rok Han, Si-Hoon Park, Woo-Jung Park, Seung-Woon Rha, Seok-Kyu Oh, Hyuck Moon Kwon, Ki-Bae Seung, Taehoon Ahn, Sang-Hyun Kim, Hyo-Soo Kim
BACKGROUND: There are limited data on the frequency of and factors associated with quantitative coronary angiography (QCA)-defined longitudinal stent deformation (LSD) in various contemporary drug-eluting stents platforms. This study sought to evaluate the predictors of LSD and its long-term clinical implication. METHODS AND RESULTS: A patient-level pooled analysis was performed with 7350 lesions in 5871 patients treated with platinum-chromium-based everolimus-eluting stent (Promus Element), cobalt-chromium-based everolimus-eluting stent (Promus/Xience V), or cobalt-chromium-based zotarolimus-eluting stent (Endeavor Resolute)...
November 2017: Circulation. Cardiovascular Interventions
Dangoisse Vincent, Schroëder Erwin, Claude Hanet, Antoine Guédès, Pancholy Samir
Percutaneous coronary intervention for bifurcated anatomy, particularly at the proximal left coronary artery site, requires guide catheters (GC) of at least 6 french and preferably larger in diameter. We describe a new trans-radial approach more suitable for small artery size: the simultaneous use of both radial arteries for double cannulation of the LMCA with 5F GC: each GC will target either the LM/LAD or the LM/CX artery (or LM-LAD/LM-LAD-1st diagonal branch) stenoses. The technique successfully was applied to 5 cases...
September 2016: Acute Cardiac Care
Giovanni Luigi De Maria, Rajesh Kharbanda, Adrian P Banning
Longitudinal rotational atherectomy of metal struts is well described as bail-out strategy to treat undilatable instent restenosis. Ablation of metal stent struts jailing the ostium of a major side branch in a coronary bifurcation is not described. In the current report, we describe a case of "transverse" rotational atherectomy to treat a failure of culotte stenting in a left main stem bifurcation. We document for the first time in vivo and in man the effect of this strategy using optical coherence tomography...
November 6, 2017: Catheterization and Cardiovascular Interventions
Kensuke Takagi, Koichi Furui, Itsuro Morishima, Hideyuki Tsuboi
No abstract text is available yet for this article.
November 27, 2017: JACC. Cardiovascular Interventions
Shao-Liang Chen, Jue-Jie Zhang, Yaling Han, Jing Kan, Lianglong Chen, Chunguang Qiu, Tiemin Jiang, Ling Tao, Hesong Zeng, Li Li, Yong Xia, Chuanyu Gao, Teguh Santoso, Chootopol Paiboon, Yan Wang, Tak W Kwan, Fei Ye, Nailiang Tian, Zhizhong Liu, Song Lin, Chengzhi Lu, Shangyu Wen, Lang Hong, Qi Zhang, Imad Sheiban, Yawei Xu, Lefeng Wang, Tanveer S Rab, Zhanquan Li, Guanchang Cheng, Lianqun Cui, Martin B Leon, Gregg W Stone
BACKGROUND: Provisional stenting (PS) is the most common technique used to treat distal left main (LM) bifurcation lesions in patients with unprotected LM coronary artery disease undergoing percutaneous coronary intervention. The double kissing (DK) crush planned 2-stent technique has been shown to improve clinical outcomes in non-LM bifurcations compared with PS, and in LM bifurcations compared with culotte stenting, but has never been compared with PS in LM bifurcation lesions. OBJECTIVES: The authors sought to determine whether a planned DK crush 2-stent technique is superior to PS for patients with true distal LM bifurcation lesions...
November 28, 2017: Journal of the American College of Cardiology
Robert W Yeh, Dean J Kereiakes, P Gabriel Steg, Donald E Cutlip, Kevin J Croce, Joseph M Massaro, Laura Mauri
BACKGROUND: Subjects undergoing coronary stenting with complex lesion anatomy may experience different risks and benefits with prolonged dual antiplatelet therapy. OBJECTIVES: The authors assessed the effect of 30 months versus 12 months of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) based on the presence or absence of anatomically-complex target lesions. METHODS: In the DAPT Study, combined myocardial infarction (MI) or stent thrombosis and moderate/severe bleeding were assessed in enrolled (n = 25,416) and randomized (n = 11,554) subjects...
October 31, 2017: Journal of the American College of Cardiology
Jens Flensted Lassen, Francesco Burzotta, Adrian P Banning, Thierry Lefèvre, Olivier Darremont, David Hildick-Smith, Alaide Chieffo, Manuel Pan, Niels Ramsing Holm, Yves Louvard, Goran Stankovic
The European Bifurcation Club (EBC) was initiated in 2004 to support a continuous overview of the field of coronary artery bifurcation interventions and aims to facilitate a scientific discussion and an exchange of ideas on the management of bifurcation disease. The EBC hosts an annual, two-day compact meeting, dedicated to bifurcations, which brings together physicians, pathologists, engineers, biologists, physicists, mathematicians, epidemiologists and statisticians for detailed discussions. Every meeting is finalised with a consensus statement that reflects the unique opportunity of combining the opinion of interventional cardiologists with the opinion of a large variety of other scientists on bifurcation management...
January 20, 2018: EuroIntervention
Yoshinobu Murasato, Yoshihisa Kinoshita, Masahiro Yamawaki, Toshiro Shinke, Yoshihiro Takeda, Kenichi Fujii, Shin-Ichiro Yamada, Yoshihisa Shimada, Takehiro Yamashita, Kazuhiko Yumoto
We investigated the effect of low-density lipoprotein cholesterol (LDL-C) on the geometry of coronary bifurcation lesions. A total of 300 non-left main bifurcation lesions in 298 patients from J-REVERSE registry were classified according to statin treatment status at admission (NT, non-treated; ST, statin-treated) and were further subdivided based on LDL-C levels with a cutoff of 100 mg/dL (NT-high, n = 76 lesions; NT-low, n = 46; ST-high, n = 99 and ST-low, n = 79). In addition, a group with strict control of LDL-C (< 70 mg/dL) was defined (ST-SC; n = 19)...
October 19, 2017: Cardiovascular Intervention and Therapeutics
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