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coronary, bifurcation, Left main

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https://www.readbyqxmd.com/read/28100341/-comparison-on-the-long-term-outcomes-post-percutaneous-coronary-intervention-or-coronary-artery-bypass-grafting-for-bifurcation-lesions-in-unprotected-left-main-coronary-artery
#1
B G Yang, X P Yu, F Chen, S Z Lyu, Q Li, J Q He, F Yuan
Objective: To compare the long-term clinical outcomes of consecutive patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention(PCI) with drug-eluting stents (DES) for bifurcation lesions in unprotected left main coronary artery (ULMCA). Methods: A total of 663 consecutively patients with unprotected left main bifurcation disease (defined as stenosis≥50%) who received either drug-eluting stents (DES) implantation (n=316) or underwent CABG (n=347) between January 2003 and July 2009 in Beijing Anzhen Hospital were enrolled retrospectively in this study...
January 25, 2017: Zhonghua Xin Xue Guan Bing za Zhi
https://www.readbyqxmd.com/read/28099289/orthogonal-views-of-coronary-vessels-a-method-for-imaging-the-delivery-of-blood-cardioplegia-using-transesophageal-echocardiography
#2
Luiz F Maracaja Neto, Raj Modak, Robert B Schonberger
Coronary blood flow can be disrupted during cardiac interventions such as mitral valve surgeries, left atrial appendage ligation, transcatheter aortic valve implantation, and aortic procedures involving reimplantation of coronary buttons. Although difficult to accomplish, coronary imaging using transesophageal echocardiography can be performed by the use of orthogonal imaging with the ability for real-time tilt for angle adjustment. The technique described herein allows imaging of the right coronary artery, left main coronary artery bifurcation, left anterior descending, and circumflex coronary arteries...
January 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28065691/difference-in-vascular-response-between-sirolimus-eluting-and-everolimus-eluting-stents-in-ostial-left-circumflex-artery-after-unprotected-left-main-as-observed-by-optical-coherence-tomography
#3
Yusuke Fujino, Guilherme F Attizzani, Satoko Tahara, Toru Naganuma, Kensuke Takagi, Hiroto Yabushita, Wei Wang, Kentaro Tanaka, Takahiro Matsumoto, Hiroyoshi Kawamoto, Yuya Yamada, Shinnosuke Amano, Yusuke Watanabe, Takayuki Warisawa, Tomohiko Sato, Satoru Mitomo, Naoyuki Kurita, Hisaaki Ishiguro, Koji Hozawa, Takahiro Tsukahara, Masahiro Motosuke, Hiram G Bezerra, Shotaro Nakamura, Sunao Nakamura
BACKGROUND: Kissing-balloon technique (KBT) is commonly performed during percutaneous coronary intervention of distal unprotected left main coronary artery (ULM) aiming at obtaining optimal opening of the side branch (left circumflex artery; LCX) ostium. Nonetheless, detailed evaluation of vascular response to stents in LCX ostium is lacking. We therefore evaluated the vascular response to different drug-eluting stents (DES) in ostial LCX after ULM by means of optical coherence tomography (OCT)...
December 23, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/28028693/a-study-of-coronary-bifurcation-shape-in-a-normal-population
#4
Pau Medrano-Gracia, John Ormiston, Mark Webster, Susann Beier, Chris Ellis, Chunliang Wang, Örjan Smedby, Alistair Young, Brett Cowan
During percutaneous coronary intervention, stents are placed in narrowings of the arteries to restore normal blood flow. Despite improvements in stent design, deployment techniques and drug-eluting coatings, restenosis and stent thrombosis remain a significant problem. Population stent design based on statistical shape analysis may improve clinical outcomes. Computed tomographic (CT) coronary angiography scans from 211 patients with a zero calcium score, no stenoses and no intermediate artery, were used to create statistical shape models of 446 major coronary artery bifurcations (left main, first diagonal and obtuse marginal and right coronary crux)...
December 27, 2016: Journal of Cardiovascular Translational Research
https://www.readbyqxmd.com/read/28012553/comparison-of-percutaneous-coronary-intervention-versus-coronary-artery-bypass-grafting-for-unprotected-left-main-coronary-artery-disease
#5
REVIEW
Syed Yaseen Naqvi, Jordan Klein, Tisa Saha, Daniel J McCormick, Sheldon Goldberg
Coronary artery bypass grafting (CABG) decreases mortality in patients with significant left main (LM) coronary artery disease and for years remained the therapy of choice for patients with this ominous lesion. Advances in percutaneous coronary intervention (PCI) have enabled it to become an alternative to CABG. The results of observational registries and randomized comparisons have shown the safety and efficacy of PCI in appropriately selected patients with low or intermediate angiographic risk scores. Furthermore, the use of physiological measures of flow limitation and the use of intracoronary imaging techniques has added benefit and improved outcomes...
November 16, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27969747/tct-396-performance-of-drug-coated-balloons-on-in-stent-restenosis-after-two-stent-implantation-for-left-main-coronary-artery-bifurcation-lesions
#6
Akimune Kuwayama, Kazushige Kadota, Katsuya Miura, Masanobu Ohya, Takenobu Shimada, Hidewo Amano, Shunsuke Kubo, Yusuke Hyodo, Suguru Otsuru, Seiji Habara, Takeshi Tada, Hiroyuki Tanaka, Yasushi Fuku, Tsuyoshi Goto
No abstract text is available yet for this article.
November 1, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27923490/surgical-strategies-for-anomalous-origin-of-the-left-coronary-artery-from-the-right-pulmonary-artery-with-an-intramural-aortic-course-a-report-of-10-cases
#7
Hui Zhang, Pei Cheng, Ge Jin, Ding Han, Yi Luo, Jia Li
OBJECTIVE: Few data are available regarding the surgical strategies for an anomalous origin of the left coronary artery (LCA) from the right pulmonary artery (RPA) with an intramural aortic course. We reviewed our experience in a case series of 10 children. METHODS: From 2007 to 2014, 10 patients (7 boys and 3 girls, aged 3 months to 11 years, median 21 months) underwent surgical repair. Before the operation, echocardiography showed the mean left ventricular ejection fraction 45% ± 10% and mean fractional shortening fraction 21% ± 7%...
November 12, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27887688/long-term-outcomes-after-stent-implantation-for-left-main-coronary-artery-from-the-multicenter-assessing-optimal-percutaneous-coronary-intervention-for-left-main-coronary-artery-stenting-registry
#8
Masanobu Ohya, Kazushige Kadota, Mamoru Toyofuku, Takeshi Morimoto, Hirooki Higami, Yasushi Fuku, Kyohei Yamaji, Hiromi Muranishi, Yuhei Yamaji, Koji Nishida, Daisuke Furukawa, Tomohisa Tada, Euihong Ko, Kenji Ando, Hiroki Sakamoto, Takashi Tamura, Kazuya Kawai, Takeshi Kimura
We assessed long-term outcomes after left main coronary artery (LMCA) stenting based on lesion types and stenting strategies. In the Assessing Optimal percutaneous coronary Intervention for Left Main Coronary Artery stenting registry, we evaluated 1,607 consecutive patients undergoing stent implantation for unprotected LMCA lesions (bifurcation lesions: n = 1318 and nonbifurcation lesions: n = 289). Among the bifurcation lesions, 1,281 lesions were treated with stenting across the bifurcation (bifurcation 1-stent strategy: n = 999 or bifurcation 2-stent strategy: n = 282)...
February 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/27806900/optical-coherence-tomography-compared-with-intravascular-ultrasound-and-with-angiography-to-guide-coronary-stent-implantation-ilumien-iii-optimize-pci-a-randomised-controlled-trial
#9
Ziad A Ali, Akiko Maehara, Philippe Généreux, Richard A Shlofmitz, Franco Fabbiocchi, Tamim M Nazif, Giulio Guagliumi, Perwaiz M Meraj, Fernando Alfonso, Habib Samady, Takashi Akasaka, Eric B Carlson, Massoud A Leesar, Mitsuaki Matsumura, Melek Ozgu Ozan, Gary S Mintz, Ori Ben-Yehuda, Gregg W Stone
BACKGROUND: Percutaneous coronary intervention (PCI) is most commonly guided by angiography alone. Intravascular ultrasound (IVUS) guidance has been shown to reduce major adverse cardiovascular events (MACE) after PCI, principally by resulting in a larger postprocedure lumen than with angiographic guidance. Optical coherence tomography (OCT) provides higher resolution imaging than does IVUS, although findings from some studies suggest that it might lead to smaller luminal diameters after stent implantation...
November 26, 2016: Lancet
https://www.readbyqxmd.com/read/27777957/optimal-revascularization-strategy-on-medina-0-1-0-left-main-bifurcation-lesions-in-type-2-diabetes
#10
Xuwei Zheng, Hongyu Peng, Donghui Zhao, Qin Ma, Kun Fu, Guo Chen, Qian Fan, Jinghua Liu
Aim. Diabetes mellitus (DM) is a major risk factor for cardiovascular disease. The implications of a diagnosis of DM are as severe as the diagnosis of coronary artery disease. For many patients with complex coronary artery disease, optimal revascularization strategy selection and optimal medical therapy are equally important. In this study, we compared the hemodynamic results of different stenting techniques for Medina 0,1,0 left main bifurcation lesions. Methods. We use idealized left main bifurcation models and computational fluid dynamics analysis to evaluate hemodynamic parameters which are known to affect the risk of restenosis and thrombosis at stented bifurcation...
2016: Journal of Diabetes Research
https://www.readbyqxmd.com/read/27765302/impact-of-operator-experience-and%C3%A2-volume-on-outcomes-after-left%C3%A2-main%C3%A2-coronary-artery-percutaneous%C3%A2-coronary-intervention
#11
Bo Xu, Björn Redfors, Yuejin Yang, Shubin Qiao, Yongjian Wu, Jilin Chen, Haibo Liu, Jue Chen, Liang Xu, Yanyan Zhao, Changdong Guan, Runlin Gao, Philippe Généreux
OBJECTIVES: The aim of this study was to assess the impact of operator experience on prognosis after left main coronary artery (LM) percutaneous coronary intervention (PCI). BACKGROUND: LM PCI can be technically challenging and potentially risky considering the amount of supplied myocardium. METHODS: Consecutive patients who underwent unprotected LM PCI at a single institution were included and compared according to whether the primary operator was an experienced, high-volume LM operator (defined as an operator who performed at least 15 LM PCIs per year for at least 3 consecutive years) or not...
October 24, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27760636/-safety-and-efficacy-of-off-pump-coronary-artery-bypass-grafting-in-octogenarians
#12
T S Liu, B T Chen, R Dong, Y Li, Y Zhao, K Hua
Objective: To discuss the clinical safety and efficacy about off-pump coronary artery bypass grafting (OPCABG) in octogenarians. Methods: From June 2005 to July 2014, 252 patients (male 208, female 44, with a mean age of 81.7 years old) underwent OPCABG in Beijing Anzhen Hospital who were aged 80 years or older were enrolled. Results: Eight (3.2%) patients were diagnosed as single vessel coronary artery disease (CAD), 29 cases (11.5%) were diagnosed as bifurcation vessel CAD, and 215 cases (85.3%) were multivessel CAD...
September 27, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27757830/off-label-use-of-7fr-guideliner-in-the-bifurcation-coronary-intervention-protecting-2-side-branches
#13
Takayuki Warisawa, Toru Naganuma, Sunao Nakamura
We report a case of percutaneous coronary intervention in a bifurcation lesion involving left circumflex (LCx) artery and 2 major posterolateral (PL) arteries. The target LCx had diffuse long and severely calcified lesion with the acute takeoff angle from the left main. Despite adequate lesion preparation with rotational atherectomy and balloon angioplasty, the stent was not deliverable, even with deep intubation of 7Fr-guiding catheter. Conventional use of guiding extension catheter (GEC) would have required removal of a wire from at least one PL because of the device interference in the GEC...
October 18, 2016: Cardiovascular Intervention and Therapeutics
https://www.readbyqxmd.com/read/27714730/anatomic-assessment-of-the-left-main-bifurcation-and-dynamic-bifurcation-angles-using-computed-tomography-angiography
#14
Osman Beton, Hatice Kaplanoglu, Baki Hekimoglu, Mehmet Birhan Yilmaz
BACKGROUND: An understanding of the left main coronary artery (LMCA) anatomy is important for accurate diagnosis and therapeutic. We aimed to investigate LMCA anatomy via 128-multisliced coronary computed-tomography-angiography (CCTA) in patients with normal LMCA. MATERIALS AND METHODS: A total of 201 CCTA studies were included in this study. Anatomical features of LMCA including cross-sectional areas of the LMCA ostial, LMCA distal, LAD ostial and LCX ostial, and degree of tapering and LMCA bifurcation angles (BA) in the form of LMCA-LCX BA, LMCA-LAD BA, LAD-LCX BA at end-diastole and end-systole...
October 7, 2016: Folia Morphologica (Warsz)
https://www.readbyqxmd.com/read/27713612/longitudinal-stent-deformation-caused-by-retraction-of-the-looped-main-branch-guidewire
#15
Hung-Hao Lee, Po-Chao Hsu, Wen-Hsien Lee, Chun-Yuan Chu, Ho-Ming Su, Tsung-Hsien Lin, Wen-Chol Voon, Wen-Ter Lai, Sheng-Hsiung Sheu, Cheng-An Chiu
A 66-year-old male was treated percutaneously for a bifurcation lesion of the left anterior descending coronary artery by provisional stenting using the jailed wire technique. After successfully stenting the main branch, retraction of the looped main branch guidewire was impossible. After using an intravascular ultrasound we discovered the guidewire was entangled with a stent strut. Thereafter, the proximal stent elongated after retraction. With the support of an over-the-wire microcatheter, we finally pulled out the entrapped guidewire...
September 2016: Acta Cardiologica Sinica
https://www.readbyqxmd.com/read/27685989/hemodynamics-in-coronary-arterial-tree-of-serial-stenoses
#16
Xi Chen, Yang Gao, Bin Lu, Xinwei Jia, Liang Zhong, Ghassan S Kassab, Wenchang Tan, Yunlong Huo
Serial segmental narrowing frequently occurs in humans, which alters coronary hemodynamics and further affects atherosclerotic progression and plaque formation. The objective of this study was to understand the distribution of hemodynamic parameters in the epicardial left main coronary arterial (LMCA) tree with serial stenoses reconstructed from patient computer tomography angiography (CTA) images. A finite volume method was used in conjunction with the inlet pressure wave and outlet flow resistance. The time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI) were determined from the flow field...
2016: PloS One
https://www.readbyqxmd.com/read/27667376/a-closer-look-at-fractional-flow-reserve-in-complex-anatomic-subsets-left-main-disease-bifurcation-lesions-and-saphenous-vein-grafts
#17
David C Lange, Morton J Kern
Fractional flow reserve (FFR) is a well-validated tool for determining the functional significance of a coronary artery stenosis, facilitating clinical decisions regarding the need for revascularization. FFR-guided revascularization improves clinical and economic outcomes. However, its application remains challenging in certain complex anatomic subsets, including left main coronary artery stenosis, bifurcation disease, and saphenous vein graft disease. This article reviews recent data supporting the use of FFR in these complex anatomic subsets...
2016: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27651390/coronary-bypass-surgery-versus-stenting-in-multivessel-disease-involving-the-proximal-left-anterior-descending-coronary-artery
#18
Rafael Cavalcante, Yohei Sotomi, Yaping Zeng, Cheol Whan Lee, Jung-Min Ahn, Carlos Collet, Erhan Tenekecioglu, Pannipa Suwannasom, Yoshinobu Onuma, Seung-Jung Park, Patrick W Serruys
OBJECTIVE: In patients with multivessel disease and proximal left anterior descending artery (LAD) involvement, the best revascularisation strategy is still unclear. We assess outcomes after coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents in a pooled analysis of individual patient-level data of the SYNTAX and BEST randomised trials. DESIGN: Proximal LAD involvement was defined by any lesion ≥ 50% diameter stenosis in the arterial segment starting from the left-main bifurcation up to (and including) the origin of the first major septal branch...
September 20, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27639736/a-computational-atlas-of-normal-coronary-artery-anatomy
#19
Pau Medrano-Gracia, John Ormiston, Mark Webster, Susann Beier, Alistair Young, Chris Ellis, Chunliang Wang, Örjan Smedby, Brett Cowan
AIMS: The aim of this study was to define the shape variations, including diameters and angles, of the major coronary artery bifurcations. METHODS AND RESULTS: Computed tomographic angiograms from 300 adults with a zero calcium score and no stenoses were segmented for centreline and luminal models. A computational atlas was constructed enabling automatic quantification of 3D angles, diameters and lengths of the coronary tree. The diameter (mean±SD) of the left main coronary was 3...
September 18, 2016: EuroIntervention
https://www.readbyqxmd.com/read/27619478/bioresorbable-vascular-scaffolds-what-does-the-future-bring
#20
COMMENT
Jacek Bil, Robert J Gil
Bioresorbable vascular scaffolds (BVS) have emerged as an interesting alternative since the presence of the prosthesis in the coronary artery is transient. This technology enables to restore the normal vasomotor tone and allows positive remodeling, simultaneously reducing the trigger for persistent inflammation and facilitating further interventions by percutaneous or surgical means. Absorb BVS(®) is the first generation everolimus-eluting poly-L-lactide (PLLA) bioresorbable scaffold. In recent meta-analyses Absorb BVS(®) was definitely proved to be safe and effective device in the treatment of symptomatic coronary artery disease...
August 2016: Journal of Thoracic Disease
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