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Bifurcation stenting coronaries

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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
#1
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)...
October 31, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27884628/skirt-followed-by-trouser-stenting-technique-true-anatomical-preservation-of-coronary-y-shaped-bifurcation-lesions-while-using-vanishing-bioresorbable-scaffolds-a-report-of-two-cases
#2
Wael Elabbassi, Arif Al Nooryani
We report on two cases in which Y-shaped coronary bifurcations were treated with the use of Bioresorbable scaffolds. The first case was of a 50-year-old man with NSTEMI. Coronary angiography showed stenosis involving a Y-shaped bifurcation of proximal to mid LAD and diagonal. The lesion was wired using two 0.14 BMW guide wires, followed by serial pre-dilatation of LAD and Diagonal branch. The stent into proximal LAD was deployed first as a skirt (3.5 × 12 BVS). Stent was post-dilated. A second 2.5 × 28 BVS was deployed into diagonal branch, protruding backwards; along with a 2...
November 3, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/27867140/impact-of-calcified-bifurcation-lesions-in-patients-undergoing-percutaneous-coronary-intervention-using-drug-eluting-stents-results-from-the-coronary-bifurcation-stent-cobis-ii-registry
#3
Min Chul Kim, Youngkeun Ahn, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Myung Ho Jeong, Hyeon-Cheol Gwon, Hyo-Soo Kim, Seung Woon Rha, Jung Han Yoon, Yangsoo Jang, Seung-Jea Tahk, Ki Bae Seun
AIMS: Few data regarding clinical outcomes according to severity of calcification in patients with coronary bifurcation target lesions are available. METHODS AND RESULTS: This prospective, multicenter, observational registry enrolled 2,897 patients undergoing percutaneous coronary intervention with drug-eluting stents for coronary bifurcation lesions. We compared target lesion failure (TLF), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), and target lesion revascularization (TLR), according to severity of calcification in coronary bifurcation target lesions, assessed by an angiographic core laboratory using quantitative coronary angiography...
November 22, 2016: EuroIntervention
https://www.readbyqxmd.com/read/27862314/impact-of-diabetes-mellitus-on-intravascular-ultrasound-guided-provisional-stenting-in-coronary-bifurcation-lesions-j-reverse-sub-study
#4
Masahiro Yamawaki, Daisuke Terashita, Hachidai Takahashi, Toshiro Shinke, Kenichi Fujii, Yoshihisa Shimada, Yoshihiro Takeda, Shinichiro Yamada, Yoshihisa Kinoshita, Yoshinobu Murasato
OBJECTIVE: To investigate the impact of diabetes mellitus (DM) on provisional coronary bifurcation stenting under the complete guidance of intravascular-ultrasound (IVUS). BACKGROUND: The efficacy of such intervention has not yet been fully elucidated in the DM patients. METHODS: A total of 100 DM and 139 non-DM patients in a prospective multi-center registry of IVUS-guided bifurcation stenting were compared in angiographic results at 9 months...
December 2016: Journal of Interventional 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
#5
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/27785622/evaluation-of-bifurcation-stenting-techniques-at-catharina-hospital-eindhoven-in-2013
#6
S J L Leus, E van Hagen, F M Zimmermann, L X van Nunen, M van 't Veer, J Koolen, N H J Pijls
AIMS: Percutaneous coronary intervention (PCI) of bifurcation lesions can be performed using various techniques. The aim of this study was to analyse the outcome of various techniques of bifurcation stenting in all patients undergoing bifurcation stenting at one large intervention centre in 2013, taking into account that more complex lesions might more often warrant a two-stent technique. METHODS AND RESULTS: This retrospective study included 260 consecutive patients who underwent non-primary PCI of a bifurcation lesion at the Catharina Hospital, Eindhoven, in 2013...
October 26, 2016: Netherlands Heart Journal
https://www.readbyqxmd.com/read/27777957/optimal-revascularization-strategy-on-medina-0-1-0-left-main-bifurcation-lesions-in-type-2-diabetes
#7
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
#8
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/27757830/off-label-use-of-7fr-guideliner-in-the-bifurcation-coronary-intervention-protecting-2-side-branches
#9
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/27757563/neointimal-response-to-everolimus-eluting-bioresorbable-scaffolds-implanted-at-bifurcating-coronary-segments-insights-from-optical-coherence-tomography
#10
Takao Sato, John Jose, Mohamed El-Mawardy, Dmitriy S Sulimov, Ralph Tölg, Gert Richardt, Mohamed Abdel-Wahab
Heterogeneity of neointimal thickness is observed after drug-eluting stents implantation in bifurcation lesions (BL). We evaluated the vascular response of everolimus-eluting bioresorbable scaffold (BRS) struts deployed at BL using optical coherence tomography (OCT). 50 patients (64 scaffolds) underwent follow-up OCT after BRS implantation. Cross-sectional areas of each BL with a side branch more than 1.5 mm were analyzed using OCT every 200 µm. All images were divided into three regions according to shear stress: the 1/2 circumference of the vessel opposite to the ostium (OO), the vessel wall adjacent to the ostium (AO) and the side-branch ostium (SO)...
October 18, 2016: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/27718756/drug-eluting-balloons-in-coronary-interventions-the-quiet-revolution
#11
Fernando Alfonso, Marcos García-Guimarães, Gonzalo Navarrete, Javier Cuesta, Teresa Bastante, Amparo Benedicto, Fernando Rivero, Bernardo Cortese
Drug-eluting balloons (DEB) may be considered as a "quiet revolution" in percutaneous coronary interventions. Early-generation DEB eluting paclitaxel proved to be very effective in animal models to reduce neointimal hyperplasia. Areas covered: Review of DEB efficacy in patients with coronary de novo lesions and in-stent restenosis (ISR). Expert opinion: Many randomized clinical trials and meta-analyses have demonstrated the value of DEB in patients with ISR. In this setting, DEB are safe and effective with clinical and angiographic results superior to plain balloon angioplasty and at least equivalent to first generation drug-eluting stents (DES)...
October 8, 2016: Expert Opinion on Drug Delivery
https://www.readbyqxmd.com/read/27714730/anatomic-assessment-of-the-left-main-bifurcation-and-dynamic-bifurcation-angles-using-computed-tomography-angiography
#12
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
#13
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/27692566/clinical-outcome-of-treatment-with-or-without-a-final-kissing-balloon-technique-for-bifurcation-in-stent-restenosis-lesions
#14
Takayuki Yabe, Mikihoto Toda, Rine Nakanishi, Daiga Saito, Ippei Watanabe, Ryo Okubo, Hideo Amano, Takanori Ikeda
BACKGROUND: The treatment strategy for in-stent restenosis (ISR) with bifurcation lesions has not been well explored. We examined the clinical outcomes between final kissing balloon technique (FKBT) after stent implantation and single-stent implantation without FKBT for bifurcation ISR lesions. METHODS: We identified 115 consecutive ISR with bifurcation lesions among 108 patients who underwent drug-eluting stent implantation. The patients were divided into the FKBT group (34 patients, 35 lesions) and the non-FKBT group (74 patients, 80 lesions)...
September 27, 2016: Journal of Cardiology
https://www.readbyqxmd.com/read/27659568/structural-damage-of-jailed-guidewire-during-the-treatment-of-coronary-bifurcation-lesions-a-microscopic-randomized-trial
#15
Manuel Pan, Soledad Ojeda, Elena Villanueva, Jorge Chavarria, Miguel Romero, Javier Suarez de Lezo, Francisco Mazuelos, Jose Segura, Francisco Carrasco, Francisco Hidalgo, Jose Lopez Aguilera, Sara Rodriguez, Miguel Puente, Jose Suarez de Lezo
OBJECTIVES: The study sought to compare the safety (resistance to damage) and efficacy (ability to cross the side branch) of polymer-coated and non-polymer-coated guidewires in the jailed wire technique used during the percutaneous treatment of bifurcation lesions. BACKGROUND: The jailed wire technique is a useful strategy in the treatment of bifurcation lesions by provisional stenting. However, these wires can be damaged or even be broken during their removal...
September 26, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27659563/contemporary-approach-to-coronary%C3%A2-bifurcation-lesion-treatment
#16
REVIEW
Fadi J Sawaya, Thierry Lefèvre, Bernard Chevalier, Phillipe Garot, Thomas Hovasse, Marie-Claude Morice, Tanveer Rab, Yves Louvard
Coronary bifurcations are frequent and account for approximately 20% of all percutaneous coronary interventions. Nonetheless, they remain one of the most challenging lesion subsets in interventional cardiology in terms of a lower procedural success rate and increased rates of long-term adverse cardiac events. Provisional side branch stenting should be the default approach in the majority of cases and we propose easily applicable and reproducible stepwise techniques associated with low risk of failure and complications...
September 26, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27651390/coronary-bypass-surgery-versus-stenting-in-multivessel-disease-involving-the-proximal-left-anterior-descending-coronary-artery
#17
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/27651317/comparative-case-control-analysis-of-a-dedicated-self-expanding-biolimus-a9-eluting-bifurcation-stent-versus-provisional-or-mandatory-side-branch-intervention-strategies-in-the-treatment-of-coronary-bifurcation-lesions
#18
Marc-Alexander Ohlow, Ahmed Farah, Stefan Richter, Mohamad El-Garhy, Hubertus von Korn, Bernward Lauer
BACKGROUND: In a number of coronary bifurcation lesions, both the main vessel and the side branch (SB) need stent coverage. OBJECTIVES: To analyze the procedural performance and the impact on radiation times (RT) and contrast medium consumption (CMC) of the Axxess™ stent system (Biosensors, Switzerland) treating de novo bifurcation lesions (DBL). METHODS: One hundred and ten consecutive prospectively enrolled cases (Axxess Group) and 110 age, sex, and lesion location matched controls undergoing mandatory (Group A, n = 56) or provisional (Group B, n = 54) SB intervention were analyzed...
September 21, 2016: Catheterization and Cardiovascular Interventions
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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