Calcific lesion preparation for coronary bifurcation stenting

Abstract

Bifurcating coronary lesions are a very common challenge in interventional cardiology because of the technical complexity in their treatment, the risk of side branch occlusion and an overall worse outcome when compared to non-bifurcating lesions. The presence of calcifications represents further complexity due to the difficulty in device delivery and stent expansion as well as enhanced risk of side branch occlusion. Rotational and orbital atherectomy, scoring and cutting balloons, coronary lithoplasty are available tools which have been introduced over the last three decades to overcome such issue. Nevertheless, their application in different contexts of bifurcations presents specific caveats and the studies directed at comparing such techniques have never been expressly oriented in the subset of the bifurcating lesion. In this paper, we review these devices and their usefulness in bifurcations by analyzing consistent data from clinical trials, and we propose a practical algorithm for the treatment of severely calcified bifurcating lesions according to their anatomical features.

Feasibility of the intravascular lithotripsy in coronary artery disease. Short-term outcomes of the Lower-Silesia Shockwave Registry

“…Numerous strategies aiming at the appropriate preparation of calcified plaques have been implemented [1]. The two main techniques include the balloon-depended and the atherectomy devices.…”

Ticagrelor versus clopidogrel in patients with acute coronary syndrome undergoing complex percutaneous coronary intervention

“…Accordingly, patients with diffuse long lesions may tend to be treated with more stents with longer stent lengths, rendering them more prone to stent under‐expansion and mal‐apposition, target vessel revascularization, or stent thrombosis 14–16 . Several studies showed that a bifurcation lesion and its relevant stent implantation in both branches also increases the risk of MI and stent thrombosis 17,18 . Likewise, patients undergoing PCI with CTO have a higher rate of adverse ischemic events 19,20 .…”

Impact of Lesion Preparation Technique on Side Branch Compromise in Calcified Coronary Bifurcations: A Subgroup Analysis of the PREPARE-CALC Trial

“…Fujino et al demonstrated that the presence of coronary calcification at the site of a bifurcation assessed by optical coherence tomography is associated with a higher risk of side branch occlusion [ 19 ]. In this context, the main issues to provide optimal vessel patency are careful lesion preparation to “soften” the lesion, prevention of plaque shifting, and careful carina reconstruction [ 20 ].…”