Comparative Analysis of Sequential Proximal Optimizing Technique Versus Kissing Balloon Inflation Technique in Provisional Bifurcation Stenting

Finet, Gérard; Dérimay, François; Motreff, Pascal; Guérin, Patrice; Pilet, Paul; Ohayon, Jacques; Darremont, Olivier; Rioufol, Gilles

doi:10.1016/j.jcin.2015.05.016

Cited by 114 publications

(111 citation statements)

References 19 publications

(13 reference statements)

Supporting

Mentioning

106

Contrasting

Order By: Relevance

“…Concurrent findings of higher rate of incomplete stent apposition and higher mechanical stress in the proximal MV stent when performing kissing balloon inflation suggested an approach involving sequential single balloon SB dilation and proximal MV postdilation as a simpler and more efficient alternative for provisional stenting of bifurcations . The approach implemented in our study, which involves a consecutive POT—SB dilation—final POT sequence, was first assessed in a comparative assessment of six optimization strategies for provisional stenting in a fractal bifurcation model bench test . Data showed that the sequential optimization strategy, that the authors have named re‐POT, significantly optimized the final result of provisional coronary bifurcation stenting, maintaining circular geometry while significantly reducing SB ostium strut obstruction and global strut malapposition .…”

Section: Discussionmentioning

confidence: 87%

Concept and practice of transradial 5 French percutaneous treatment of coronary bifurcation lesions

Sgueglia

Gioffrè

Santis

et al. 2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives To assess the efficacy and safety of transradial 5 French percutaneous treatment of coronary bifurcations using conventional devices. Background Radial artery is smaller than femoral artery, and its size may potentially limit transradial intervention, especially when coronary anatomy is not known. Methods Patients with bifurcations lesions undergoing transradial 5 French ad hoc revascularization were treated according to provisional side branch (SB) stenting followed by the POT—SB dilation—final POT sequence. Only conventional devices were used. Results Overall, 80 patients (58 men, 65 ± 10 years) were enrolled. True bifurcations accounted for 64% of cases, with the left anterior descending artery/diagonal branch being the most frequent bifurcation site (n = 37, 46%) and left main coronary artery bifurcation being treated in 6 (8%) patients. Angiographic success was achieved in 78 (97.5%) patients through a 5 French guiding catheter whereas in two cases, a 5–6 French guiding catheter upgrade was required to optimize SB treatment after the main bifurcation vessel have been secured. Overall, procedural success was achieved in all but one patient who had periprocedural necrosis following multivessel PCI. Another patient underwent target bifurcation revascularization because of a critical restenosis in a significant SB yielding an acute coronary syndrome five months after the index procedure. Conclusions This study demonstrates the feasibility of transradial 5 French bifurcation intervention with nondedicated devices and preliminary supports its efficacy and safety over a wide range of bifurcation anatomy and complexity.

show abstract

Section: Discussionmentioning

confidence: 87%

Concept and practice of transradial 5 French percutaneous treatment of coronary bifurcation lesions

Sgueglia

Gioffrè

Santis

et al. 2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…MCT, with capability of directly visualizing metal stents, has been broadly adopted in assessment of stent performance ex vivo [8, 9]. However, most of BRSs currently available were made of PLLA that is invisible directly under mCT scanning.…”

Section: Resultsmentioning

confidence: 99%

Visualizing polymeric bioresorbable scaffolds with three-dimensional image reconstruction using contrast-enhanced micro-computed tomography

Cai

et al. 2016

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

There are no previous studies showing how to visualize polymeric bioresorbable scaffolds (BRSs) by micro-computed tomography (mCT). There are no previous studies showing how to visualize polymeric bioresorbable scaffolds (BRSs) by micro-computed tomography (mCT). This study aimed to explore the feasibility of detecting polymeric BRS with 3-dimensional reconstruction of BRS images by contrast-enhanced mCT and to determine the optimal imaging settings. BRSs, made of poly-l-lactic acid (PLLA), were implanted in coronary bifurcation models. Five treatments were conducted to examine an optimal condition for imaging BRSs: Baseline treatment, samples were filled with normal saline and scanned with mCT immediately; Treatment-1, -2, -3 and -4, samples were filled with contrast medium and scanned with mCT immediately and 1, 2 and 3 h thereafter, corresponding to soaking time of contrast medium of 0, 1, 2 and 3 h. Compared to Baseline, mCT scanning completely discriminate the scaffold struts from the vascular lumen immediately after filling the samples with contrast agent but not from the vascular wall until the contrast agent soaking time was more than 2 h (Treatment-3 and -4). By setting 10–15 HU as a cut-point of CT values, the scaffold strut detectable rate at Baseline and Teatment-1, -2, -3 and -4 were 1.23 ± 0.31%, 1.65 ± 0.26%, 58.14 ± 12.84%, 97.97 ± 1.43% and 98.90 ± 0.38%, respectively (Treatment-3 vs. Treatment-2, p < 0.01); meanwhile, the success rate of 3D BRS reconstruction with high quality images at Baseline and Teatment-1, -2, -3 and -4 were 1.23%, 1.65%, 58.14%, 97.97% and 98.90%, respectively (Treatment-3 vs. Treatment-2, p < 0.01). In conclusions, reconstruction of 3D BRS images is technically feasible by contrast-enhanced mCT and soaking time of contrast agent for more than 2 h is necessary for complete separation of scaffold struts from the surrounding structures in the phantom samples.Electronic supplementary materialThe online version of this article (doi:10.1007/s10554-016-1049-z) contains supplementary material, which is available to authorized users.

show abstract

“…The main finding of this analysis is that 5-year mortality was lower among patients who underwent a simple strategy rather than a complex strategy [17 patients (3.8%) vs. 31 patients (7.0%); P=0.04]. Interestingly, the Kaplan-Meyer curves appear to separate after 2 years Figure 1 Proposed contemporary approach to treatment of severe bifurcation lesion (20). *, typically a large SB (>2.5 mm) supplying a large territory of myocardium with significant ostial disease extending over a long segment into the SB; **, typically a smaller SB (<2.5 mm) with focal involvement of the ostium; ***, presence of important dissection or < TIMI 3 flow in SB.…”

mentioning

confidence: 85%

Coronary bifurcation lesions: is less more?

Bennett

Dubois²

2016

J. Thorac. Dis.

View full text Add to dashboard Cite

Coronary bifurcation lesions are frequent in everyday practise and account for up to 20% of all percutaneous coronary interventions (PCI) (1). The treatment of bifurcation lesions with drug-eluting stents (DES), especially when a double stent technique is used, remains challenging and is associated with a lower procedural success rate and a higher rate of long-term adverse cardiac events such as stent restenosis and thrombosis compared to non-bifurcation PCI (2). The question relating to a one or two stent strategy for bifurcation lesions has been a subject of many debates over recent years and numerous observational and randomized studies (3-6) have supplied data to this important though at times controversial subject.Recently, Behan et al. (7) presented the 5-year outcome data from a patient-level pooled analysis of coronary bifurcation lesions treated with simple or complex stenting in two pivotal studies (7): more specifically, pooled 5-year results of the NORDIC 1 (8) and the British Bifurcation Coronary Study: Old, New, and Evolving Strategies (BBC ONE) (4), both of similar magnitude and methodology (N=413 and 500, respectively), that compared all-cause mortality and other clinical endpoints after simple singlestent (provisional T stenting) versus complex two-stent (culotte, crush and T-stenting) techniques, using DES.Before looking at the results in more detail it is important to note that differences in bifurcation anatomy and disease severity are major determinants of treatment approach and remain at the discretion and judgement of the single operator. Several valuable bifurcation classifications have been proposed (9-11), none of them fully encompassing variations in anatomy, including vessel size, bifurcation angle and extent of disease in the side branch. From a practical point of view, the operator is generally speaking faced with one of two situations: in the first scenario, due to the severity of the disease at the bifurcation and extending in to large calibre branches, two stents are required from the outset. This type has typically not been represented (thus giving rise to selection bias) in the randomized studies to date comparing different strategies as operators are not willing to risk randomising these patients to a single-stent strategy. The second type of bifurcation lesion is where one or two stents can be used. For these bifurcation lesions, multiple randomized studies comparing a routine twostent strategy with a provisional strategy (single stent in the main vessel with additional side branch stent only if indicated) have shown comparable efficacy outcomes (target vessel/target lesion revascularization rates) between the two treatment strategies, although the provisional strategy resulted in lower rates of peri-procedural myocardial infarction (MI), less contrast use, lower X-ray doses and shorter procedural times (3,4,6). There is therefore, for this second type of lesion, a general consensus that it is better to Keep It as Simple and Safe as possible and implant one stent (KISS provis...

show abstract

Comparative Analysis of Sequential Proximal Optimizing Technique Versus Kissing Balloon Inflation Technique in Provisional Bifurcation Stenting

Cited by 114 publications

References 19 publications

Concept and practice of transradial 5 French percutaneous treatment of coronary bifurcation lesions

Concept and practice of transradial 5 French percutaneous treatment of coronary bifurcation lesions

Visualizing polymeric bioresorbable scaffolds with three-dimensional image reconstruction using contrast-enhanced micro-computed tomography

Coronary bifurcation lesions: is less more?

Contact Info

Product

Resources

About