Consensus from the 7th European Bifurcation Club meeting

Stanković, Goran; Lefèvre, Thierry; Chieffo, Alaide; Hildick‐Smith, David; Lassen, Jens Flensted; Pan, Manuel; Darremont, Olivier; Albiero, Remo; Ferenc, Mirosław; Finet, Gérard; Adriaenssens, Tom; Koo, Bon Kwon; Burzotta, Francesco; Louvard, Yves

doi:10.4244/eijv9i1a7

Cited by 101 publications

(61 citation statements)

References 64 publications

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“…Stent size selection is generally determined based on a stent-to-artery ratio of 1.0:1 to 1.2:1 [15]. Nevertheless, particularly in left main [5] and likewise long and bifurcated lesions [20,29], vessel tapering can be an important problem, which may not be adequately solved by conventional tubular stents [30]. Thus, a large diameter mismatch at the distal site of the stent may lead to damage in the arterial wall, increased wall stress, endothelial dysfunction and, as a result, worse clinical outcomes [5,27,30].…”

Section: Discussionmentioning

confidence: 99%

“…The European Bifurcation Club has advised routine measurement of LMCA-LAD BA (or distal LMCA BA) for planning bifurcation treatment strategy and for the prediction of procedural outcomes [19,20,26,29]. A T-stent or modified T-stent, or TAP (T-and-protrusion) techniques are considered for T-shaped (≥ 70%) LMCA distal BA lesions because of its contribution to complete coverage of the bifurcation [19,20,26,29].…”

Section: Discussionmentioning

confidence: 99%

“…PCI for distal LMCA stenosis is associated with relatively poor clinical outcomes [22,29]. Angiographic in-stent restenosis which leads to repeat revascularisation is the main reason of distal LMCA PCI-related poor clinical outcomes [6].…”

Section: Introductionmentioning

confidence: 99%

“…Distal LMCA stenosis can be presented with a wide variety of complexity [20,26,29]. PCI for distal LMCA stenosis is associated with relatively poor clinical outcomes [22,29].…”

Section: Introductionmentioning

confidence: 99%

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Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Distal LMCA stenosis can be presented with a wide variety of complexity [20,26,29]. PCI for distal LMCA stenosis is associated with relatively poor clinical outcomes [22,29].…”

Section: Introductionmentioning

confidence: 99%

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Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography

et al. 2017

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“…The advancements shown in this work are perfectly timed as ~150 key opinion leaders from academia, industry and cardiology recently expressed their willingness to adopt a new way of thinking that includes the possibility of simulating interventions using patientspecific data (Stankovic et al, 2013). Unfortunately enthusiasm is tempered by the fact that translation of virtual patient-specific computational modeling to the clinic is dependent on the time needed to obtain the results, as well as to their reliability.…”

mentioning

confidence: 99%

Computational replication of the patient-specific stenting procedure for coronary artery bifurcations: From OCT and CT imaging to structural and hemodynamics analyses

Chiastra

Dickerhoff

et al. 2016

Journal of Biomechanics

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The optimal stenting technique for coronary artery bifurcations is still debated. With additional advances computational simulations can soon be used to compare stent designs or strategies based on verified structural and hemodynamics results in order to identify the optimal solution for each individual's anatomy. In this study, patient-specific simulations of stent NOT THE PUBLISHED VERSION; this is the author's final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation at the bottom of the page. Biomechanics, Vol 49, No. 11 (July 26, 2016): pg. 2102-2111. DOI. This article is © Elsevier Ltd. and permission has been granted for this version to appear in e-Publications@Marquette. Elsevier Ltd. does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from Elsevier Ltd. Journal of3 deployment were performed for 2 cases to replicate the complete procedure conducted by interventional cardiologists. Subsequent computational fluid dynamics (CFD) analyses were conducted to quantify hemodynamic quantities linked to restenosis.Patient-specific pre-operative models of coronary bifurcations were reconstructed from CT angiography and optical coherence tomography (OCT). Plaque location and composition were estimated from OCT and assigned to models, and structural simulations were performed in Abaqus. Artery geometries after virtual stent expansion of Xience Prime or Nobori stents created in SolidWorks were compared to post-operative geometry from OCT and CT before being extracted and used for CFD simulations in SimVascular. Inflow boundary conditions based on body surface area, and downstream vascular resistances and capacitances were applied at branches to mimic physiology.Artery geometries obtained after virtual expansion were in good agreement with those reconstructed from patient images. Quantitative comparison of the distance between reconstructed and post-stent geometries revealed a maximum difference in area of 20.4%. Adverse indices of wall shear stress were more pronounced for thicker Nobori stents in both patients. These findings verify structural analyses of stent expansion, introduce a workflow to combine software packages for solid and fluid mechanics analysis, and underscore important stent design features from prior idealized studies. The proposed approach may ultimately be useful in determining an optimal choice of stent and position for each patient.

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Functional side‐branch stenosis after cross‐over stenting

Belardi

Albertal

2013

Cathet Cardio Intervent

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Despite advances in catheter-based technology, coronary artery bifurcations continue to defy operators. In fact for decades, we have been fascinated by the diverse morphology of coronary bifurcations (i.e., degree of angulations, various branch sizes, and patterns of plaque distribution) along with the erratic changes in luminal size exhibited after cross-over stenting. Currently, a large body of evidence supports main branch (MB) stenting with provisional side branch (SB) stenting as the primary strategy for the vast majority of bifurcations [1]. With this strategy, poststenting SB narrowing occurs often. Recently, a serial intravascular ultrasound (IVUS) imaging study elucidated the mechanism responsible for SB narrowing following cross-over stenting [2]. In that study, a reduction in luminal size at the SB ostium site was observed in 78% of bifurcations. This reduction was chiefly related to the modification in bifurcation angles (carina shift) and, to a lesser extent, an increase in plaque burden at the SB ostium site (plaque shift) [2]. Nonetheless, several reports have shown that most jailed SB do not bare physiological significance [1] and may not warrant further intervention [1]. In this issue of Catheterization and Cardiovascular Interventions, Kang et al. further extend the evidence by illustrating the role of these two mechanisms (carina shift and plaque shifts) in the causation of functional stenosis at the SB ostium [3]. In 40 patients undergoing single stent cross-over stenting, 31 (78%) had >10% reduction in minimum luminal area at the SB ostium. In the setting of luminal narrowing, carina shift was found in 97% of cases, whereas the presence of plaque shift was less common. Meanwhile, a fractional flow reserve (FFR) value <0.8 was found only in 6 (15%) patients. In those individuals with functional stenosis, the detection of plaque shift was common (83%), whereas carina shift was not (20%). Importantly, functional SB stenosis was strongly related to the baseline severity (low minimum luminal area and large plaque burden) at the SB ostium and MB carina. These parameters of baseline severity may identify patients at greater risk for plaque shift, and eventually, functional deterioration of the SB lumen. Although these preliminary results highlight the potential use of IVUS for the baseline evaluation of coronary bifurcations, the low rate of functional SB stenosis after crossover stenting along with the recent introduction of very effective and safe drug-eluting stents may argue against the routine use of IVUS during the percutaneous treatment of coronary bifurcations. After many decades, the debate about the precise role of IVUS during percutaneous coronary interventions continues. REFERENCES1. Stankovic G, Lefevre T, Chieffo A, Hildick-Smith D, Lassen JF, Pan M, Darremont O, Albiero R, Ferenc M, Finet G, et al. Consensus from the 7th European Bifurcation Club meeting. EuroIntervention 2013;9:36-45. 2. Kang SJ, Mintz GS, Kim WJ, Lee JY, Oh JH, Park DW, Lee SW, Kim YH, Lee CW, Park SW, et al. Change...

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Consensus from the 7th European Bifurcation Club meeting

Cited by 101 publications

References 64 publications

Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography

Anatomic assessment of the left main bifurcation and dynamic bifurcation angles using computed tomography angiography

Computational replication of the patient-specific stenting procedure for coronary artery bifurcations: From OCT and CT imaging to structural and hemodynamics analyses

Functional side‐branch stenosis after cross‐over stenting

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