Effectiveness of decremental diameter balloon catheters (tapered balloon)

Banka, Vidya S.; Baker, Howard A.; Vemuri, Dwarka N.; Voci, Gerardo; Maniet, Alan R.

doi:10.1016/0002-9149(92)91303-l

Cited by 19 publications

(16 citation statements)

References 12 publications

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“…In one study, Banka et al analyzed tapered coronary anatomy, 1 cm proximal and distal to the stenosis, in 100 consecutive coronary arteries. They observed that 23% of arteries had ≥ 1 mm taper and 19% arteries had a 0.5 - 0.99 mm taper [12]. Hence, stent sizing is critical for the success of PCI for treating long-tapered lesions as “stent over-sizing” (stent larger in diameter than the healthy artery) may induce pathological stress on the arterial wall and damage to the artery may be irreversible leading to aneurysm formation, late ST and even late perforations.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Novel Long-Tapered Sirolimus-Eluting Coronary Stent System in Real-World Patients With Long Diffused De Novo Coronary Lesions

et al. 2018

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BackgroundWhen coronary lesions involve segments > 48 mm, the only treatment possibility is stent overlapping which is associated with higher neointimal proliferation that lead to more restenosis. Furthermore, tapering of coronary arteries is a major challenge observed with long diffuse coronary lesions. This study attempted to assess the safety and performance of world’s first commercialised long-tapered (60 mm) sirolimus-eluting coronary stent (SES) system for the treatment of long diffused de novo coronary lesions in real world scenario.MethodsThis was a retrospective, non-randomised, multicentre study which included 362 consecutive patients implanted with long-tapered BioMime™ Morph SES system for the treatment of long diffused de novo coronary lesions. Safety endpoint was major adverse cardiac events (MACE), which was defined as composite of cardiac death, myocardial infarction (MI) and ischemic-driven target lesion revascularization (ID-TLR), at 12-month follow-up.ResultsOut of 362 patients included, 170 (47.0%) were diabetic and 159 (43.9%) were hypertensive. The mean age of all patients was 61.09 ± 9.04 years. A total of 625 lesions were identified; out of which 402 lesions were intervened successfully using BioMime Morph. The cumulative incidence of MACE was 7 (2.0%) at 12-month follow-up which included four (1.1%) cardiac deaths, one (0.3%) case of MI and two (0.6%) ID-TLR. Acute stent thrombosis was reported in one (0.3%) patient.ConclusionsThe present study confirms the safety and performance of BioMime Morph, and hence, can be considered as a treatment of choice for long diffused tapered de novo coronary lesions in routine clinical practice.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Novel Long-Tapered Sirolimus-Eluting Coronary Stent System in Real-World Patients With Long Diffused De Novo Coronary Lesions

et al. 2018

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“…Surface meshes from the three bifurcations for each patient were imported into VMTK (http://www.vmtk.org) and MATLAB (MathWorks, Natick, MA) to determine centerlines, bifurcation vectors, and metrics (Table ). Centerlines were determined in VMTK as the shortest path between the proximal and distal ends of each artery using the centers of maximally inscribed spheres.…”

Section: Methodsmentioning

confidence: 99%

“…A taper factor for each artery location was calculated as

T = \frac{D_{prox, mean} - D_{dist, mean}}{0.5 \cdot L}

. This represents a modification from previous studies designed to mitigate the impact of extreme diameters at the inlet and outlet of each branch. Finally, curvature C was calculated at each point along centerlines as the inverse of the radius of the local osculating circle, and reported as an average for each artery location.…”

Section: Methodsmentioning

confidence: 99%

Image‐based quantification of 3D morphology for bifurcations in the left coronary artery: Application to stent design

Ellwein

Marks

Migrino

et al. 2015

Cathet Cardio Intervent

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Background Improved strategies for stent-based treatment of coronary artery disease at bifurcations requires a greater understanding of artery morphology. Objective We developed a workflow to quantify morphology in the left main coronary (LMCA), left anterior descending (LAD), and left circumflex (LCX) artery bifurcations. Methods Computational models of each bifurcation were created for 55 patients using computed tomography images in 3D segmentation software. Metrics including cross-sectional area, length, eccentricity, taper, curvature, planarity, branching law parameters, and bifurcation angles were assessed using open-sources software and custom applications. Geometric characterization was performed by comparison of means, correlation and linear discriminant analysis (LDA). Results Differences between metrics suggest dedicated or multi-stent approaches should be tailored for each bifurcation. For example, the side branch of the LCX (i.e., obtuse marginal; OM) was longer than that of the LMCA (i.e. LCXprox) and LAD (i.e. first diagonal; D1). Bifurcation metrics for some locations (e.g. LMCA Finet ratio) provide results and confidence intervals agreeing with prior findings, while revised metric values are presented for others (e.g., LAD & LCX). LDA revealed several metrics that differentiate between artery locations (e.g., LMCA vs D1, LMCA vs OM, LADprox vs D1, and LCXprox vs D1). Conclusions These results provide a foundation for elucidating common parameters from healthy coronary arteries and could be leveraged in the future for treating diseased arteries. Collectively the current results may ultimately be used for design iterations that improve outcomes following implantation of future dedicated bifurcation stents.

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“…This type of lesion may pose multiple challenges during the procedure, such as difficulties in evaluating the lesion, selecting the stent size, setting the landing zone as well as choosing the balloon size for poststenting optimization. [1][2][3] A stent or balloon size that is suitable for the proximal segment of a mismatch lesion may be oversized for the distal segment and cause excessive damage to the vessel wall in this area. 3,4 On the contrary, a smaller stent or balloon which fits the distal segment of the lesion may be undersized for the proximal segment and can easily lead to stent mal-apposition.…”

Section: Introductionmentioning

confidence: 99%

“…Other solutions that utilize dedicated tapered stents, tapered balloons, or selfexpandable stents to attain more flexible adaptation with both proximal and distal segments of the mismatch lesion are not widely available. 2,5,6 Due to the abovementioned reasons, better understanding about the angiographic and intravascular ultrasound (IVUS) characteristics of coronary mismatch lesions may help to achieve more accurate lesion assessment, prepare more effective intervention strategy, and therefore improve the procedure outcomes for this type of lesion.…”

Section: Introductionmentioning

confidence: 99%

Imaging Characteristics of Mismatch Lesions: An Angiographic and Intravascular Ultrasound Analysis of 1369 Coronary Lesions

Phan

Nguyen

Nguyen³

et al. 2019

Angiology

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Objectives:To evaluate the angiographic and intravascular ultrasound (IVUS) characteristics of coronary mismatch lesions.Background:Better understanding about the characteristics of mismatch lesions may help to achieve more accurate lesion assessment and, thereby, to improve the outcomes of percutaneous coronary intervention (PCI).Methods:Angiographic and IVUS data from 1369 lesions were analyzed. Mismatch lesion was defined as the difference between proximal and distal reference lumen diameters of ≥1.0 mm or ≥30% of the distal reference lumen diameter.Results:The incidence of mismatch lesions was 20.1% (275/1369). Compared to nonmismatch group, mismatch group had longer lesions (21.3 [6.4] mm vs 18.4 [6.4] mm, P < .001) with smaller minimum lumen diameter (0.87 [0.29] mm vs 1.10 [0.31] mm, P < .001) and more severe diameter stenosis (78.8% [9.2%] vs 66.3% [10.3%], P < .001). On IVUS, mismatch group had larger lumen area (18.7 [5.0] vs 15.8 [5.1] mm2, P < .001) but lower plaque burden at the proximal reference segment (41.0% [9.2%] vs 45.7% [9.9%], P < .001) and smaller lumen area (4.83 [1.89] vs 7.36 [2.89] mm, P < .001) but higher plaque burden at the distal reference segment (42.9% [10.4%] vs 41.4% [10.1%], P = .023). Multivariable logistic regression analysis showed that mismatch lesions were frequently accompanied by diffuse lesions (odds ratio [OR] = 2.50; 95% confidence interval [CI]: 1.83-3.40; P < .001), bifurcation lesions (OR = 5.83; 95% CI: 4.40-7.74; P < .001), and lesions with a low TIMI flow grade (OR = 1.70; 95% CI: 1.08-2.67; P = .022) or severe diameter stenosis (OR = 3.05; 95% CI: 2.10-4.43; P < .001).Conclusions:Mismatch lesions are quite common and characterized by greater lesion complexity compared with nonmismatch lesions. Further studies may be necessary to address the impact of this lesion type on the outcome of PCI.

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Effectiveness of decremental diameter balloon catheters (tapered balloon)

Cited by 19 publications

References 12 publications

Clinical Outcomes of Novel Long-Tapered Sirolimus-Eluting Coronary Stent System in Real-World Patients With Long Diffused De Novo Coronary Lesions

Clinical Outcomes of Novel Long-Tapered Sirolimus-Eluting Coronary Stent System in Real-World Patients With Long Diffused De Novo Coronary Lesions

Image‐based quantification of 3D morphology for bifurcations in the left coronary artery: Application to stent design

Imaging Characteristics of Mismatch Lesions: An Angiographic and Intravascular Ultrasound Analysis of 1369 Coronary Lesions

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