Examination of Stent Deformation and Gap Formation after Complex Stenting of Left Main Coronary Artery Bifurcations Using Microfocus Computed Tomography

Murasato, Yoshinobu; Hikichi, Yutaka; Horiuchi, Masataka

doi:10.1111/j.1540-8183.2009.00436.x

Cited by 50 publications

(33 citation statements)

References 22 publications

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“…These differences explain why main branchrelated clinical events are more frequent and more severe than side branch-related events and why the previous studies failed to prove the benefit of routine stenting for side branches in bifurcation lesions. Revascularization for clinically insignificant side branches cannot be translated into clinical benefit and may even be harmful (21)(22)(23). In this regard, future studies designed to show the clinical benefit of a new device or treatment strategy in bifurcation lesions should include only the clinically relevant side branches.…”

Section: Discussionmentioning

confidence: 95%

Assessment of Clinical, Electrocardiographic, and Physiological Relevance of Diagonal Branch in Left Anterior Descending Coronary Artery Bifurcation Lesions

Koo

Lee

et al. 2012

JACC: Cardiovascular Interventions

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Section: Discussionmentioning

confidence: 95%

Assessment of Clinical, Electrocardiographic, and Physiological Relevance of Diagonal Branch in Left Anterior Descending Coronary Artery Bifurcation Lesions

Koo

Lee

et al. 2012

JACC: Cardiovascular Interventions

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“…6 In addition, inadequate side-branch dilatation may result in stent deformation or incomplete stent apposition. 7 In contrast, quantitative coronary angiography (QCA) conducted in the Nordic-Baltic Bifurcation Study III showed better expansion of the side-branch orifice in the FKI group. 6 Because delayed arterial healing characterized by exposed stent struts is considered a possible risk factor for stent thrombosis, 8 struts floating at the side-branch orifice (jailing strut) could affect thrombus formation after DES implantation.…”

mentioning

confidence: 99%

Potential Benefit of Final Kissing Balloon Inflation After Single Stenting for the Treatment of Bifurcation Lesions

Hasegawa

Shinke

Otake

et al. 2013

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp benefit of routine FKI after single stenting of bifurcation lesions. 6 In addition, inadequate side-branch dilatation may result in stent deformation or incomplete stent apposition. 7 In contrast, quantitative coronary angiography (QCA) conducted in the Nordic-Baltic Bifurcation Study III showed better expansion of the side-branch orifice in the FKI group. 6 Because delayed arterial healing characterized by exposed stent struts is considered a possible risk factor for stent thrombosis, 8 struts floating at the side-branch orifice (jailing strut) could affect thrombus formation after DES implantation. Despite these controversies, the relationship between stenting strategies and local findings, such as stent apposition, thrombus formation, and neointimal coverage, which may be associated with long-term clinical outcome, has not been well evaluated to date.Several studies have shown that the high resolution of optical coherence tomography (OCT) enables visualization of coronary arteries at the micron level for evaluation of strut coverercutaneous coronary intervention (PCI) using drugeluting stents (DES) reduces restenosis and major adverse cardiac events (MACE) compared to PCI with bare metal stents. 1 Even in the DES era, however, the procedures for bifurcation remain complex and challenging. 2,3 The single-stent strategy is currently considered preferable because the 2-stent strategy has higher rates of periprocedural myocardial infarction and long-term MACE, 4,5 which is probably associated with the increased use of contrast and prolonged procedure time. Therefore, a 1-stent strategy with a provisional approach to the side branch with final kissing inflation (FKI) might be the most acceptable strategy in clinical practice.Recently, the Nordic-Baltic Bifurcation Study III, a randomized comparison of clinical outcomes in patients with coronary bifurcation lesions treated with FKI vs. without FKI after main vessel (MV) stenting, found a similar 6-month clinical outcome between the 2 groups, raising questions regarding the Background: Treatment of coronary bifurcation lesions using a single stenting strategy is preferable over that using a 2-stent technique. The benefit of final kissing inflation (FKI), however, has not been established.

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“…Indeed, bench tests have shown that when stents are crushed, there is a trough between the MV and SB stents on the side opposite to the crushed portion (42)(43)(44)(45). If a wire recrosses the MV stent through a distal strut, it may pass outside the stents through the trough before entering the SB stent.…”

Section: Gaining Insight Into Kbmentioning

confidence: 97%

Kissing Balloon Inflation in Percutaneous Coronary Interventions

Sgueglia

Chevalier

2012

JACC: Cardiovascular Interventions

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Bifurcation lesions are the most frequently approached complex coronary lesions in everyday interventional practice. Bifurcations complexity relies essentially on their very specific anatomy that is imperfectly handled by current coronary devices and, despite dedicated techniques and drug-eluting stents, percutaneous coronary interventions directed toward the treatment of bifurcations are technically demanding and require proper execution. Kissing balloon (KB) inflation was the first specific bifurcation technique to have been developed for percutaneous bifurcation interventions and continues to currently play an important role. Indeed, KB has been proposed to optimize stent apposition, improve side branch access while correcting stent deformation or distortion. Over the years, the KB technique has been deeply investigated by many different methods, from bench testing and computer simulations to in vivo intravascular imaging and clinical studies, producing a large amount of data pointing out the benefits and limitations of the technique. We sought to provide here a comprehensive overview of all those aspects.

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Examination of Stent Deformation and Gap Formation after Complex Stenting of Left Main Coronary Artery Bifurcations Using Microfocus Computed Tomography

Abstract: MFCT analysis in the 3D phantom model is useful to assess the structural deformation of the stents and gap on vessel wall coverage after complex stenting at the LM bifurcation.

Cited by 50 publications

References 22 publications

Assessment of Clinical, Electrocardiographic, and Physiological Relevance of Diagonal Branch in Left Anterior Descending Coronary Artery Bifurcation Lesions

Assessment of Clinical, Electrocardiographic, and Physiological Relevance of Diagonal Branch in Left Anterior Descending Coronary Artery Bifurcation Lesions

Potential Benefit of Final Kissing Balloon Inflation After Single Stenting for the Treatment of Bifurcation Lesions

Kissing Balloon Inflation in Percutaneous Coronary Interventions

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