Experience with a technique for coronary angioplasty of bifurcational lesions

Zack, Paul M.; Ischinger, Thomas

doi:10.1002/ccd.1810100504

Cited by 61 publications

(13 citation statements)

References 6 publications

(3 reference statements)

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“…In order to avoid the risk of occlusion and possible difficulties related to recanalization protecting side branches involved in bifurcational lesions [7,8] [5], who examined the outcome of side branches larger than 1 mm, considered surgically graftable. Interestingly in these studies only 17% of patients with side branch occlusion developed a (small) myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Coronary angioplasty of bifurcational lesions without protection of large side branches

Ciampricotti

Gamal

Gelder

et al. 1992

Cathet. Cardiovasc. Diagn.

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To assess the risk and clinical relevance of side branch (SB) occlusion during angioplasty (PTCA) we attempted PTCA of major branches (MB) without protection of lesion-associated large (> or = 1.8 mm) SBs in 67 patients (50 men). There were 32 patients with unstable angina and 35 with stable angina. Their mean age was 55 years (range 31-77). There were 69 SBs: 43 with severe ostium stenosis (type A); 6 with severe non ostial stenosis (type B); and 20 with no or slight nonostial stenosis (type C). PTCA of the MB was successful in all but one patient who underwent acute bypass surgery. After MB PTCA occlusion occurred in 10 SBs (7A, 1B, 2C) and was asymptomatic in 5. Recanalization and dilatation was successful in 4 out of 5 symptomatic SB occlusions. A single patient developed a non-q wave myocardial infarction. PTCA was also attempted in 21 diseased SBs and failed in one. 21 SBs remained severely stenotic and 6 occluded. During follow-up symptomatic MB restenosis occurred in 12 patients, associated with restenosis in 4 out of 6 dilated SBs. Four patients underwent bypass surgery and 8 repeat successful PTCA. The SB was redilated in 2 cases and occluded silently in one. Angiography in 16 asymptomatic patients showed moderate MB restenosis in 3 and SB occlusion in 2. At 2.2 years follow-up 60 (89%) patients were asymptomatic with a normal exercise test and/or maintained angiographic result. Angioplasty of bifurcational lesions without SB protection can be effectively performed with a low rate of complications and a favourable long-term outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 99%

Coronary angioplasty of bifurcational lesions without protection of large side branches

Ciampricotti

Gamal

Gelder

et al. 1992

Cathet. Cardiovasc. Diagn.

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“…Ainda quando se utilizava apenas angioplastia coronária com cateter-balão, foram descritas técnicas que utilizaram dois cateteres-guia e inflações alternadas 9 , a técnica kissing balloon (KB) utilizando dois cateteres-guia e inflações simultâneas 10 e a mesma téc-nica KB utilizando um único cateter-guia e dois cateteres-balão de baixo perfil 11 .…”

Section: Históricounclassified

Lesões coronarianas de bifurcação: classificação, estratégias de tratamento e perspectivas

Miranda¹,

Filho²,

Gusmão³

et al. 2007

Rev. Bras. Cardiol. Invasiva

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SUMMARY Coronary Bifurcation Lesions: Classification, Strategies of Treatment and PerspectivesThe occurrence of coronary lesions that involve side branches, with greater or lesser risk of occlusion, is not a rare event.The percutaneous treatment of these bifurcation lesions is a challenge to interventional cardiology. Their extremely varied presentation, whether due to the arrangement of the branches, or to the plaque distribution in the branches, has resulted in the description of several classifications. When coronary angioplasty was performed only with balloon catheters, many techniques were described. Results at follow up were unsatisfactory. After the introduction of stents, other strategies, using one or two stents, were described. However, the rates of target lesion revascularization remained high. Although, the use of drug-eluting stents has shown better results than bare metal stents, they are not totally convincing yet, especially in regards to the occurrence of restenosis at the ostia of side branches. Despite of not being a new idea, other models of stents specially designed for the treatment of bifurcation lesions, called dedicated stents, are being tested and some are already on the market.

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“…As steerable wire technology advanced, the kissing balloon technique was used to a greater extent by Meier et a1 [6], Zack et a1 [7], and Pinkerton et a1 181. Their early experience with three, eight, and 13 patients, respectively, suggested that the risk of major side branch occlusion may be minimized by this technique.…”

Section: Introductionmentioning

confidence: 98%

Balloon angioplasty of coronary bifurcation lesions: The kissing balloon technique

George

Myler

Stertzer

et al. 1986

Cathet. Cardiovasc. Diagn.

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Initial experience with the technique of "kissing balloon" angioplasty is described in 52 patients undergoing coronary angioplasty. Guiding catheters employing both the femoral and brachial approach were used in all but two of the coronary angioplasties and, in addition, the bilateral femoral approach was used in the renal and peripheral angioplasties. Initial success was achieved in 51 (98%) patients. Abrupt closure requiring urgent coronary revascularization occurred in one patient six hours following the completion of the procedure. Another patient developed a new Q-wave on the electrocardiogram and moderate elevation of CPK-MB fraction following the procedure due to loss of a diagonal branch. No deaths occurred in this series. Angiographic restenosis developed in ten patients. In the recurrence group, five had repeat kissing balloon angioplasty, two had repeat single vessel angioplasty, and three patients chose elective surgical revascularization. Based on our experience, the technique of kissing balloon coronary angioplasty can be performed safely utilizing the brachio-femoral technique. The risk of major side branch occlusion can be minimized with this technique and the overall complication rate does not significantly differ from that of our experience in single vessel coronary angioplasty. Patient selection criteria are based upon the angiographic relationship of the major branch to the side branch and is important in determining the initial and long-term success of this technique.

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Experience with a technique for coronary angioplasty of bifurcational lesions

Cited by 61 publications

References 6 publications

Coronary angioplasty of bifurcational lesions without protection of large side branches

Coronary angioplasty of bifurcational lesions without protection of large side branches

Lesões coronarianas de bifurcação: classificação, estratégias de tratamento e perspectivas

Balloon angioplasty of coronary bifurcation lesions: The kissing balloon technique

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