Impact of three‐dimensional characteristics of the left main coronary artery bifurcation on outcome of crush stenting

Murasato, Yoshinobu

doi:10.1002/ccd.20916

Cited by 35 publications

(26 citation statements)

References 23 publications

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“…The model used in these studies has been previously described [13]. Briefly, it consists of a 4-mm diameter silicon tube, corresponding to the left anterior descending (LAD) artery, glued along the long axis of a 7.5-cm diameter column, and a second, 3-mm diameter tube, corresponding to left circumflex (LCX) artery, glued along the short axis of the column, at a 908 to the first.…”

Section: Methodsmentioning

confidence: 99%

“…However, 75% of restenotic lesions in these studies were located at the ostium of the side branch [18][19][20][21]; this has been variously attributed to incomplete apposition between stent and vessel [12][13][14], under-expansion [21], and fracture of the side branch stent [22]. It has been shown that a wide (>708) bifurcation angle promotes the distortion of the side branch stent, which as a result, is not completely apposed to the vessel, even after KB inflation [12,13]. A wide bifurcation angle has also been demonstrated to be a risk factor for repeat TLR [23].…”

Section: Crush Stentingmentioning

confidence: 99%

“…Recent experimental studies have demonstrated that a wide-angle bifurcation [12,13], the three-dimensional (3D) vascular structure [13,14], gradual crush [14] and stent overlap or crossing in the distal LMCA [13], can prominently contribute to incomplete apposition after double stenting. However, the impacts of spatial distribution of stent expansion and distortion of the native 3D structure have not yet been completely clarified.…”

Section: Introductionmentioning

confidence: 99%

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Three‐dimensional modeling of double‐stent techniques at the left main coronary artery bifurcation using micro‐focus X‐ray computed tomography

Murasato¹,

Horiuchi²

2007

Cathet Cardio Intervent

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Section: Methodsmentioning

confidence: 99%

Section: Crush Stentingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Three‐dimensional modeling of double‐stent techniques at the left main coronary artery bifurcation using micro‐focus X‐ray computed tomography

Murasato¹,

Horiuchi²

2007

Cathet Cardio Intervent

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“…6,14 In clinical practice, restenosis frequent occurs at the SB origin, a location that can easily be left without strut coverage in the case of provisional T-stenting, whether the SB is stented or not. 6,9 Incomplete SB coverage has been implicated as a possible cause of the high restenosis rate found at the SB origin. 6,8 It could be the consequence of different factors, such as recoil and struts malapposition at the SB origin (leading to a potential lack in drug application).…”

Section: Discussionmentioning

confidence: 99%

“…6,8 The high rate of SB ostium restenosis could be due to limited strut coverage in this area, with consequently inadequate drug distribution to the stented artery. 9 The aim of this study was to analyze the consequences of the kissing postdilatation technique (postdilatation by using simultaneous kissing balloon inflation) on 5 DESs commercially available in France, using microfocus x-ray computerized tomography (MFCT) and scanning electron microscopy (SEM). …”

mentioning

confidence: 99%

Drug-Eluting Stents in Bifurcations

Guérin

Pilet

Finet

et al. 2010

Circ: Cardiovascular Interventions

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Background-The use of a drug-eluting stent (DES) has strongly limited the incidence of in-stent restenosis in bifurcation lesions; nevertheless, restenosis still remains a problem at the origin of the bifurcation side branch. The aim of this study is to analyze the consequences of the kissing postdilatation technique on 5 DESs, using microfocus x-ray computerized tomography and scanning electron microscopy. Methods and Results-Five different DESs (Cypher, Cypher Select, Endeavor, Taxus Express, and Taxus Liberté) were deployed using kissing postdilatation protocols in a bench-top model. For all types of DES, microfocus x-ray computerized tomography analysis showed that (1) kissing postdilatation of the stent by 2 coaxial balloons caused elliptic deformation in the proximal segment and (2) kissing postdilatation technique reduced the ratio of potential metal to artery (manufacturer's data/calculated ratio [%]: Cypher, 12.7/8.8; Cypher Select, 13.5/10.2; Endeavor, 19.0/13.3; Taxus Express, 20.5/4.7; Taxus Liberté, 17.9/12.5) and the potential drug application to area in the proximal segment, including the ostial struts (struts adjacent to and lying around the side branch ostium) (manufacturer's data/calculated drug application [g/mm 2 ]: Cypher, 1.4/1.0; Cypher Select, 1.4/1.1; Endeavor, 1.6/1.1; Taxus Express, 1.0/0.7; Taxus Liberté, 1.0/0.7). Scanning electron microscopy analysis showed a significantly greater coating damage to the ostial struts in all stents evaluated (PϽ0.05). Conclusions-Commercially available DESs subjected to simultaneous kissing balloon postdilatation in an unconstrainedmodel may contribute to side branch ostial restenosis by proximal segment elliptic deformation and damage to the polymer coating. (Circ Cardiovasc Interv. 2010;3:120-126.)Key Words: bifurcations Ⅲ stents Ⅲ angioplasty Ⅲ coronary disease Ⅲ restenosis B ifurcation lesions frequently occur in Ϸ15% of percutaneous coronary interventions. 1,2 Angioplasty with baremetal coronary stenting became the routine treatment for these lesions, but bifurcation stenting was still associated with a high rate of restenosis, especially when multiple stents were used. 2,3 The use of a drug-eluting stent (DES) has been reported to reduce restenosis in bifurcation lesions; however, side branch (SB) ostial restenosis still remains a problem in 10% to 20% of cases. 4 -7 Implanting a second stent in the SB does not limit restenosis, 6 and systematic SB stenting seems to be associated with a higher risk of restenosis than with the provisional T-stenting technique. 6,8 The high rate of SB ostium restenosis could be due to limited strut coverage in this area, with consequently inadequate drug distribution to the stented artery. 9 The aim of this study was to analyze the consequences of the kissing postdilatation technique (postdilatation by using simultaneous kissing balloon inflation) on 5 DESs commercially available in France, using microfocus x-ray computerized tomography (MFCT) and scanning electron microscopy (SEM). Clinical Perspective on p 126 M...

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Final kissing balloon inflation by classic crush stenting did not improve the clinical outcomes for the treatment of unprotected left main bifurcation lesions: The importance of double‐kissing crush technique

Chen

Zhang

et al. 2008

Cathet Cardio Intervent

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Impact of three‐dimensional characteristics of the left main coronary artery bifurcation on outcome of crush stenting

Cited by 35 publications

References 23 publications

Three‐dimensional modeling of double‐stent techniques at the left main coronary artery bifurcation using micro‐focus X‐ray computed tomography

Three‐dimensional modeling of double‐stent techniques at the left main coronary artery bifurcation using micro‐focus X‐ray computed tomography

Drug-Eluting Stents in Bifurcations

Final kissing balloon inflation by classic crush stenting did not improve the clinical outcomes for the treatment of unprotected left main bifurcation lesions: The importance of double‐kissing crush technique

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