Intravascular ultrasound-guided percutaneous coronary intervention in left main coronary bifurcation lesions: a review

Isolated Coronary Artery Stenoses (CAS) involving the ostium of the Left Anterior Descending (LAD) artery is very challenging, especially in a setting of primary Angioplasty in Myocardial Infarction (PAMI). Intimal atherosclerosis in the Left Main Coronary Artery (LMCA) bifurcation is primarily in area of low shear stress which is the lateral wall, close to the LAD and Left Circumflex (LCx). Thus, carina is usually free of disease, which can explain why single-stent strategy can be successful. However, precise stent placement is often difficult due to unwanted stent movement within vessel or its proximity to side branches. A decision must be made at the outset, to decide on the approach to be employed, to treat osteal LAD lesions. Limited data is available on patients undergoing primary PCI of osteal LAD lesions. Here, we present our experience and problems encountered during the management of osteal LAD lesions in the setting of PAMI.

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“…Various techniques of both single vessel and bifurcation stenting have been described [6][7][8]. Floating-stent technique [9].…”

Section: Discussionmentioning

confidence: 99%

Clinical Profile and Approach to Osteal LAD Lesion During Primary Angioplasty in Myocardial Infarction (PAMI)

Sanzgiri

Thanedar

et al. 2020

CCCM

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“… Culotte technique : 2 stents are deployed at the same time, from the main vessel into each branch with strut opening to each branch by kissing balloon inflation leaving the proximal main vessel covered with two overlapped stents. DK Crush technique: which consists of stenting from the main vessel into the SB, balloon crushing from the MB, kissing balloon inflation, stenting from the main vessel into the MB and final kissing balloon inflation [ 21 – 23 ]. …”

Section: Methodsmentioning

confidence: 99%

“…DK Crush technique: which consists of stenting from the main vessel into the SB, balloon crushing from the MB, kissing balloon inflation, stenting from the main vessel into the MB and final kissing balloon inflation [ 21 – 23 ].…”

Section: Methodsmentioning

confidence: 99%

Early effect of different bifurcation techniques on left ventricular mechanics in elective percutaneous coronary intervention

Elsheikh,

Elsaeid,

Sharafeldin

et al. 2024

Egypt Heart J

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Background Bifurcation lesions are prevalent amongst patients with symptomatic coronary artery disease subjected to percutaneous coronary intervention (PCI). Recent consensus commends a conservative (provisional) approach when managing the side branch. Here, the aim was to explore the immediate impact of different bifurcation techniques (one stent and two stent strategies) on left ventricular LV) myocardial functions using speckle tracking echocardiography in patients subjected to elective PCI. Sixty two consecutive patients diagnosed with coronary bifurcation lesion (CBL) were enrolled. Patients were categorized into: one-stent strategy (Provisional group, n = 44) and a two-stent strategy (TAP, DK crush, or Culotte technique, n = 18), based on the coronary bifurcation site, angle, side branch diameter and Medina classification. LVEF%, regional and global longitudinal strain (GLS), and E/E' were measured before and within 24 h post PCI. Results In both provisional and 2- stent technique, the mitral inflow velocities and mitral annular velocities showed improvement with significant reduction in E/e' (P < 0.03 and P < 0.001) respectively while LVEF% did not change. There were no significant changes in any other echo parameters post PCI. In provisional group, there were significant improvements in LAD (P < 0.001), RCA (P < 0.01) territories and GLS (P < 0.01). Δ LAD was expressively higher (34.5%) compared with Δ LCX (9.6%) and ΔRCA (25.4%), P < 0.001, P < 0.01 respectively. In the 2-stent technique group, there were significant improvements in peak longitudinal strain of LAD territory (P < 0.01), RCA territory (P < 0.01) and GLS (P < 0.01) respectively. Δ LAD territory was significantly higher in provisional group in comparison with the 2- stent technique group. Δ GLS was correlated inversely to Gensini score in provisional group and to the number of vessel diseased in 2-stent technique group. Conclusion PCI of the bifurcation lesion positively impact myocardial function. Both bifurcation techniques improve LV mechanical properties using 2D strain imaging while LV EF% remains unchanged.

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Intravascular ultrasound-guided percutaneous coronary intervention in left main coronary bifurcation lesions: a review

Cited by 2 publications

References 49 publications

Clinical Profile and Approach to Osteal LAD Lesion During Primary Angioplasty in Myocardial Infarction (PAMI)

Clinical Profile and Approach to Osteal LAD Lesion During Primary Angioplasty in Myocardial Infarction (PAMI)

Early effect of different bifurcation techniques on left ventricular mechanics in elective percutaneous coronary intervention

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