Kissing Balloon or Sequential Dilation of the Side Branch and Main Vessel for Provisional Stenting of Bifurcations

Foin, Nicolas; Torii, Ryo; Mortier, Peter; Beule, M. De; Viceconte, Nicola; Chan, Pak Hei; Davies, Justin E.; Xu, Xiao Yun; Krams, Rob; Mario, Carlo Di

doi:10.1016/j.jcin.2011.08.019

Cited by 113 publications

(58 citation statements)

References 31 publications

(33 reference statements)

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“…This procedure consists of the simultaneous expansion of two balloons in both the branches and usually concludes the PSB [7]. The haemodynamic influence of the FKB was also studied by Foin et al [8] comparing this technique with a simpler two-step sequential post-dilatation of the SB and MB. In vitro models where stents were deployed replicating clinical implanting procedures were used as a starting point to create the numerical models.…”

Section: Introductionmentioning

confidence: 99%

Computational fluid dynamic simulations of image-based stented coronary bifurcation models

Chiastra

Morlacchi

Gallo

et al. 2013

J. R. Soc. Interface.

115

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One of the relevant phenomenon associated with in-stent restenosis in coronary arteries is an altered haemodynamics in the stented region. Computational fluid dynamics (CFD) offers the possibility to investigate the haemodynamics at a level of detail not always accessible within experimental techniques. CFD can quantify and correlate the local haemodynamics structures which might lead to in-stent restenosis. The aim of this work is to study the fluid dynamics of realistic stented coronary artery models which replicate the complete clinical procedure of stent implantation. Two cases of pathologic left anterior descending coronary arteries with their bifurcations are reconstructed from computed tomography angiography and conventional coronary angiography images. Results of wall shear stress and relative residence time show that the wall regions more prone to the risk of restenosis are located next to stent struts, to the bifurcations and to the stent overlapping zone for both investigated cases. Considering a bulk flow analysis, helical flow structures are generated by the curvature of the zone upstream from the stent and by the bifurcation regions. Helical recirculating microstructures are also visible downstream from the stent struts. This study demonstrates the feasibility to virtually investigate the haemodynamics of patient-specific coronary bifurcation geometries.

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Section: Introductionmentioning

confidence: 99%

Computational fluid dynamic simulations of image-based stented coronary bifurcation models

Chiastra

Morlacchi

Gallo

et al. 2013

J. R. Soc. Interface.

115

View full text Add to dashboard Cite

show abstract

“…reducing the nonuniformity of proximal stent expansion by proximal dilation of the mother vessel (MoV) with an optimally sized balloon after KBI (6), minimizing the overlap between the 2 balloons (7), applying asymmetric inflation pressures (8), and finally, foregoing KBI altogether in favor of a final proximal optimizing technique (POT) (9). Provisional Stenting Optimization Techniques respectively).…”

mentioning

confidence: 99%

Comparative Analysis of Sequential Proximal Optimizing Technique Versus Kissing Balloon Inflation Technique in Provisional Bifurcation Stenting

Finet

Dérimay

Motreff

et al. 2015

JACC: Cardiovascular Interventions

114

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“…32,33 However, protruding and malapposed stent struts create back-facing steps, which disturb the blood flow and produce flow separation with eddies and larger shear rates. [34][35][36] The aim of the present study was to investigate the influence of increasing malapposition severity on intracoronary flow disturbances and biological response in vivo.…”

mentioning

confidence: 99%

Incomplete Stent Apposition Causes High Shear Flow Disturbances and Delay in Neointimal Coverage as a Function of Strut to Wall Detachment Distance

Foin

Gutiérrez‐Chico

Nakatani

et al. 2014

Circ: Cardiovascular Interventions

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186

118

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13are common morphological findings in fatal cases of LST after DES.9-14 DES can interfere with this physiological healing process through different mechanisms: first, the antiproliferative drug released by the device prevents the cellular mitosis required to restore the endothelial continuity; second, the polymer carrying the drug exerts a proinflammatory effect itself 15 ; finally, in Background-Lack of re-endothelialization and neointimal coverage on stent struts has been put forward as the main underlying mechanism leading to late stent thrombosis. Incomplete stent apposition (ISA) has been observed frequently in patients with very late stent thrombosis after drug eluting stent implantation, suggesting a role of ISA in the pathogenesis of this adverse event. The aim of this study was to evaluate the impact of different degrees of ISA severity on abnormal shear rate and healing response with coverage, because of its potential implications for stent optimization in clinical practice. Methods and Results-We characterized flow profile and shear distribution in different cases of ISA with increasing strutwall detachment distance (ranging from 100 to 500 μm). Protruding strut and strut malapposed with moderate detachment (ISA detachment distance <100 μm) have minimal disturbance to blood flow as compared with floating strut that has more significant ISA distance. In vivo impact on strut coverage was assessed retrospectively using optical coherence tomography evaluation on 72 stents (48 patients) sequentially at baseline and after 6-month follow-up. Analysis of coverage revealed an important impact of baseline strut-wall ISA distance on the risk of incomplete strut coverage at follow-up. Malapposed segments with an ISA detachment <100 μm at baseline showed complete strut coverage at follow-up, whereas segments with a maximal ISA detachment distance of 100 to 300 μm and >300 μm had 6.1% and 15.7% of their struts still uncovered at follow-up, respectively (P<0.001). Conclusions-Flow disturbances and risk of delayed strut coverage both increase with ISA detachment distance. Insights from this study are important for understanding malapposition as a quantitative, rather than binary phenomenon (present or absent) and to define the threshold of ISA detachment that might benefit from optimization during stent implantation. (Circ Cardiovasc Interv. 2014;7:180-189.)

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Kissing Balloon or Sequential Dilation of the Side Branch and Main Vessel for Provisional Stenting of Bifurcations

Abstract: Sequential 2-step post-dilation of the SB and MV may offer a simpler and more efficient alternative to final KB technique for provisional stenting of bifurcations.

Cited by 113 publications

References 31 publications

Computational fluid dynamic simulations of image-based stented coronary bifurcation models

Computational fluid dynamic simulations of image-based stented coronary bifurcation models

Comparative Analysis of Sequential Proximal Optimizing Technique Versus Kissing Balloon Inflation Technique in Provisional Bifurcation Stenting

Incomplete Stent Apposition Causes High Shear Flow Disturbances and Delay in Neointimal Coverage as a Function of Strut to Wall Detachment Distance

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