Mechanical debulking versus balloon angioplasty for the treatment of true bifurcation lesions

Dauerman, Harold L.; Higgins, Peter J.; Sparano, Anthony; Gibson, C. Michael; Garber, Gary R.; Carrozza, Joseph P.; Kuntz, Richard E.; Laham, Roger J.; Shubrooks, Samuel J.; Baim, Donald S.; Cohen, David J.

doi:10.1016/s0735-1097(98)00488-4

Cited by 67 publications

(46 citation statements)

References 33 publications

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“…27,28 However, these techniques require more time and higher technical expertise than conventional procedures, and are potentially dangerous. 29 Specialized procedures may therefore only be warranted when the risk of side branch occlusion is particularly high.…”

Section: Discussionmentioning

confidence: 99%

Intravascular Ultrasound Predictors of Side Branch Occlusion in Bifurcation Lesions After Percutaneous Coronary Intervention

Furukawa

Hibi

Kosuge

et al. 2005

Circ J

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lthough success rates of percutaneous coronary intervention (PCI) are high, PCI of bifurcation lesions is associated with a relatively low success rate and a relatively high incidence of procedural complications, including side branch occlusion and myocardial infarction. . [1][2][3][4][5] Meier et al were among the first to identify the risk of side branch occlusion associated with parent vessel angioplasty. 1 They emphasized that side branches involved in vessel narrowing are at high risk for side branch occlusion during PCI. Boxt et al has reported that vessels with angiographic ostial stenosis >50% have a higher risk of occlusion than those without ostial stenosis. 2 Prior studies have demonstrated that intravascular ultrasound (IVUS) provides information not generated by angiography alone, and the use of sonographic measurements of vascular dimensions has improved short-and long-term outcomes. 6-10 Despite several lines of evidence suggesting that IVUS guidance can reduce the need for target lesion revascularization after PCI, 9,10 it remains controversial whether preintervention IVUS findings can help to identify side branches likely to occlude after PCI of bifurcation lesions.We examined whether preintervention IVUS provides information not available by angiography alone and if it can be used to predict side branch occlusion after PCI. Circulation Journal Vol.69, March 2005 Methods Lesions and the Patient PopulationThe study group consisted of 105 bifurcation lesions in 96 patients with coronary artery disease, all of which had undergone preintervention IVUS examination in the native coronary artery. No directional coronary atherectomy, rotational atherectomy, nor thrombectomy were performed. The clinical diagnoses included: acute myocardial infarction (AMI) (57%), stable angina pectoris (17%), unstable angina pectoris (15%), and previous myocardial infarction (11%). We studied bifurcation lesions involving the main branch and the ostium of the side branch. 11 Only side branches with an estimated reference luminal diameter of 1 mm or greater were considered. Twenty-four lesions were excluded for the following reasons: kissing balloon technique or sequential dilatation was performed (n=6) and extensive target lesion calcification or artifacts which precluded accurate cross-sectional evaluation of the vessel involved (n=18). The remaining 81 bifurcation lesions in 72 patients were studied.Side branch occlusion was defined as a thrombolysis in myocardial infarction (TIMI) flow of ≤2 by the final angiogram after PCI procedures. 12 Quantitative Coronary AngiographyAngiograms were reviewed before introduction of coronary guidewire and after balloon dilation or stent deployment. The coronary flow pattern of side branches was graded according to the classification system of the TIMI trial. 12 Angiograms were digitized and analyzed using an automated edge-detection algorithm (QCA-CMS, version 4.0, Medical Imaging Systems, Rotterdam, The Netherlands).

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Section: Discussionmentioning

confidence: 99%

Intravascular Ultrasound Predictors of Side Branch Occlusion in Bifurcation Lesions After Percutaneous Coronary Intervention

Furukawa

Hibi

Kosuge

et al. 2005

Circ J

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“…These data are summarised in comparison with the results of bifurcational rotational atherectomy studies published to date [12, 13]in table 4.…”

Section: Resultsmentioning

confidence: 99%

High-Speed Rotational Atherectomy in the Treatment of Bifurcation-Type Coronary Lesions

Nageh

Kulkarni²,

Thomas³

2001

Cardiology

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Background: Bifurcational coronary lesions present a major interventional challenge. The differential cutting mechanism of high-speed rotational atherectomy (HSRA) may provide a favourable technique of treating this complex lesion subtype. Methods: We evaluated the use of HSRA (32 lesions) compared to balloon angioplasty (BA) (118 lesions), with provisional stenting in both groups, in a non-randomised, retrospective study of 150 bifurcation-type lesions. Results: The HSRA/stent group had a high primary success rate of 97%, an acceptably low in-hospital event rate of 9% and an overall major adverse cardiac event (MACE) rate at a mean follow-up period of 15 ± 3.4 months of 22.5% with a target lesion revascularisation (TLR) rate of 18.7%. Procedural success in the BA/stent group was 81% with an in-hospital event rate of 14.4%, and the overall MACE rate at follow-up was 27.5% with a TLR rate of 23%. We achieved a greater acute gain in minimal luminal diameter and a lesser percentage of residual stenosis after intervention in the HSRA/stent group compared to the BA/stent group (p < 0.01). Outcome at follow-up favoured the HSRA/stent group, although the difference did not reach statistical significance. Conclusion: HSRA with provisional stenting provided a safe and effective means of treating bifurcation lesions.

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“…In comparison to other PCIs, bifurcation interventions tend to have lower rates of procedural success, higher resource utilization, and higher rates of clinical and angiographic restenosis. [3][4][5][6][7][8] Stents deployed at low pressure might leave a gap (underdeployment) between the stent and the wall of the proximal vessel that normally have a larger diameter. Guide wires and even a short balloon can go through stent struts (false-true or true-false-true) without an appreciable resistance, and this commonly causes stent crush after balloon inflation.…”

Section: A B C Discussionmentioning

confidence: 99%

Intravascular Ultrasound (IVUS) Guided Fixation of an Accidentally Crushed Coronary Stent

et al. 2008

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SUMMARYStent deployment during coronary intervention has become more and more common recently. Inappropriate stent deployment may lead to unexpected high mortality and morbidity rates. A 62 year-old man with unstable angina presented with a bifurcation lesion after diagnostic coronary angiography. A drug-eluting stent was successfully deployed across the bifurcation lesion. However, after wire exchange and rewiring followed by high pressure balloon postdilatation, the stent was accidentally crushed under IVUS guidance. We used a looping wire technique and successfully redilated the crushed instent portion. This case suggests interventionists should not always change the wire before stent well deployment and should bear in mind the value of IVUS in managing such a complication. ( These complications are also associated with unexpected high morbidity and mortality rates. However, inadvertent stent crush is a rare, yet commonly missed, complication by interventionists if the coronary angiogram is not reviewed very carefully for a lower threshold of intravascular ultrasound (IVUS) use in such situations.2) Here, we describe a bifurcation stenting case that appeared to proceed smoothly, with inadvertent severe stent crush diagnosed and corrected with IVUS guidance. CASE REPORTA 62 year-old man with unstable angina was referred to our institute for coronary angiography. A critical bifurcation stenosis was found at the mid left anteFrom the

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Mechanical debulking versus balloon angioplasty for the treatment of true bifurcation lesions

Cited by 67 publications

References 33 publications

Intravascular Ultrasound Predictors of Side Branch Occlusion in Bifurcation Lesions After Percutaneous Coronary Intervention

Intravascular Ultrasound Predictors of Side Branch Occlusion in Bifurcation Lesions After Percutaneous Coronary Intervention

High-Speed Rotational Atherectomy in the Treatment of Bifurcation-Type Coronary Lesions

Intravascular Ultrasound (IVUS) Guided Fixation of an Accidentally Crushed Coronary Stent

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