Natural history of small and medium-sized side branches after coronary stent implantation

Poerner, Tudor C.; Kralev, Stefan; Voelker, Wolfram; Sueselbeck, Tim; Latsch, Asvin; Pfleger, Stefan; Schumacher, Burghard; Borggrefe, Martin; Haase, Karl K.

doi:10.1067/mhj.2002.120411

Cited by 72 publications

(62 citation statements)

References 12 publications

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“…24 Poerner et al suggested that the most common cause of side branch occlusion is 'snowplowing' of atherosclerotic plaque into branch vessels. 16 In the current study, side branches in which diffuse atherosclerotic plaque truly involved the ostium had a higher occlusion rate than those in which angiographic ostial stenosis was due to atherosclerotic plaque only in the main vessel. This finding suggests that a 'snowplowing' phenomenon may be pronounced when diffuse atherosclerosis directly involves the ostium of a side branch.…”

Section: Discussionmentioning

confidence: 81%

“…15 Poerner et al reported that independent predictors of acute side branch occlusion after stent implantation included reference side branch diameter at baseline, ostial side branch stenosis before stenting and involvement of the side branch origin within the lesion of the parent vessel. 16 Among side branches at high risk, however, it is difficult to distinguish which side branches are most likely to occlude after PCI solely on the basis of angiographic findings. To our knowledge, this is the first study to examine IVUS predictors of side branch occlusion after currently used techniques for PCI in patients with coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

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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: 81%

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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“…[4][5][6] Therefore, side branch compromise after stent implantation is safe and effective. [10][11][12] In this study, the angiographic outcomes of compromised side branches (stent jail) after PCI, postprocedural MI and the 6-month clinical outcomes were similar between the patients treated with SES and PES. The in-hospital and 6-month major adverse cardiac event rates were low in both groups despite a conservative treatment strategy for the compromised or occluded small side branches after stenting in the LAD.…”

Section: )5)mentioning

confidence: 99%

Comparison of the Clinical and Angiographic Outcomes of Compromised Side Branches (Stent Jail) after Percutaneous Coronary Intervention between Sirolimus-Eluting Stents and Paclitaxel-Eluting Stents

Lee

et al. 2007

Korean Circ J

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Background and Objectives: Drug-eluting stents (DES) have been used worldwide for conducting safe and effective percutaneous coronary intervention (PCI) for treating coronary artery disease. However, the DES might cause a higher frequency of an acute side branch occlusion or stent jails near the target lesion after PCI than that with using bare metal stents (BMS). This may be due to the eluted drug or the thick stent struts. We evaluated the clinical and angiographic outcomes of compromised side branches (stent jail) after PCI and the frequency of side branch occlusion or stent jails between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES). Subjects and Methods: We analyzed the clinical results and angiographic findings of 47 patients who were treated with a SES and 45 patients who were treated with a PES. We only analyzed the left anterior descending artery (LAD) and its side branches that were more than one millimeter in diameter. Side branch occlusion was defined as the development of total occlusion or a reduction of the thrombolysis in myocardial infarction (TIMI) flow more than grade 1 after stenting. The peak cardiac enzyme levels were measured. We evaluated the clinical outcomes in the hospital and at the 6 month follow up. Results: There were no significant differences of the baseline clinical demographics between the SES and the PES groups. The total length and diameter of the implanted stents were 42.85±15.3 mm vs. 41.68±13.3 mm (p=0.93) and 3.09±0.3 mm vs. 3.1±0.2 mm (p=0.69) in the SES group and PES group, respectively. On average, the number of side branches of the LAD were 2.00±0.9 vs. 2.13±0.8 and on angiography after stenting, side branch occlusion and reduction of the TIMI developed in 8.51% vs. 13.33% (p=0.46) and 17% vs. 15% (p=0.88) of the SES group and PES group, respectively. The laboratory data showed that the peak creatine kinase-MB (CK-MB) and troponin-I levels were 13.5±31 U/L vs. 15.6±33 U/L (p=0.77) and 6.3±15 ng/mL vs. 5.42±9 ng/mL (p=0.77), respectively. There were no clinical in-hospital events for either group. There were no statistically significant differences in major adverse cardiac events (MACEs) at the 6-month follow up (4.3% vs. 8.9%, respectively). Conclusion: The clinical and angiographic outcomes of compromised side branches (stent jail) after PCI and the frequency of side branch occlusion or stent jails between SES and PES were similar. (Korean Circ J 2007;37: [630][631][632][633][634]

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“…7 The mechanism of injury during PCI involves distal embolization and side branch occlusions, mainly during stent deployment or balloon postdilatation, 7 followed by spontaneous lysis and reperfusion. 8 Thus, it is possible that myocardial injury after PCI can be used as a model for assessment of interventions that reduce ischemia-reperfusion injury. Using such a model is important considering the difficulty in the translation of cardioprotective interventions to clinical practice.…”

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confidence: 99%

Remote Ischemic Postconditioning During Percutaneous Coronary Interventions

Lavi

D'Alfonso

Diamantouros

et al. 2014

Circ: Cardiovascular Interventions

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Background-Remote ischemic preconditioning may result in reduction in infarct size during percutaneous coronary intervention (PCI). It is unclear whether remote ischemic postconditioning (RIPost) will reduce the incidence of myocardial injury after PCI, and whether ischemic conditioning of a larger remote organ (thigh versus arm) would provide further myocardial protection. Methods and Results-We randomized 360 patients presenting with stable or unstable angina (28% of patients) and negative Troponin T at baseline to 3 groups: 2 groups received RIPost (induced by ischemia to upper or lower limb), and a third was the control group. RIPost was applied during PCI immediately after stent deployment, by three 5-minute cycles of blood pressure cuff inflation to >200 mm Hg in the arm or thigh (20 mm Hg in the control) with 5-minute breaks between each cycle. The primary end-point was the proportion of patients with Troponin T levels >3×ULN postprocedure (at 6 or 18-24 hours), where ULN stands for upper limit of normal. A total of 120 patients were randomized to each group. There were no differences in baseline characteristics between the 3 groups. The primary outcome occurred in 30%, 35%, and 35% of the arm, thigh, and control groups, respectively (P=0.64). There were no differences in creatine kinase or high sensitivity C-reactive protein levels after PCI or in the incidence of acute kidney injury between the groups. Conclusions-RIPost during PCI did not reduce the incidence of periprocedural myocardial injury. Similar effect was obtained when remote ischemia was induced to the upper or lower limb. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00970827.(Circ Cardiovasc Interv. 2014;7:225-232.)

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Natural history of small and medium-sized side branches after coronary stent implantation

Cited by 72 publications

References 12 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

Comparison of the Clinical and Angiographic Outcomes of Compromised Side Branches (Stent Jail) after Percutaneous Coronary Intervention between Sirolimus-Eluting Stents and Paclitaxel-Eluting Stents

Remote Ischemic Postconditioning During Percutaneous Coronary Interventions

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