Predictors of long-term outcome after crush stenting of coronary bifurcation lesions: Importance of the bifurcation angle

Džavík, Vladimir; Kharbanda, Rajesh K.; Ivanov, Joan; Ing, Douglas; Bui, Sanh; Mackie, Karen; Ramsamujh, Rachael; Barolet, Alan; Schwartz, Leonard; Seidelin, Peter H.

doi:10.1016/j.ahj.2006.04.033

Cited by 153 publications

(92 citation statements)

References 18 publications

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“…FKI after the 2-stent technique produces better results than the 2-stent technique without FKI, 13 but few studies have demonstrated the benefit of FKI after single stent placement. A recent report measuring fractional flow reserve in 25 bifurcation PCI showed that FKI increased the fractional flow reserve of the side branch from 0.65±0.08 to 0.85±0.07.…”

Section: Prevalence Of Jailing Struts At the Side-branch Orificementioning

confidence: 99%

Potential Benefit of Final Kissing Balloon Inflation After Single Stenting for the Treatment of Bifurcation Lesions

Hasegawa

Shinke

Otake

et al. 2013

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp benefit of routine FKI after single stenting of bifurcation lesions. 6 In addition, inadequate side-branch dilatation may result in stent deformation or incomplete stent apposition. 7 In contrast, quantitative coronary angiography (QCA) conducted in the Nordic-Baltic Bifurcation Study III showed better expansion of the side-branch orifice in the FKI group. 6 Because delayed arterial healing characterized by exposed stent struts is considered a possible risk factor for stent thrombosis, 8 struts floating at the side-branch orifice (jailing strut) could affect thrombus formation after DES implantation. Despite these controversies, the relationship between stenting strategies and local findings, such as stent apposition, thrombus formation, and neointimal coverage, which may be associated with long-term clinical outcome, has not been well evaluated to date.Several studies have shown that the high resolution of optical coherence tomography (OCT) enables visualization of coronary arteries at the micron level for evaluation of strut coverercutaneous coronary intervention (PCI) using drugeluting stents (DES) reduces restenosis and major adverse cardiac events (MACE) compared to PCI with bare metal stents. 1 Even in the DES era, however, the procedures for bifurcation remain complex and challenging. 2,3 The single-stent strategy is currently considered preferable because the 2-stent strategy has higher rates of periprocedural myocardial infarction and long-term MACE, 4,5 which is probably associated with the increased use of contrast and prolonged procedure time. Therefore, a 1-stent strategy with a provisional approach to the side branch with final kissing inflation (FKI) might be the most acceptable strategy in clinical practice.Recently, the Nordic-Baltic Bifurcation Study III, a randomized comparison of clinical outcomes in patients with coronary bifurcation lesions treated with FKI vs. without FKI after main vessel (MV) stenting, found a similar 6-month clinical outcome between the 2 groups, raising questions regarding the Background: Treatment of coronary bifurcation lesions using a single stenting strategy is preferable over that using a 2-stent technique. The benefit of final kissing inflation (FKI), however, has not been established.

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Section: Prevalence Of Jailing Struts At the Side-branch Orificementioning

confidence: 99%

Potential Benefit of Final Kissing Balloon Inflation After Single Stenting for the Treatment of Bifurcation Lesions

Hasegawa

Shinke

Otake

et al. 2013

Circ J

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“…It has been suggested that the Medina classification should also contain information on the lesion length, especially for the SB, or presence of calcifications. Moreover, the angle between the two branches has been recently shown to have a significant impact on certain techniques and on the clinical outcome at follow-up [28]. However, apart from the fact that the presence of quantifiable variables would be recorded under ''yes'' or ''no,'' the addition of these 3 parameters and possibly others (eccentric location of the main branch lesion, TIMI flow, and so on) would negate the simplicity of the Medina classification.…”

Section: Definition and Classification Of Coronary Bifurcation Lesionsmentioning

confidence: 99%

Classification of coronary artery bifurcation lesions and treatments: Time for a consensus!

Louvard

Thomas

Džavík

et al. 2007

Cathet Cardio Intervent

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269

139

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Background: Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains a subject of debate. Many studies have been published in this setting. They are often small scale and display methodological flaws and other shortcomings such as inaccurate designation of lesions, heterogeneity, and inadequate description of techniques implemented. Methods: The aim is to propose a consensus established by the European Bifurcation Club (EBC), on the definition and classification of bifurcation lesions and treatments implemented with the purpose of allowing comparisons between techniques in various anatomical and clinical settings. Results: A bifurcation lesion is a coronary artery narrowing occurring adjacent to, and/or involving, the origin of a significant side branch. The simple lesion classification proposed by Medina has been adopted. To analyze the outcomes of different techniques by intention to treat, it is necessary to clearly define which vessel is the distal main branch and which is (are) the side branche(s) and give each branch a distinct name. Each segment of the bifurcation has been named following the same pattern as the Medina classification. The classification of the techniques (MADS: Main, Across, Distal, Side) is based on the manner in which the first stent has been implanted. A visual presentation of PCI techniques and devices used should allow the development of a software describing quickly and accurately the procedure performed. Conclusion: The EBC proposes a new classification of bifurcation lesions and their treatments to permit accurate comparisons of well described techniques in homogeneous lesion groups. '

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“…After obtaining the best view of the bifurcation, the acute angle between the central axial lines of the side branch and the main vessel was taken as the angle of side branch delivery, as reported previously. 8 The side branches were subsequently also classified into 2 groups: (1) large angle ≥50° and (2) small angle <50°.…”

Section: Measurement Of the Side Branch Anglementioning

confidence: 99%

Assessment by Optical Coherence Tomography of Stent Struts Across Side Branch

Liu

Imanishi

Kubo

et al. 2011

Circ J

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Background: Late stent thrombosis (LST) after drug-eluting stent (DES) implantation is a major clinical problem that has not been fully explained. Incomplete neointimal coverage of stent struts is an important morphometric predictor of LST, which may be associated with impaired healing and the absence of full coverage of struts at branch-point ostia. Optical coherence tomography (OCT) was performed to compare 3 types of stents placed across side branches. Methods and Results:At 9-month follow-up, the neointimal coverage of the struts of 58 stents across a side branch was measured by OCT (bare metal (BMS), n=20; sirolimus-eluting (SES), n=23; paclitaxel-eluting (PES), n=15). According to the diameter ratio of side branch to main vessel, the side branches were classified as either large (ratio >0.33) or small (ratio ≤0.33). BMS had the lowest frequency of uncovered struts (29.4%) and the greatest neointimal thickness on the struts (123±33 μm). Neointimal thickness on the struts was less for SES than for PES (72±16 vs. 91±22 μm, P=0.009), but there was no difference in the frequency of uncovered struts (66.1% vs. 58.6%, P=0.493). For large side branches, the frequency of uncovered struts was greater than in the small group for SES (87.5% vs. 40.7%, P=0.0002) and PES (83.3% vs. 18.2%; P=0.0013); there was no significant difference for BMS (43.8% vs. 16.7%, P=0.138). Conclusions:Neointimal coverage on struts across a side branch was less frequently observed in DES than in BMS, particularly in large side branches. (Circ J 2011; 75: 106 - 112)

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Predictors of long-term outcome after crush stenting of coronary bifurcation lesions: Importance of the bifurcation angle

Cited by 153 publications

References 18 publications

Potential Benefit of Final Kissing Balloon Inflation After Single Stenting for the Treatment of Bifurcation Lesions

Potential Benefit of Final Kissing Balloon Inflation After Single Stenting for the Treatment of Bifurcation Lesions

Classification of coronary artery bifurcation lesions and treatments: Time for a consensus!

Assessment by Optical Coherence Tomography of Stent Struts Across Side Branch

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