Prognostic impact of final kissing balloon technique after crossover stenting for the left main coronary artery: from the AOI-LMCA registry

Nishida, Koji; Toyofuku, Mamoru; Morimoto, Takeshi; Ohya, Masanobu; Fuku, Yasushi; Higami, Hirooki; Yamaji, Kyohei; Muranishi, Hiromi; Yamaji, Yuhei; Furukawa, Daisuke; Tada, Takeshi; Ko, Euihong; Kadota, Kazushige; Ando, Kenji; Sakamoto, Hiroki; Tamura, Takashi; Kawai, Kensuke; Kimura, Takeshi; Investigators, Aoi Lmca Stenting Registry

doi:10.1007/s12928-018-0522-0

Cited by 11 publications

(6 citation statements)

References 28 publications

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“…In fact, the presence of "floating" struts across the ostium may aid in the development of "fenestrated" LCx ostial restenosis. In contrast, a thorough registry of patients treated with crossover stenting from LM to the left anterior descending (LAD) branch indicated that the 5year cumulative incidence of TLR was not significantly different between the kissing balloon and non-kissing balloon groups (22). Therefore, the appropriate management of coronary bifurcation lesions remains debatable, especially with LM true bifurcations (23).…”

Section: Discussionmentioning

confidence: 99%

Drug-coated balloon in the treatment of coronary left main true bifurcation lesion: A patient-level propensity-matched analysis

Pan

Liu

Han

et al. 2022

Front. Cardiovasc. Med.

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AimsAn increasing body of evidence suggests that drug-coated balloon (DCB) angioplasty represents a valuable option for revascularization in selected patients with coronary bifurcation disease. However, there remains a paucity of real-world observational evidence on the efficacy of DCB in left main (LM) true bifurcation lesion. We compared clinical and angiographic outcomes of hybrid [DCB + drug-eluting stent (DES)] versus DES-only strategy (provisional stenting or two-stent strategies) in de novo LM true bifurcated lesions.MethodsThe primary endpoint was the 2-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction (TVMI), or clinically driven target lesion revascularization (CD-TLR). A routine 1-year angiographic follow-up was scheduled. Propensity-score matching was utilized to assemble a cohort of patients with similar baseline characteristics.ResultsAmong 1077 eligible patients, 199 who received DCB treatment and 398 who were assigned to DES therapy had similar propensity scores and were included in the analysis. TLF within 2 years occurred in 13 patients (7.56%) assigned to DCB group, and 52 patients (14.36%) assigned to DES group (odds ratio: 0.487; 95% confidence interval: 0.258–0.922; P = 0.025; Log-rank P = 0.024). Compared with the DES group, the DCB group resulted in a lower rate of CD-TLR (2.91% vs. 9.42%; P = 0.007). Cardiac death, TVMI, all-cause mortality, and stent thrombosis were comparable between both groups. Patients treated with DES-only were associated with a higher late lumen loss (0.42 ± 0.62 mm vs. 0.13 ± 0.42 mm, P < 0.001) compared with the DCB group at 1 year. In sensitivity analysis, the DCB group also presented a lower incidence of TLF, CD-TLR and stent thrombosis both compared to the two-stent strategy and compared to provisional stenting (Ps < 0.05).ConclusionThe 2-year results of PCI utilizing DCB for LM true bifurcation lesions are superior to employing DES alone in terms of safety and effectiveness.

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Section: Discussionmentioning

confidence: 99%

Drug-coated balloon in the treatment of coronary left main true bifurcation lesion: A patient-level propensity-matched analysis

Pan

Liu

Han

et al. 2022

Front. Cardiovasc. Med.

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“…Although these struts are thought to increase the risk of fenestrated restenosis in the SB ostium, recent analyses have failed to demonstrate the clinical benefits of routine KB inflation after a single-stent strategy. 9 , 10 Moreover, it has been shown that while the incidence of SB restenosis decreases with KB inflation, the risk of MB restenosis increases. 11 Finally, the fact that the stenosis in the SB ostium was evaluated only anatomically, but not physiologically, may have contributed to the high KB rate in the CS group in our study.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Long-Term Outcomes of Crossover or Focal Ostial Stenting of Left Anterior Descending Artery Ostial Stenosis

Soylu¹,

Yildirim²,

Nasifov³

et al. 2022

The Anatolian Journal of Cardiology

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Background: Optimal management of patients with ostial left anterior descending artery stenosis remains an unresolved issue. Methods: Patients with ostial left anterior descending stenosis who underwent stent implantation were included in this study. Coronary records of all patients were monitored, and long-term clinical outcomes were recorded. The patients were divided into 2 groups according to the stenting method: focal left anterior descending stenting [ostial stenting group] and stenting from the left main coronary artery to the left anterior descending [crossover stenting group]. Results: Of the 97 eligible consecutive patients, 56 were treated with ostial stenting and 41 with crossover stenting. At a mean follow-up of 23.6 ± 12.6 months, non-fatal myocardial infarction (3.9% vs. 12.8%, P = .118), target lesion revascularization (5.9% vs. 12.8%, P = .252), and all-cause death (2.0% vs. 7.7%, P = .191) rates were not statistically significant. However, the rate of major adverse cardiovascular events defined as a composite of non-fatal myocardial infarction, target lesion revascularization, or all-cause death was significantly higher in the crossover stenting group (8.2% vs. 28.2%, P = .013). In the multiple regression analysis, left main coronary artery diameter (odds ratio = 4.506; 95% CI: 1.225-16.582, P = .024) and application of the crossover stenting technique (odds ratio = 5.126; 95% CI: 1.325-19.833, P = .018) were found to be the most effective predictors of major adverse cardiovascular events. Conclusion: In our study, the ostial stenting group was associated with better clinical outcomes in the treatment of ostial left anterior descending stenosis. However, it is not appropriate to apply a single method to all patients with such lesions.

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“…The COBIS (Korean Coronary Bifurcation Stenting) II registry study [36] showed that final KBI in single-stent approach is associated with favorable long-term clinical outcomes and reduced TLR. The recent AOI-LMCA (Assessing Optimal Percutaneous Coronary Intervention for LMCA) study [37], on the other hand, indicated that performing final KBI did not affect TLR and other clinical outcomes at 5 years of follow-up. In the recent EXCEL study, the 4-year composite end points such as death, MI and stroke were not significantly different with or without final KBI for either single or dual stenting.…”

Section: Pot and Kbimentioning

confidence: 99%

Recent Evidence on Advances in PCI Treatment for Left Main Coronary Artery Disease

Jin¹,

Niu²,

Shen³

2022

Rev. Cardiovasc. Med.

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Revascularization therapy significantly improves the outcomes of patients with left main coronary artery disease (LMCAD), compared with medical therapy alone. For many years, coronary artery bypass grafting (CABG) has been the primary and standard treatment strategy. However, with advances in percutaneous coronary intervention (PCI) techniques and improvements in patients' outcomes, there is growing evidence supporting PCI for LMCAD. In this review, we aim to integrate the available evidences on advances in PCI treatment for LMCAD and provide guidance for further clinical practice.

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Prognostic impact of final kissing balloon technique after crossover stenting for the left main coronary artery: from the AOI-LMCA registry

Abstract: Assessing Optimal Percutaneous Coronary Intervention for Left Main Coronary Artery Stenting Registry (AOI LMCA Stenting Registry). http://www.umin.ac.jp/ctr/index/htm/ . Unique Identifier: UMIN000014706.

Cited by 11 publications

References 28 publications

Drug-coated balloon in the treatment of coronary left main true bifurcation lesion: A patient-level propensity-matched analysis

Drug-coated balloon in the treatment of coronary left main true bifurcation lesion: A patient-level propensity-matched analysis

Evaluation of Long-Term Outcomes of Crossover or Focal Ostial Stenting of Left Anterior Descending Artery Ostial Stenosis

Recent Evidence on Advances in PCI Treatment for Left Main Coronary Artery Disease

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