Provisional T‐stenting and kissing balloon in the treatment of coronary bifurcation lesions: Results of the French multicenter “TULIPE” study

Brunel, Philippe; Lefèvre, Thierry; Darremont, Olivier; Louvard, Yves

doi:10.1002/ccd.20800

Cited by 95 publications

(53 citation statements)

References 16 publications

(14 reference statements)

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“…As a result, some have advocated a strategy of treating the main vessel with a single drug-eluting stent, and to proceed with the implantation of a second, side-branch stent only when the result is deemed suboptimal (provisional stenting) [6,[9][10][11]. Such an approach leads to placement of a side-branch stent in 30-51% of cases [9][10][11], indicating that a complete understanding of double-stent techniques and outcomes is essential, even when provisional stenting is the favored approach.…”

Section: Introductionmentioning

confidence: 99%

Three‐dimensional modeling of double‐stent techniques at the left main coronary artery bifurcation using micro‐focus X‐ray computed tomography

Murasato¹,

Horiuchi²

2007

Cathet Cardio Intervent

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Section: Introductionmentioning

confidence: 99%

Three‐dimensional modeling of double‐stent techniques at the left main coronary artery bifurcation using micro‐focus X‐ray computed tomography

Murasato¹,

Horiuchi²

2007

Cathet Cardio Intervent

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“…Furthermore, patients with long sidebranch lesions were systematically excluded from the randomized trials [4]. Registries, though available in greater numbers [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], are of variable quality and use different lesion classification systems, quantitative coronary angiography (QCA) measurements performed in unclear technical conditions, with identical technical strategies bearing different names or different techniques grouped under a single name. Other than the comparison between stent deployment in one versus two branches, a meta-analysis of these various reports has proven quite impossible.…”

Section: Introductionmentioning

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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274

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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“…Current remaining problems involve a relatively high incidence of restenosis at ostial locations of the SB, and KBT is considered mandatory to reduce stenosis. 7,12,21 Although the clini- cal importance of KBT has been proven, determination of appropriate diameters of the 2 balloons matching to the main and the branching arteries remains difficult in the actual clinical setting because of the lack of specific investigations and a working index. We believe the formula used in our study presented here is very simple and may potentially be an answer to these questions.…”

Section: Discussionmentioning

confidence: 99%

Functional Formula to Determine Adequate Balloon Diameter of Simultaneous Kissing Balloon Technique for Treatment of Bifurcated Coronary Lesions Clinical Validation by Volumetric Intravascular Ultrasound Analysis

Morino

Yamamoto

Mitsudo

et al. 2008

Circ J

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Background Final kissing balloon technique (KBT) is known to alter long-term clinical outcomes for treatment of bifurcated coronary lesions. However, determination of adequate diameters of the 2 balloons remains difficult because of lack of a working index. Methods and ResultsTwenty-one cases of left main (LM)-related bifurcated lesions, treated with Cypher™ stents (single/crush stenting) and final KBT, were enrolled. The formula "R 2 = D1 2 + D2 2 " was used, adjusting balloon diameter (D1, D2) to the downstream branches, to predict the theoretical mean hugging balloon diameter (R) within the main portion. The degree and pattern of stent expansion in the LM and main branch (MB) segments was compared by volumetric intravascular ultrasound assessment. Stents in the LM segments expanded to a greater extent and more asymmetrically than in MB segments (average stent area: 13.2±3.1 mm 2 vs 7.6± 2.1 mm 2 , p<0.0001, stent symmetry index: 0.77±0.08 vs 0.88±0.03, p<0.0001). The actual mean stent diameter significantly correlated with R (p=0.0003, r=0.76). The ratio of actual to theoretical stent expansion was highly consistent between the LM and MB (93.1% vs 93.4%, p=NS). Conclusion The proposed formula may be useful for predicting resultant stent expansion following KBT, despite a more elliptical dilation. (Circ J 2008; 72: 886 -892)

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Provisional T‐stenting and kissing balloon in the treatment of coronary bifurcation lesions: Results of the French multicenter “TULIPE” study

Abstract: A strategy of provisional T-stenting with a tubular stent and final kissing balloon angioplasty for the treatment of coronary bifurcation lesions was safe and associated with a low TLR rate at 7 months. This strategy should be applicable to the new era of drug eluting stents.

Cited by 95 publications

References 16 publications

Three‐dimensional modeling of double‐stent techniques at the left main coronary artery bifurcation using micro‐focus X‐ray computed tomography

Three‐dimensional modeling of double‐stent techniques at the left main coronary artery bifurcation using micro‐focus X‐ray computed tomography

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

Functional Formula to Determine Adequate Balloon Diameter of Simultaneous Kissing Balloon Technique for Treatment of Bifurcated Coronary Lesions Clinical Validation by Volumetric Intravascular Ultrasound Analysis

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