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

Murasato, Yoshinobu; Horiuchi, Masataka

doi:10.1002/ccd.21133

Cited by 26 publications

(18 citation statements)

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“…24 Interestingly, however, recent bench test and clinical studies showed these different techniques to be consistently associated with a risk of malapposition, which in turn had been shown previously to be associated with restenosis or late stent thrombosis. [25][26][27] Dedicated DESs may limit the risk of polymer breakage, improving arterial wall coverage; indeed, the risk of ostial restenosis does seem to be reduced, but these studies need to be confirmed. 20 -22,28 At least, the results of the recent Nordic Bifurcation Study III point the interest to discussion of systematic DES kissing postdilatation in bifurcation lesions (M Niemela, Transcatheter Cardiovascular Therapeutics, unpublished data, 2009).…”

Section: Guérin Et Al Bench Study Of Drug-eluting Stent In Bifurcatiomentioning

confidence: 99%

Drug-Eluting Stents in Bifurcations

Guérin

Pilet

Finet

et al. 2010

Circ: Cardiovascular Interventions

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Background-The use of a drug-eluting stent (DES) has strongly limited the incidence of in-stent restenosis in bifurcation lesions; nevertheless, restenosis still remains a problem at the origin of the bifurcation side branch. The aim of this study is to analyze the consequences of the kissing postdilatation technique on 5 DESs, using microfocus x-ray computerized tomography and scanning electron microscopy. Methods and Results-Five different DESs (Cypher, Cypher Select, Endeavor, Taxus Express, and Taxus Liberté) were deployed using kissing postdilatation protocols in a bench-top model. For all types of DES, microfocus x-ray computerized tomography analysis showed that (1) kissing postdilatation of the stent by 2 coaxial balloons caused elliptic deformation in the proximal segment and (2) kissing postdilatation technique reduced the ratio of potential metal to artery (manufacturer's data/calculated ratio [%]: Cypher, 12.7/8.8; Cypher Select, 13.5/10.2; Endeavor, 19.0/13.3; Taxus Express, 20.5/4.7; Taxus Liberté, 17.9/12.5) and the potential drug application to area in the proximal segment, including the ostial struts (struts adjacent to and lying around the side branch ostium) (manufacturer's data/calculated drug application [g/mm 2 ]: Cypher, 1.4/1.0; Cypher Select, 1.4/1.1; Endeavor, 1.6/1.1; Taxus Express, 1.0/0.7; Taxus Liberté, 1.0/0.7). Scanning electron microscopy analysis showed a significantly greater coating damage to the ostial struts in all stents evaluated (PϽ0.05). Conclusions-Commercially available DESs subjected to simultaneous kissing balloon postdilatation in an unconstrainedmodel may contribute to side branch ostial restenosis by proximal segment elliptic deformation and damage to the polymer coating. (Circ Cardiovasc Interv. 2010;3:120-126.)Key Words: bifurcations Ⅲ stents Ⅲ angioplasty Ⅲ coronary disease Ⅲ restenosis B ifurcation lesions frequently occur in Ϸ15% of percutaneous coronary interventions. 1,2 Angioplasty with baremetal coronary stenting became the routine treatment for these lesions, but bifurcation stenting was still associated with a high rate of restenosis, especially when multiple stents were used. 2,3 The use of a drug-eluting stent (DES) has been reported to reduce restenosis in bifurcation lesions; however, side branch (SB) ostial restenosis still remains a problem in 10% to 20% of cases. 4 -7 Implanting a second stent in the SB does not limit restenosis, 6 and systematic SB stenting seems to be associated with a higher risk of restenosis than with the provisional T-stenting technique. 6,8 The high rate of SB ostium restenosis could be due to limited strut coverage in this area, with consequently inadequate drug distribution to the stented artery. 9 The aim of this study was to analyze the consequences of the kissing postdilatation technique (postdilatation by using simultaneous kissing balloon inflation) on 5 DESs commercially available in France, using microfocus x-ray computerized tomography (MFCT) and scanning electron microscopy (SEM). Clinical Perspective on p 126 M...

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Section: Guérin Et Al Bench Study Of Drug-eluting Stent In Bifurcatiomentioning

confidence: 99%

Drug-Eluting Stents in Bifurcations

Guérin

Pilet

Finet

et al. 2010

Circ: Cardiovascular Interventions

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“…We demonstrated that microfocus computed tomography (MFCT) with minimal resolution of 0.06 mm was useful for analyzing complex stenting on a phantom model 11 . Stent deformation and gap formation after two‐stent deployment were clearly observed in the 3D reconstruction view 11 . MFCT also has good resolution in both cross‐sectional and longitudinal views.…”

Section: Introductionmentioning

confidence: 99%

“…Phantom Model The construction of an LM bifurcation model was previously reported 11,12 . In brief, a silicon tube corresponding to the left anterior descending artery (LAD) was glued and oriented vertically while a tube corresponding to the circumflex artery (LCX) was glued in a transverse direction, with a 90‐degree angle between both tubes; a tube corresponding to the LM was glued and oriented at a 135‐degree angle with respect to the other two branches 11,12 …”

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Examination of Stent Deformation and Gap Formation after Complex Stenting of Left Main Coronary Artery Bifurcations Using Microfocus Computed Tomography

Murasato¹,

Hikichi²,

Horiuchi³

2009

J Interven Cardiology

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“…This investigational approach illustrates the realistic configuration of the complex bifurcation stenting techniques with clear visualization using high-resolution invasive imaging (e.g., optical coherence tomography, intravascular ultrasound) or noninvasive imaging (e.g., chargecoupled device camera, endoscopy, scanning electron microscopy, and micro-computed tomography(micro-CT) (56,57). Crossing through a proximal cell results in unapposed struts in front of the carina, reduction of the struts-free side branch ostial area, and suboptimal scaffolding of the side branch ostium (Figure 2)(56,58,65). The images acquired are processed to allow volume rendering, geometry rotation, cut-plane views, and fly-through animations.…”

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confidence: 99%

Biomechanical Modeling to Improve Coronary Artery Bifurcation Stenting

Antoniadis

Mortier

Kassab

et al. 2015

JACC: Cardiovascular Interventions

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Treatment of coronary bifurcation lesions remains an ongoing challenge for interventional cardiologists. Stenting of coronary bifurcations carries higher risk for in-stent restenosis, stent thrombosis, and recurrent clinical events. This review summarizes the current evidence regarding application and use of biomechanical modeling in the study of stent properties, local flow dynamics, and outcomes after percutaneous coronary interventions in bifurcation lesions. Biomechanical modeling of bifurcation stenting involves computational simulations and in vitro bench testing using subject-specific arterial geometries obtained from in vivo imaging. Biomechanical modeling has the potential to optimize stenting strategies and stent design, thereby reducing adverse outcomes. Large-scale clinical studies are needed to establish the translation of pre-clinical findings to the clinical arena.

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

Cited by 26 publications

References 30 publications

Drug-Eluting Stents in Bifurcations

Drug-Eluting Stents in Bifurcations

Examination of Stent Deformation and Gap Formation after Complex Stenting of Left Main Coronary Artery Bifurcations Using Microfocus Computed Tomography

Biomechanical Modeling to Improve Coronary Artery Bifurcation Stenting

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