A case of very late stent thrombosis on the protruded struts at the left main coronary bifurcation

Murasato, Yoshinobu; Shibao, Keigo; Meno, Kyohei; Takenaka, Katsuto

doi:10.1016/j.jccase.2020.04.007

Cited by 2 publications

(3 citation statements)

References 8 publications

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“…The cross-over stenting technique has better clinical efficacy for this type of lesions compared to ostial stenting (4). Nev-ertheless, it has been shown that the stent struts suspended in the side branch ostium can easily lead to thrombosis after discontinuing DAPT or fenestrated restenosis of the SB ostium (16,19). In addition, the value of SB dilation after cross-over stenting is debatable and may be challenging.…”

Section: Discussionmentioning

confidence: 99%

“… 4 Nevertheless, it has been shown that the stent struts suspended the side branch ostium, which can easily lead to thrombosis after discontinuing DAPT or fenestrated restenosis of SB ostium. 16 , 19 Additionally, the value of SB dilation after cross-over stenting is debatable and may be challenging. SB intervention is recommended whenever the lumen dimensions of the untreated branch are compromised; however, today there are no established cutoffs for considering PCI to the disease-free side branch and a switch to a two-stent strategy.…”

Section: Discussionmentioning

confidence: 99%

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DCB combined with provisional DES implantation in the treatment of De Novo Medina 0,1,0 or 0,0,1 left main coronary bifurcation lesions: A proof-of-concept study

Erdoğan¹,

Li²,

Zhu³

et al. 2022

Anatolian J Cardiol

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Percutaneous coronary intervention (PCI) for coronary bifurcation lesions (CBL) represents one of the most challenging procedures in interventional cardiology because of lower angiographic success rate and increased risk of procedural complications (1).Currently, the single stent strategy has been considered as the default approach for the treatment of CBL (2); however, the optimal therapy for Medina type 0,1,0 or 0,0,1 left main stem (LMS) bifurcation lesions remains unclear. For these lesions, precise ostial stent placement and crossover stenting technique have been proposed. Nevertheless, precise stent placement is known to be challenging, and there is no established technique for perfect ostial stent deployment despite the fact that different strategies and/or devices have been tested (3). Several studies have shown that the cross-over stenting approach is superior to the ostial stenting with a lower rate of major adverse cardiovascular event (MACE) rate during longterm clinical follow-up (4, 5). However, data indicates that this procedure may be complicated by a significant stenosis of the other major branch of the LMS even if ABSTRACT Objective: To investigate the safety and efficacy of a percutaneous revascularization strategy that is based on the use of drug-coated balloon (DCB) for the treatment of patients with acute coronary syndrome (ACS) and de novo Medina type 0,1,0 or 0,0,1 left main stem (LMS) bifurcation lesions. Methods:In this multicenter, prospective, proof-of-concept study, patients fulfilling the above criteria were enrolled and received treatment with DCB combined with provisional drug-eluting stent (DES) implantation in the proximal major branches of the LMS. Patients who declined this revascularization approach were treated with DES implantation 1-2 mm distally to the LAD or LCx ostium followed by DCB therapy for the ostial disease. The primary endpoint of the study was percent diameter stenosis (%DS) on quantitative coronary angiography post procedure as well as event rate at 8 months follow-up.Results: Thirty patients were enrolled in the study with mean age of 60.3±7.8 years, of whom 22 (73.3%) were male. Twenty-two patients were treated only with DCB and provisional DES implantation, and 8 had DES implantation followed by DCB therapy of the ostium of the LMS major branch. All the procedures were successful with no immediate complications. Lesion %DS decreased significantly post-procedure from 62.9±14.6 to 13.3±7.5, p<0.001. During the follow-up period, no major adverse cardiac events were reported. Conclusion:This proof-of-concept study indicates that ostial DCB therapy of the LMS major branches is safe and effective. Larger clinical data and longer follow-up is needed before advocating its regular use in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

DCB combined with provisional DES implantation in the treatment of De Novo Medina 0,1,0 or 0,0,1 left main coronary bifurcation lesions: A proof-of-concept study

Erdoğan¹,

Li²,

Zhu³

et al. 2022

Anatolian J Cardiol

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“…The first attempt failed, and the guidewire crossed outside the LAD stent. Successful second wire crossing more distal to the first wire was confirmed by stacking the catheter at the jailing struts (33) and 3D OCT imaging (Supplementary Movie 7). The most proximal cell was stretched to a single string and LM-LCX stenting was performed.…”

Section: Figurementioning

confidence: 95%

How to use three-dimensional optical coherence tomography effectively in coronary bifurcation stenting

Murasato

2022

Front. Cardiovasc. Med.

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Imaging-guided coronary bifurcation intervention has improved clinical outcomes due to the appropriate size selection of the devices and optimization of the procedure (sufficient stent expansion, reduction of stent malapposition, appropriate stent landing zone, and detection of vessel dissection). In particular, three-dimensional optical coherence tomography (3D OCT) facilitates clear visualization of stent configuration and guidewire position, which promotes optimal guidewire crossing to the side branch. Successive side branch dilation leads to wide ostial dilation with less strut malapposition. However, the link connection of the stent located on the bifurcated carina has been found to be an impediment to sufficient opening of the side branch, resulting in incomplete strut apposition. In such cases, the aggressive proximal optimization technique improves the jailing strut pattern, and 3D OCT navigates the guidewire crossing to the optimal cell that is most likely to be expanded sufficiently, which is not always a distal cell. In two-stent deployment, 3D OCT facilitates optimal guidewire crossing, which leads to less metallic carina, clustering, and overlapping. The present review describes a method of clear visualization and assessment with 3D OCT and discusses the efficacy of 3D OCT in coronary bifurcation stenting in clinical practice.

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A case of very late stent thrombosis on the protruded struts at the left main coronary bifurcation

Cited by 2 publications

References 8 publications

DCB combined with provisional DES implantation in the treatment of De Novo Medina 0,1,0 or 0,0,1 left main coronary bifurcation lesions: A proof-of-concept study

DCB combined with provisional DES implantation in the treatment of De Novo Medina 0,1,0 or 0,0,1 left main coronary bifurcation lesions: A proof-of-concept study

How to use three-dimensional optical coherence tomography effectively in coronary bifurcation stenting

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