A prospective intravascular ultrasound investigation of the necessity for and efficacy of postdilation beyond nominal diameter of 3 current generation DES platforms for the percutaneous treatment of the left main coronary artery

Shand, James A; Sharma, Divyesh; Hanratty, Colm G.; McClelland, Anthony; Menown, Ian; Spence, Mark S.; Richardson, G. S.; Herity, Niall A.; Walsh, Simon

doi:10.1002/ccd.25265

Cited by 20 publications

(11 citation statements)

References 31 publications

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“…When treating ULMCA lesions, the large (5.7 ± 0.7 [range 4–7.4] mm) LM diameter and the fractal anatomy (from LM to LAD or LCX) make it difficult the selection of the conventional DES diameter . IVUS data indicated that the mean maximal CSA of the LM range between 18 mm 2 (4.8 mm maximal diameter) and 23.3 mm 2 (5.5 mm maximal diameter) .…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, current guidelines report a class IB recommendation for ULMCA disease with a SYNTAX score ≤22 and class IIa for ULMCA disease with a SYNTAX score 23–32 . Major features that may be responsible for the suboptimal success of PCI in ULMCA lesions are (1) the large diameter of the left main (LM), (2) the fractal anatomy (from LM to left anterior descending artery [LAD] or left circumflex artery [LCX]), and (3) involvement of the bifurcation, which still represents a predictor of restenosis . In order to adapt the conventional drug‐eluting stent (DES) with the fractal anatomy of the bifurcation, the proximal optimization technique (POT) is mandatory.…”

Section: Introductionmentioning

confidence: 99%

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Sirolimus‐eluting BiOSS LIM dedicated bifurcation stent in the treatment of unprotected distal left main stenosis

Briguori

Visconti

Golino

et al. 2019

Cathet Cardio Intervent

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Background Proximal optimization technique (POT) has been proposed to adapt the conventional drug‐eluting stent (DES) with the fractal anatomy of the bifurcation. However, only few DES are labeled for post‐expansion beyond 5.0 mm. Furthermore, recrossing in the side branch (SB) through the main vessel (MV) stent cells may be challenging. Objectives To compare the sirolimus‐eluting, balloon‐expandable dedicated bifurcation stent BiOSS LIM DES versus the second generation DES in the treatment of distal unprotected left main coronary arteries (ULMCAs) lesions. Methods Forty‐two consecutive patients with distal ULMCA lesions were treated with the BiOSS LIM (BiOSS LIM group) in our center. A matched‐group of patients treated with second‐generation DES was selected from our database (Control group). The primary endpoint was the procedural complication rate, including (a) SB occlusion, defined as intraprocedural TIMI flow grade <3 immediately after MV stenting; and/or (b) trouble in SB access, defined as the need of ≥2 guidewires or a failure to recross in the SB trough the MV stent cells. The need of POT in the two groups was also analyzed. Results The primary endpoint occurred in four (9.5%) patients in the BiOSS LIM group and in 13 (31%) in the Control group (p = 0.028; OR = 4.25; 95% confidence interval: 1.25–14.43). POT was performed more often in the Control group (71% vs. 35%; p = 0.004). Conclusions Compared to conventional DES, the BiOSS LIM stent (1) facilitates SB recrossing and (2) fits well with the fractal anatomy of the left main bifurcation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sirolimus‐eluting BiOSS LIM dedicated bifurcation stent in the treatment of unprotected distal left main stenosis

Briguori

Visconti

Golino

et al. 2019

Cathet Cardio Intervent

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“…Previous studies 6,18,23,[26][27][28] did not have a primary focus on the clinical outcomes of non-complex LMCA disease treated with a single stenting technique. Only Agostoni, et al 22) reported that when ostial or mid-LMCA disease is treated with DES, the rate of cardiac events is particularly low.…”

Section: Discussionmentioning

confidence: 99%

Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary Artery Diseases

et al. 2017

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SummaryThere is limited long-term comparative clinical outcome data concerning angiography-versus intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in non-complex left main coronary artery (LMCA) disease treated with the single stenting technique in the drug-eluting stent (DES) era.The aim of this study was to investigate whether angiography-guided stenting is comparable to IVUSguided stenting during 3-year clinical follow-up periods in patients with non-complex LM disease treated with the single stenting technique.A total of 196 patients treated with either angiography-guided (n = 74) or IVUS-guided (n = 122) PCI were included. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (Non-TVR). To adjust for any potential confounders, propensity score (PS) adjusted analysis was performed.During 3-year follow-up, the PS adjusted Cox-proportional hazard ratio (HR) was not significantly different between the two groups for total death, cardiac death, and MI. Also, TLR and the combined rates of TVR and non-TVR were not significantly different. Finally, MACE was not significantly different between the two groups (HR: 0.63, 95% Confidence interval (CI): 0.33-1.17; P = 0.149).Angiography-guided PCI for non-complex LMCA diseases treated with the single stenting technique showed comparable results compared with IVUS-guided PCI in reducing clinical events during 3-year clinical follow-up in the DES era. Although IVUS guided PCI is the ideal strategy, angiography-guided PCI can be an option for LMCA PCI in some selected cases.(Int Heart J 2017; 58: 704-713) Key words: Left main coronary artery, Percutaneous coronary intervention, Intravascular ultrasound, Drug eluting stents U ntil recently, left main coronary artery (LMCA) disease was a hotly debated topic among interventional cardiologists as it is a challenging and risky lesion subset. According to recent guidelines, percutaneous coronary intervention (PCI) for an ostial or midshaft lesion of LMCA (non-true bifurcation) is defined as a Class IIa indication. 1) Even though LMCA disease treatment has been traditionally reserved for surgery, there have been numerous registries with drug-eluting stents (DES) that have shown favorable outcomes. 2,3) In this uniquely challenging aspect, the use of intravascular ultrasound (IVUS) may help to evaluate the target lesion and enable optimal stent deployment during PCI; and these optimized procedural results may translate into improved long-term clinical outcomes. A recent study 4) demonstrated that the survival rate and the rate of free of major adverse cardiac events (MACE) after 3 years were higher in the IVUS group, and the incidence of stent thrombosis was lower in the IVUS group. However, recent studies did not focus on the role of IVUS in non-complex LM disease treated with the single stenting tec...

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“…In an ectatic or aneurysmal LMCA, only a few current stent designs can overcome disparate dimensions between the LMCA and its branches; the use of other stents might lead to deformation or substantial shortening of the stent platform. In one study of 125 patients who had significant left epicardial arterial stenosis, 6 the mean maximal diameter of the distal LM stem was 5.7 ± 0.7 mm (range, 4-7.4 mm), which would necessitate postdilating the DES platforms beyond the recommended diameterseven in conservative sizing-to attain good apposition.…”

Section: Discussionmentioning

confidence: 99%

Stent Choice in Very Large Left Main Lesions in 3 Patients

Lozano¹,

Rondán²,

Vegas³

et al. 2017

Texas Heart Institute Journal

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Interventionalists encounter widely different coronary anatomies during left main coronary artery stenting. Optimal percutaneous coronary intervention in left main disease necessitates stents that achieve adequate apposition and adapt to frequently disparate diameters in the same lesion, without the need for overexpansion. Until recently, stent designs have hampered the treatment of very large lesions in left main arteries. Postdilation of the stents beyond their recommended diameters can cause restenosis, thrombosis, or arterial dissection. We report successful angiographic outcomes after our deployment of different stents in 3 patients, present our rationale for choosing each stent, and discuss considerations that influence the percutaneous treatment of severe left main disease.

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A prospective intravascular ultrasound investigation of the necessity for and efficacy of postdilation beyond nominal diameter of 3 current generation DES platforms for the percutaneous treatment of the left main coronary artery

Cited by 20 publications

References 31 publications

Sirolimus‐eluting BiOSS LIM dedicated bifurcation stent in the treatment of unprotected distal left main stenosis

Sirolimus‐eluting BiOSS LIM dedicated bifurcation stent in the treatment of unprotected distal left main stenosis

Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary Artery Diseases

Stent Choice in Very Large Left Main Lesions in 3 Patients

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