Angiographic result of T-stenting with small protrusion using drug-eluting stents in the management of ischemic side branch: the ARTEMIS study

Abstract

The aim of this study was to examine the mid-term angiographic result of T-stenting with small protrusion (TAP) as the bailout strategy for treating coronary bifurcation lesions. From 2009 to 2012, symptomatic patients who had severe coronary bifurcation stenoses were treated with one-stent strategy using drug-eluting stents, with kissing balloon inflation performed whenever side branch (SB) impingement occurred. TAP was performed if residual diameter stenosis of SB was ≥75%, presence of ≥type B dissection or flow impairment was observed in the SB. Seventy-one patients (83% male, mean age of 61 ± 12 years) were recruited into the study. MEDINA classification 1,1,1 lesions were observed in over 60% of patients. The mean stent size and length in the main vessel (MV) and SB were 2.86 ± 0.43 and 30 ± 12, and 2.45 ± 0.26 and 16 ± 6 mm, respectively. Restudy angiography was performed on 64 (90 %) patients at 9.2 ± 3.9 months. Angiographic restenosis was observed in 8 (12.5%) patients with late lumen loss in the MV and SB being 0.22 ± 0.19 and 0.34 ± 0.37 mm, respectively. The use of TAP as the bailout technique for treating coronary bifurcation lesions is associated with good angiographic outcomes, in terms of late lumen loss and restenosis, at 9 months.

Impact of catheter size on reliability of quantitative coronary angiographic measurements (comparison of 4Fr and 6Fr catheters)

“…Thus, QCA analysis methodology, SOPs, and coronary angiography protocol (standardized image acquisition) are mandatory to minimize measurements variability such as interobserver variability. In randomized controlled trials that investigate stent and technique [13] efficacy and plaque progression or regression reliability of MLD and %DS is of particular importance. From this standpoint, a 6Fr catheter would be desirable for control as well as follow-up coronary angiographies as a calibration device for QCA.…”

Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial

“…Percutaneous interventions of TBL, which are characterized by an advanced atherosclerotic disease burden that obstructs the main vessel and the side-branch, are often technically more demanding, require more frequently complex techniques that involve the implantation of 2 stents, and were previously associated with a higher restenosis risk [1, 3–5]. Besides the increased procedural complexity of stenting, a more diffuse distribution of atherosclerotic plaque and a more advanced disease stage may account for an increased risk of adverse events in patients treated for TBL.…”

“…Percutaneous coronary interventions (PCIs) of TBL are often technically more challenging, require more often two-stent techniques [1, 2], and have previously been associated with somewhat lower technical success rate and a higher restenosis risk [3–5]. Meanwhile, second-generation drug-eluting stents (DES) were developed, which have shown favorable outcomes in broad patient populations [6, 7].…”

Summary of Bifurcation Stenting Strategies and Outcomes in Women

“…Although this technique has been adopted worldwide, there are no large randomized trials with long-term outcome data to reference (►Table 1). [34][35][36] Left Main PCI This entity warrants a separate discussion particularly as the latest European Society of Cardiology guidelines on myocardial revascularization confer a Class I for a Syntax Score <22 and Class IIb for a Syntax Score 23-32. 19 The DELTA (drug-eluting stent for left main (LM) coronary artery disease) Registry noted that lesions of the distal LM bifurcations reported a higher event rate that is primarily driven by repeat revascularisation.…”

“…Although this technique has been adopted worldwide, there are no large randomized trials with long-term outcome data to reference ( Table 1 ). 34 35 36…”