Approach to Treatment of Bifurcation Lesions

Alomari, Ihab; Seto, Arnold H.

doi:10.1007/s11936-015-0428-4

Cited by 6 publications

(6 citation statements)

References 34 publications

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“…This capability is expected to improve detection of stent deployment problems, such as stent malapposition, and stent integrity degradation, e.g. fractures and “jailed struts” occurring after kissing balloon inflation procedure in bifurcation regions 6 . Stent fracture occurs in almost 30% of cases, as revealed by autopsy reports 19 , contrary to the 1–2% of cases revealed by imaging due to the current limited spatial resolution of standard CT.…”

Section: Discussionmentioning

confidence: 99%

“…This increase in spatial resolution is expected to strongly reduce blooming artifacts, potentially improving restenosis detection and interpretation 5 . Reduction in blooming artifacts should allow morphological assessment of the mesh of the stent which is expected to improve detection of stent deployment problems and stent integrity degradation 6 . Furthermore, owing to the spectral separation capabilities of photon counting, specific K-edge images can be obtained 7–12 .…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of improving vascular imaging in the presence of metallic stents using spectral photon counting CT and K-edge imaging

Sigovan¹,

Si‐Mohamed²,

Bar-Ness³

et al. 2019

Sci Rep

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Correct visualization of the vascular lumen is impaired in standard computed tomography (CT) because of blooming artifacts, increase of apparent size, induced by metallic stents and vascular calcifications. Recently, due to the introduction of photon-counting detectors in the X-ray imaging field, a new prototype spectral photon-counting CT (SPCCT) based on a modified clinical CT system has been tested in a feasibility study for improving vascular lumen delineation and visualization of coronary stent architecture. Coronary stents of different metal composition were deployed inside plastic tubes containing hydroxyapatite spheres to simulate vascular calcifications and in the abdominal aorta of one New Zealand White (NZW) rabbit. Imaging was performed with an SPCCT prototype, a dual-energy CT system, and a conventional 64-channel CT system (B64). We found the apparent widths of the stents significantly smaller on SPCCT than on the other two systems in vitro (p < 0.01), thus closer to the true size. Consequently, the intra-stent lumen was significantly larger on SPCCT (p < 0.01). In conclusion, owing to the increased spatial resolution of SPCCT, improved lumen visualization and delineation of stent metallic mesh is possible compared to dual-energy and conventional CT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility of improving vascular imaging in the presence of metallic stents using spectral photon counting CT and K-edge imaging

Sigovan¹,

Si‐Mohamed²,

Bar-Ness³

et al. 2019

Sci Rep

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“…The complexity of coronary bifurcation lesions lies in the involvement of two daughter branches and/or one parent vessel, unpredictable shifts of both plaque and carina induced by devices, and wide discrepancies of vessel diameters from distal to proximal segments . Acute intra‐procedural occlusion of a SB is benign in most cases; however, it is not rare, and to some extent, is fatal if a SB diameter is larger (particularly left circumflex or larger diagonal branch).…”

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confidence: 99%

Facts speak louder than words

Chen

2016

Cathet Cardio Intervent

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Practice is the sole criterion for testing truth.-Xiaoping Deng (previous Premier Minister of China)Since its inception, evidence-based medicine has dramatically changed our way of thinking, shifting clinical practice away from case-based experiences to optimally improve patients' healthcare. Clinical studies, particularly in randomized/multicenter clinical trials and observational studies with larger sample populations, have become a powerful resource to guide physician's routine work [1]. Of note, interventional cardiology has benefited in many ways from modern clinical studies. Almost all interventionalists are extremely busy performing procedures and generating research results to determine the most appropriate stenting techniques for opening an occluded coronary artery for patients with obstructive coronary artery disease. If recanalization of a chronic total occlusion is one potential solution, stenting a coronary bifurcation lesion is somewhat of a logical intervention. With more devices and stenting techniques being used for bifurcated lesions, determining how to evaluate the potential risk of acute occlusion of a patented side branch (SB) is unavoidable.The complexity of coronary bifurcation lesions lies in the involvement of two daughter branches and/or one parent vessel, unpredictable shifts of both plaque and carina induced by devices, and wide discrepancies of vessel diameters from distal to proximal segments [2]. Acute intra-procedural occlusion of a SB is benign in most cases; however, it is not rare, and to some extent, is fatal if a SB diameter is larger (particularly left circumflex or larger diagonal branch). The Korean Coronary Bifurcation Stenting (COBIS) registry study [3] reported a higher rate of permanent occlusion of SBs among acutely occluded daughter vessels with a provisional stenting approach. As such, insight from the protective approaches, including jailed wires or jailed balloons, to build a stratification model predictive of the likelihood of acute SB occlusion is. From this perspective, the risk prediction of side branch occlusion in the coronary bifurcation intervention (RESOLVE) system [4] is dedicated to assessing SB occlusion and is an invaluable contribution to scoring the risk of SB occlusion and identifying the optimal stenting techniques for a given bifurcation lesion.In the current issue of Catheterization and Cardiovascular Interventions, Dr. Chen et al [5] reported an increased incidence of SB occlusion in Group II and Group III when compared with Group I, stratified by the ratio of diameter stenosis to the main vessel (MV) and/or SB median value(s). This study should be acknowledged, as it provided the interventional community with new information, offering at least a partial solution for the problems mentioned above, with true bifurcation lesions consisting of three

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“…( 4 33) Frequentemente a TKB é utilizada após o uso dos stents de modo a otimizar a aposição deles na parede. (30,31,(34)(35)(36) Embora esta questão não tenha sido resolvida até o momento, a maioria dos artigos concluiu que a TKB só é útil em coronárias nas técnicas em que se utilizam 2 stents. (30,(34)(35)(36) Na Cardiologia, muitos aspectos da bifurcação das artérias são considerados e eles são importantes na tomada de decisão de qual técnica empregar.…”

Section: Aos Meus Residentes Dounclassified

“…(30,31,(34)(35)(36) Embora esta questão não tenha sido resolvida até o momento, a maioria dos artigos concluiu que a TKB só é útil em coronárias nas técnicas em que se utilizam 2 stents. (30,(34)(35)(36) Na Cardiologia, muitos aspectos da bifurcação das artérias são considerados e eles são importantes na tomada de decisão de qual técnica empregar. É utilizada geralmente a classificação de Medina para a localização das lesões entre cada ramo e artéria principal (Figura 1).…”

Section: Aos Meus Residentes Dounclassified

Tratamento endovascular de artérias infrapoplíteas pela técnica de kissing-balloon em pacientes com isquemia crítica

Biagioni¹

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This study aimed to analyze the technical aspects and follow-up findings regarding patients with critical limb ischemia who underwent the kissing-balloon technique. Methods: Thirty patients (34 bifurcations) were enrolled in this retrospective analysis between September 2010 and February 2017. All patients were submitted to infrapopliteal intervention for critical limb ischemia. The KBT was the primary treatment in three situations: for cases with >70% stenosis of the main artery at located less than 1cm to the bifurcation, occlusion of one branch with greater than 50% stenosis of the contralateral branch, or greater than 50% bilateral stenosis. Stents were considered in cases of recoil greater than 30% or flow-limiting recoil and were used in 7 of the 34 bifurcations (20.5%). Result: Primary patency at 30 days, 1 year, and 2 years was 100%, 68.1% and 68.1, respectively. Limb salvage rates at 30 days, 1 year and 2 years were 100%, 86.6%, and 65.0%, respectively. Wound healing rates at 30 days, 6 months, 1 year, and 2 years were 7.1%, 34.4%, 44.5%, and 68.7%, respectively. The bifurcations of the V-shape and T-shape groups were compared in terms of wound healing, primary patency, and limb salvage. No differences were observed in wound healing (P=0.268), primary patency (P=0.394), and limb salvage (P=0.755). Conclusions:The kissing-balloon technique is a feasible bifurcation approach for infrapopliteal angioplasties to maintain the patency of both branches after ballooning.The comparison between the anterior tibial artery and tibioperoneal trunk bifurcation and the peroneal artery and posterior tibial artery bifurcation revealed no difference in wound healing, primary patency, and limb salvage.

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Approach to Treatment of Bifurcation Lesions

Cited by 6 publications

References 34 publications

Feasibility of improving vascular imaging in the presence of metallic stents using spectral photon counting CT and K-edge imaging

Feasibility of improving vascular imaging in the presence of metallic stents using spectral photon counting CT and K-edge imaging

Facts speak louder than words

Tratamento endovascular de artérias infrapoplíteas pela técnica de kissing-balloon em pacientes com isquemia crítica

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