Bifurcation Coronary Lesions Treated With the “Crush” Technique

Costa, Ricardo; Mintz, Gary S.; Carlier, Stéphane; Lansky, Alexandra J.; Moussa, Issam; Fujii, Kenichi; Takebayashi, Hideo; Yasuda, Takenori; Costa, J. Ribamar; Tsuchiya, Y.; Jensen, Lisette Okkels; Cristea, Ecaterina; Mehran, Roxana; Dangas, George; Iyer, Sriram S.; Collins, Michael B.; Kreps, Edward M.; Colombo, Antonio; Stone, Gregg W.; Leon, Martin B.; Moses, Jeffrey W.

doi:10.1016/j.jacc.2005.05.034

Cited by 202 publications

(129 citation statements)

References 12 publications

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“…Two-stent deployment may increase the risk of stent thrombosis and repeat revascularization in bifurcation LMCA lesions. 24,25) In our study, as shown in the Kaplan-Meier survival curve (Figure 1), most deaths occurred before 1 year after index PCI. If very late stent thrombosis had occurred more frequently in our study, the rates of MACE may have revealed different results.…”

Section: Discussionsupporting

confidence: 58%

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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Section: Discussionsupporting

confidence: 58%

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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“…6,7,18 Because bifurcation lesions vary and are complicated subsets of coronary artery disease, sophisticated imaging modality such as IVUS might be helpful to evaluate accurately and select more optimal treatment strategies. Previous studies using bare metal stent showed that IVUS guidance during PCI reduced the rate of in-stent restenosis and the incidence of reintervention.…”

Section: Discussionmentioning

confidence: 99%

“…It may play an advantageous role to guide appropriate treatment strategy and affect the better clinical outcomes by optimal stenting for different individual cases. 2,6,7 Previous studies with bare metal stent and DES have shown that IVUS guidance during percutaneous coronary intervention (PCI) improved clinical outcomes. 8,9 However, the impact of IVUS on clinical outcomes has been controversial according to different lesion subsets.…”

mentioning

confidence: 99%

Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions: Data from a Korean multicenter bifurcation registry

Kim

Hong

et al. 2011

American Heart Journal

101

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“…21 In most catheterization laboratories, IVUS is not frequently used due to the associated cost, time and unproven benefit for routine procedures, but a more liberal approach is suggested in patients with ambiguous lesions on coronary angiography or undergoing complex interventions to improve diagnostic accuracy and guide therapy to improve clinical outcomes. 15,16,22 …”

Section: Discussionmentioning

confidence: 99%

Intraluminal Filling Defects on Coronary Angiography: More than Meets the Eye

Jaffe

Irfan

Hong

et al. 2007

Clinical Cardiology

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SummaryIntraluminal filling defects are occasionally encountered on coronary angiography and often related with coronary thrombi. However, other conditions affecting the coronary arteries may present with similar angiographic findings causing diagnostic uncertainty. Accurate characterization of the angiographic filling defect is critical, particularly in patients planned for a percutaneous coronary intervention (PCI), as diagnosis of a coronary thrombus not only increases the risk of post procedural adverse events but also requires a specific therapeutic approach. In this paper, we report three patients in whom coronary angiography revealed intraluminal filling defects mimicking coronary thrombi. When further investigated with intravascular ultrasound (IVUS) as a part of the planned PCI, the thrombus was excluded and alternate etiology of the filling defect was confirmed in all patients. The angiographic "pseudothrombi" were produced by coronary dissection in one and by heavy calcification within the atherosclerotic plaque in two patients. The use of IVUS allowed accurate characterization of the angiographic filling defect and provided important information to guide management and optimize therapeutic approach. Coronary angiography is a common investigation performed in patients suspected with coronary artery disease. 1 Intraluminal filling defects are occasional findings on coronary angiography and may present a diagnostic and a therapeutic dilemma. Although they are often associated with intra coronary thrombi, particularly in the setting of an acute coronary syndrome, several other pathologies such as coronary artery dissection, emboli, mural calcification and unopposed stent struts in a previously stented segment may also result in similar angiographic findings. As the treatment markedly differs for these diverse conditions, it is imperative to characterize the true nature of these filling defects for proper diagnosis and management. In this paper, we report three cases with intraluminal filling defects that mimicked thrombi on coronary angiography. However, further interrogation with IVUS revealed alternate causes for the angiographic appearance. The accurate identification of the underlying pathology allowed application of a specific treatment strategy with good clinical outcome. Case 1An 85-year-old man with past medical history of hypertension, dyslipidemia and peripheral vascular disease was hospitalized after an inferior ST-elevation myocardial infarction. He did not receive thrombolytic therapy due to late presentation, but experienced further angina after admission to the coronary care unit. Coronary angiography revealed moderate disease in the left coronary artery and two intraluminal filling defects in the mid-segment of the right coronary artery (RCA), Fig. 1(A), suggesting presence of thrombi. An IVUS

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Bifurcation Coronary Lesions Treated With the “Crush” Technique

Abstract: In the majority of bifurcation lesions treated with the crush technique, the smallest minimum stent area appeared at the SB ostium. This may contribute to a higher restenosis rate at this location.

Cited by 202 publications

References 12 publications

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

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

Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions: Data from a Korean multicenter bifurcation registry

Intraluminal Filling Defects on Coronary Angiography: More than Meets the Eye

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