Classification of coronary artery bifurcation lesions and treatments: Time for a consensus!

Louvard, Yves; Thomas, Martyn; Džavík, Vladimir; Hildick‐Smith, David; Galassi, Alfredo R.; Pan, Manuel; Burzotta, Francesco; Želı́zko, Michael; Dudek, Darius; Ludman, Peter; Sheiban, Imad; Lassen, Jens Flensted; Darremont, Olivier; Kastrati, Adnan; Ludwig, Josef; Iakovou, Ioannis; Brunel, Philippe; Lansky, Alexandra J.; Meerkin, David; Legrand, Victor; Medina, Alfonso; Lefèvre, Thierry

doi:10.1002/ccd.21314

Cited by 277 publications

(147 citation statements)

References 54 publications

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“…The measurement was performed in the angiographic view in which the foreshortening of the 3 segments was minimal. 7,[12][13][14] …”

Section: Angiographic Analysismentioning

confidence: 99%

Changes in Left Main Bifurcation Geometry After a Single-Stent Crossover Technique

Kang

Mintz²,

Kim³

et al. 2011

Circ: Cardiovascular Interventions

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Background-We assessed geometric changes responsible for acute lumen loss at the left circumflex coronary artery (LCX) ostium after crossover stenting from the left anterior descending coronary artery (LAD) to the left main artery. Methods and Results-Twenty-three left main artery bifurcation lesions with a preprocedural angiographic diameter stenosis Ͻ50% at the LCX ostium were evaluated using prestenting and poststenting intravascular ultrasound pullbacks from both the LAD and the LCX. At the minimal lumen area (MLA) sites within the LCX ostium and at the LCX carina, the lumen, stent, plaqueϩmedia (PϩM), and external elastic membrane (EEM) areas were measured; the EEM eccentricity was calculated at the LCX carina. The change in MLA within the LCX ostium (⌬L), the change in EEM area at the MLA site (⌬V), and the change in PϩM area at the MLA site (⌬P) were calculated. The MLA within the LCX ostium significantly decreased from 5.4 mm 2 (first and third quartiles, 4.3 mm 2 , 7.2 mm 2 ) prestenting to 4.0 mm

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“…The measurement was performed in the angiographic view in which the foreshortening of the 3 segments was minimal. 7,[12][13][14] …”

Section: Angiographic Analysismentioning

confidence: 99%

Changes in Left Main Bifurcation Geometry After a Single-Stent Crossover Technique

Kang

Mintz²,

Kim³

et al. 2011

Circ: Cardiovascular Interventions

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“…For example, in a recent statement by the European Bifurcation Club, complex treatment strategies are discussed and the evidence in favor of the simple strategy is ignored. 23 Of course, in clinical practice, complex stenting is often inevitable, especially in the case of a true bifurcated lesion with a massive plaque burden and a side branch of considerable size. However, the angiographic appearance of ostial residual stenosis of a side branch does not correspond to its functional significance, and in most cases, kissing balloon dilatation may suffice.…”

Section: Circ Cardiovasc Intervent October 2009mentioning

confidence: 99%

Double Versus Single Stenting for Coronary Bifurcation Lesions

Katritsis

Siontis

Ioannidis

2009

Circ: Cardiovascular Interventions

123

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Background-Several trials have addressed whether bifurcation lesions require stenting of both the main vessel and side branch, but uncertainty remains on the benefits of such double versus single stenting of the main vessel only. Methods and Results-We have conducted a meta-analysis of randomized trials including patients with coronary bifurcation lesions who were randomly selected to undergo percutaneous coronary intervention by either double or single stenting. Six studies (nϭ1642 patients) were eligible. There was increased risk of myocardial infarction with double stenting (risk ratio, 1.78; Pϭ0.001 by fixed effects; risk ratio, 1.49 with Bayesian meta-analysis). The summary point estimate suggested also an increased risk of stent thrombosis with double stenting, but the difference was not nominally significant given the sparse data (risk ratio, 1.85; Pϭ0.19). No obvious difference was seen for death (risk ratio, 0.81; Pϭ0.66) and target lesion revascularization (risk ratio, 1.09; Pϭ0.67). Key Words: angioplasty Ⅲ coronary bifurcation Ⅲ PCI Ⅲ stents Ⅲ meta-analysis P ercutaneous coronary intervention (PCI) of bifurcation lesions remains a subject of debate in terms of optimum treatment technique. Balloon angioplasty and bare metal stents have gradually been replaced by drug-eluting stents. [1][2][3][4][5][6] When stenting is used, a major question is whether both the main vessel and the side branch should be stented. Such double stenting is appealing because it produces attractive postprocedural angiographic results. However, there have been concerns about long-term major adverse cardiac events and, in particular, stent thrombosis with adjacent stents. Among several randomized trials published so far, 7-13 the deployment of an additional stent on the side branch of a bifurcation lesion has never been shown to result in significantly improved clinical outcomes as initially hypothesized. These trials, however, have been of too limited a sample size to allow robust conclusions, when seen in isolation. A synopsis of 3 randomized and 3 observational comparisons failed to detect any significant differences between double and single stenting in a bifurcation. 14 However, several other trials have appeared recently. We have, therefore, performed a meta-analysis of randomized trials to examine the relative outcomes of the double versus single stenting strategies for bifurcation lesions in terms of mortality, myocardial infarction, stent thrombosis, and target lesion revascularization. Conclusions-Stenting Clinical Perspective on p 415 Methods Study Eligibility and SelectionWe have conducted a meta-analysis of randomized trials including patients with coronary bifurcation lesions who were randomly selected to undergo PCI by either single stenting of the main vessel only (simple strategy) or double stenting of both the main vessel and the side branch (complex strategy) with any PCI technique. For study selection, we searched PubMed, using the terms bifurcation, coronary, and stent (last update, February 26, 2009). In...

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“…Reduction of restenosis rate by introduction of DES led to the development of many techniques based on the implantation of two or more stents [17]. However, none of them was superior to MB stenting with the use of a single stent and provisional side-branch stenting [18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Coronary bifurcation stenting with dedicated Tryton side-branch stent. Early and 6-month results of 40 patients

Lesiak¹,

Stanisławska²,

Drewnicki³

et al. 2011

pwki

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A b s t r a c tBackground: Coronary artery bifurcation stenting using standard stents is associated with increased risk of complications and poor long-term prognosis. Bifurcation-dedicated stents raise a hope of improving the acute and late results of such procedures.Aim: To assess the early and mid-term results of bifurcation stenting with the specially designed bifurcation-dedicated Tryton side-branch stent.Methods and results: We evaluated 40 consecutive procedures of coronary artery bifurcation stenting using a Tryton stent in patients with stable angina or acute coronary syndrome without ST elevation. The stent was successfully implanted in 39 patients. The main vessel was treated with drug-eluting stents in 38 cases, whereas bare metal stents were used in the remaining two. In one case the procedure was complicated by non-Q wave myocardial infarction. During 30-day and 6-month observation no additional major adverse cardiac events were observed.Conclusion: Coronary bifurcation stenting with the Tryton side-branch stent is highly effective, with a low rate of acute and midterm complications.Key words: coronary bifurcation lesion, percutaneous coronary intervention, bifurcation dedicated stents S t r e s z c z e n i e Wstęp: Stentowanie bifurkacji tętnic wieńcowych przy użyciu standardowych stentów obarczone jest zwiększonym ryzykiem powikłań i gorszym rokowaniem odległym. Stenty specjalnie przeznaczone do bifurkacji mogą się przyczynić do poprawy wyników bezpośrednich i odległych zabiegów.Cel: Ocena wczesnych i średnioterminowych wyników stentowania zwężeń bifurkacji tętnic wieńcowych za pomocą implantacji stentu przeznaczonego do protekcji bocznicy Tryton.Metody i wyniki: Ocenie poddano kolejnych 40 zabiegów stentowania bifurkacji tętnic wieńcowych z zastosowaniem stentu Tryton u pacjentów z dławicą piersiową stabilną lub ostrym zespołem wieńcowym bez uniesienia odcinka ST. Stent skutecznie implantowano do bocznicy u 39 pacjentów. Naczynie główne leczono implantacją stentu uwalniającego lek w 38 przypadkach, w dwóch implantowano stent metalowy. W jednym przypadku zabieg był powikłany zawałem serca bez wytworzenia załamków Q. W obserwacji 30-dniowej oraz 6-miesięcznej nie stwierdzono żadnych dodatkowych niekorzystnych zdarzeń sercowych.Wnioski: Leczenie zwężeń bifurkacji tętnic wieńcowych z zastosowaniem stentu Tryton przeznaczonego do protekcji bocznicy cechuje się wysoką skutecznością bezpośrednią i niskim ryzykiem powikłań w obserwacji 30-dniowej i 6-miesięcznej.Słowa kluczowe: zwężenie bifurkacji tętnic wieńcowych, przezskórne interwencje wieńcowe, stenty przeznaczone do bifurkacji

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Classification of coronary artery bifurcation lesions and treatments: Time for a consensus!

Cited by 277 publications

References 54 publications

Changes in Left Main Bifurcation Geometry After a Single-Stent Crossover Technique

Changes in Left Main Bifurcation Geometry After a Single-Stent Crossover Technique

Double Versus Single Stenting for Coronary Bifurcation Lesions

Coronary bifurcation stenting with dedicated Tryton side-branch stent. Early and 6-month results of 40 patients

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