Immediate and long-term results of “T” stenting for bifurcation coronary lesions

Sheiban, Imad; Albiero, Remo; Marsico, Federica; Dharmadhikari, Aniruddha; Tzifos, Vaios; Pagnotta, Paolo; Montorfano, Matteo; Leonardo, Filippo; Saba, Piersergio; Mario, Carlo Di; Colombo, Antonio

doi:10.1016/s0002-9149(00)00712-8

Cited by 67 publications

(35 citation statements)

References 13 publications

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“…Among the 6 ostial lesions, 4 were located in the side branch of bifurcation stenting treatment, all treated with "T" stent technique (stent in the side branch implanted with its proximal border located at the ostium of the branch; stent in the main vessel implanted encompassing the side branch ostium, thereby creating a "T" configuration). 5 …”

Section: Patients With Restenosis After Sirolimus-eluting Stent Implamentioning

confidence: 99%

Coronary Restenosis After Sirolimus-Eluting Stent Implantation

et al. 2003

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Background-We describe the clinical and morphological patterns of restenosis after sirolimus-eluting stent (SES) implantation. Methods and Results-From 121 patients with coronary angiography obtained Ͼ30 days after SES implantation, restenosis (diameter stenosis Ͼ50%) was identified in 19 patients and 20 lesions (located at the proximal 5-mm segment in 30% or within the stent in 70%). Residual dissection after the procedure or balloon trauma outside the stent was identified in 83% of the proximal edge lesions. Lesions within the stent were focal, and stent discontinuity was identified in some lesions evaluated by intravascular ultrasound. Conclusions-Sirolimus-eluting stent edge restenosis is frequently associated with local trauma outside the stent. In-stent restenosis occurs as a localized lesion, commonly associated with a discontinuity in stent coverage. Local conditions instead of intrinsic drug-resistance to sirolimus are likely to play a major role in post-SES restenosis.

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Section: Patients With Restenosis After Sirolimus-eluting Stent Implamentioning

confidence: 99%

Coronary Restenosis After Sirolimus-Eluting Stent Implantation

et al. 2003

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“…Furthermore, patients with long sidebranch lesions were systematically excluded from the randomized trials [4]. Registries, though available in greater numbers [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], are of variable quality and use different lesion classification systems, quantitative coronary angiography (QCA) measurements performed in unclear technical conditions, with identical technical strategies bearing different names or different techniques grouped under a single name. Other than the comparison between stent deployment in one versus two branches, a meta-analysis of these various reports has proven quite impossible.…”

Section: Introductionmentioning

confidence: 99%

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

Louvard

Thomas

Džavík

et al. 2007

Cathet Cardio Intervent

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Background: Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains a subject of debate. Many studies have been published in this setting. They are often small scale and display methodological flaws and other shortcomings such as inaccurate designation of lesions, heterogeneity, and inadequate description of techniques implemented. Methods: The aim is to propose a consensus established by the European Bifurcation Club (EBC), on the definition and classification of bifurcation lesions and treatments implemented with the purpose of allowing comparisons between techniques in various anatomical and clinical settings. Results: A bifurcation lesion is a coronary artery narrowing occurring adjacent to, and/or involving, the origin of a significant side branch. The simple lesion classification proposed by Medina has been adopted. To analyze the outcomes of different techniques by intention to treat, it is necessary to clearly define which vessel is the distal main branch and which is (are) the side branche(s) and give each branch a distinct name. Each segment of the bifurcation has been named following the same pattern as the Medina classification. The classification of the techniques (MADS: Main, Across, Distal, Side) is based on the manner in which the first stent has been implanted. A visual presentation of PCI techniques and devices used should allow the development of a software describing quickly and accurately the procedure performed. Conclusion: The EBC proposes a new classification of bifurcation lesions and their treatments to permit accurate comparisons of well described techniques in homogeneous lesion groups. '

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“…1 Although the introduction of coronary stents resulted in more predictable results and higher success rates, angiographic restenosis rates remain high, despite the use of different approaches. [2][3][4] Specifically, the use of bare metal stents for both branches has not improved the results. 5,6 The sirolimus-eluting Bx Velocity balloon-expandable stent (Cypher stent, Cordis Corp, a Johnson & Johnson Company) has been reported to remarkably reduce restenosis after implantation in selected lesions, but bifurcation lesions were excluded.…”

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confidence: 99%

Randomized Study to Evaluate Sirolimus-Eluting Stents Implanted at Coronary Bifurcation Lesions

et al. 2004

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Background-A sirolimus-eluting stent (Cypher, Cordis Corp) has been reported to markedly decrease restenosis in selected lesions; higher-risk lesions, including coronary bifurcations, have not been studied. Methods and Results-This prospective study evaluated the safety and efficacy of sirolimus-eluting stents for treatment of coronary bifurcation lesions. Patients were randomly assigned to either stenting of both branches (group A) or stenting of the main branch with provisional stenting of the side branch (SB) (group B). Eighty-five patients (86 lesions) were enrolled. There was 1 case of unsuccessful delivery of any device at the bifurcation site. Given the high crossover, more lesions were treated with 2 stents (nϭ63) than with stent/balloon (nϭ22). Clinical follow-up at 6 months was completed in all patients and angiographic follow-up in 53 patients in group A (85.5%) and 21 in group B (95.4%). One patient died suddenly 4.5 months after the procedure. There were 3 cases of stent thrombosis (3.5%). The total restenosis rate at 6 months was 25.7%, and it was not significantly different between the double-stenting (28.0%) and the provisional SB-stenting (18.7%) groups. Fourteen of the restenosis cases occurred at the ostium of the SB and were focal. Target lesion revascularization was performed in 7 cases; target vessel failure occurred in 15 cases (17.6%). Conclusions-These results are an improvement compared with historical controls using bare metal stents. Restenosis at the SB remains a problem. At this time, no statement can be made regarding the most appropriate technique to use when treating bifurcations with the Cypher stent.

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Immediate and long-term results of “T” stenting for bifurcation coronary lesions

Cited by 67 publications

References 13 publications

Coronary Restenosis After Sirolimus-Eluting Stent Implantation

Coronary Restenosis After Sirolimus-Eluting Stent Implantation

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

Randomized Study to Evaluate Sirolimus-Eluting Stents Implanted at Coronary Bifurcation Lesions

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