Interventional Therapy of Bifurcation Lesions

Korn, Hubertus von; Yu, Jiangtao; Ohlow, Marc‐Alexander; Huegl, Burkhard; Schulte, Walter; Wagner, Andreas H.; Wassmer, Gernot; Gruene, Stefan; Petek, Oliver; Lauer, Bernward

doi:10.1161/circinterventions.108.833046

Cited by 53 publications

(7 citation statements)

References 17 publications

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“…15 However, only 73% of the patients in that study compared with 97.1% in our study underwent kissing balloon dilatation in the FKBD arm, and 17.9% of the patients had stenting of the SB in the FKBD arm 15 compared with 1.3% in the present study.…”

Section: Niemelä Et Alcontrasting

confidence: 63%

Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting

et al. 2011

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MD; for the Nordic-Baltic PCI Study GroupBackground-It is unknown whether the preferred 1-stent bifurcation stenting approach with stenting of the main vessel (MV) and optional side branch stenting using drug-eluting stents should be finalized by a kissing balloon dilatation (FKBD). Therefore, we compared strategies of MV stenting with and without FKBD. Methods and Results-We randomized 477 patients with a bifurcation lesion to FKBD (nϭ238) or no FKBD (nϭ239) after MV stenting. The primary end point was major adverse cardiac events: cardiac death, non-procedure-related index lesion myocardial infarction, target lesion revascularization, or stent thrombosis within 6 months. The 6-month major adverse cardiac event rates were 2.1% and 2.5% (Pϭ1.00) in the FKBD and no-FKBD groups, respectively. Procedure and fluoroscopy times were longer and more contrast media was needed in the FKBD group than in the no-FKBD group. Three hundred twenty-six patients had a quantitative coronary assessment. At 8 months, the rate of binary (re)stenosis in the entire bifurcation lesion (MV and side branch) was 11.0% versus 17.3% (Pϭ0.11), in the MV was 3.1% versus 2.5% (Pϭ0.68), and in the side branch was 7.9% versus 15.4% (Pϭ0.039) in the FKBD versus no-FKBD groups, respectively. In patients with true bifurcation lesions, the side branch restenosis rate was 7.6% versus 20.0% (Pϭ0.024) in the FKBD and no-FKBD groups, respectively. Conclusions-MV

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Section: Niemelä Et Alcontrasting

confidence: 63%

Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting

et al. 2011

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“…The direct comparison of aggressive strategy (treating any ostial post-stent SB stenosis more than 75% vs. treating only ostial stenosis causing TIMI flow less than 3) yields equivalent results with almost identical TLR rates at one year (9.4% in the conservative group vs. 9.2% in the aggressive group, p = 0.97) [45]. These results reflect the earlier results with SB flow-guided strategy, performed with a first-generation DES (with a difference of more than doubled restenosis rates at shorter follow-up time) [46]. Some authors are against SB predilatation considering the potential for major dissection of the SB ostium, requiring additional stenting (which is also the official position of the European Bifurcation Club) [2].…”

Section: Side-branch Compromise and Periprocedural Myonecrosis: How Msupporting

confidence: 57%

Is it possible to further improve clinical results with coronary bifurcation stenting, or what is more important — the technique or the stent?

2017

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“…SBs with take-off angles of ≤45° show a greater occurrence of transient occlusion than those at angles of >45°; this event is infrequent, however, and it often resolves during the procedure and uniformly resolves by 6 months [16]. Korn et al [17 ]demonstrated that a TIMI flow-guided concept for treating the SB only when TIMI flow was 0 or 1 and/or the patient had angina was not inferior to a final kissing balloon PCI with provisional stenting of the SB, except with very large SBs such as a stenosis of the left main coronary artery. Recent studies suggest that the main mechanism for the aggravation of an SB ostial stenosis after MV stenting is alteration in the geometry of the carina and a shift of the MV plaque [18,19].…”

Section: Discussionmentioning

confidence: 99%

Impact of Coronary Bifurcation Angle on Clinical Outcomes after Percutaneous Coronary Intervention in Real-World Practice: Results from the COBIS Registry

Yang

Song

et al. 2012

Cardiology

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Objectives: Bifurcation angle has emerged as a predictor of outcome after percutaneous coronary intervention (PCI) for bifurcation lesions. We investigated the impact of bifurcation angle on clinical outcomes in patients undergoing bifurcation lesion PCI. Methods: Consecutive patients who received PCI for bifurcation lesions were enrolled from 16 centers in Korea between January 2004 and June 2006. Patients were divided into low-angle and high-angle groups using the median bifurcation angle (50°). We compared major adverse cardiac events, including cardiac death, myocardial infarction and target lesion revascularization as well as periprocedural outcomes between the 2 groups. Results: We evaluated 1,432 patients with bifurcation lesions with a median follow-up duration of 21 months. The rates of interventional side branch procedures such as guide-wiring of side branches, side-branch ballooning, final kissing ballooning and side-branch stenting were higher in the low-angle group. However, the incidences of major adverse cardiac events and target lesion revascularization were not significantly different between the 2 groups (6.6 vs. 6.9%, p = 0.856 and 4.6 vs. 5.7%, p = 0.375, respectively). Conclusions: Bifurcation angle may not influence long-term clinical outcome in patients with non-left main bifurcation lesion undergoing PCI despite its association with more interventional side-branch procedures.

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Interventional Therapy of Bifurcation Lesions

Cited by 53 publications

References 17 publications

Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting

Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting

Is it possible to further improve clinical results with coronary bifurcation stenting, or what is more important — the technique or the stent?

Impact of Coronary Bifurcation Angle on Clinical Outcomes after Percutaneous Coronary Intervention in Real-World Practice: Results from the COBIS Registry

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