Intravascular ultrasound‐guided systematic two‐stent techniques for coronary bifurcation lesions and reduced late stent thrombosis

Chen, Shao‐Liang; Ye, Fei; Zhang, Junjie; Tian, Nai‐Liang; Liu, Zhizhong; Santoso, Teguh; Zhou, Yujie; Jiang, Tieming; Wen, Shimin; Kwan, Tak

doi:10.1002/ccd.24601

Cited by 55 publications

(31 citation statements)

References 34 publications

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“…1 In the DES era, a meta-analysis including this trial and 10 registries reported that IVUS guidance may reduce ST and cardiac death after DES, although TVR rates were reduced only in complex lesion cohorts. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The present study reports by far the largest experience with IVUS guidance of DES implantation, with a major strength being enrollment of an all-comers population. In this population, IVUS guidance was associated with lower rates of ST, MI, and ischemia-driven TLR and TVR compared with angiography guidance alone.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Nonetheless, definitive randomized trials to demonstrate whether IVUS guidance improves clinical outcomes after stent implantation have not been performed, with most prior trials being underpowered and restricted to noncomplex lesions. The benefits of IVUS after drug-eluting stent (DES) use are particularly controversial given the improved outcomes with DES compared with bare metal stents.…”

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confidence: 99%

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Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents

et al. 2014

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Background-Prior small to modest-sized studies suggest a benefit of intravascular ultrasound (IVUS) guidance in noncomplex lesions. Whether IVUS guidance is associated with improved clinical outcomes after drug-eluting stent (DES) implantation in an unrestricted patient population is unknown. Methods and Results-Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter, nonrandomized "all-comers" study of 8583 consecutive patients at 11 international centers designed to determine the frequency, timing, and correlates of stent thrombosis and adverse clinical events after DES. Propensity-adjusted multivariable analysis was performed to examine the relationship between IVUS guidance and 1-year outcomes. IVUS was utilized in 3349 patients (39%), and larger-diameter devices, longer stents, and/or higher inflation pressures were used in 74% of IVUS-guided cases. IVUS guidance compared with angiography guidance was associated with reduced 1-year rates of definite/probable stent thrombosis (0.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents

et al. 2014

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“…IVUS contributes to the assessment of complex bifurcation lesions, plaque burden and location, bifurcation angles, morphology of the carina, and ostial lesions [12][13][14][15]. Since IVUS guidance facilitates the lesion evaluation, the selection of an optimal device size, the full coverage of the lesion, and an accurate assessment of the treatment, it might lower the rates of TLR, death, stent thrombosis, and MI [12][13][14][15]. However, the complete IVUS guidance in the present study did not lead to prominent reduction of TLR compared to other previous studies in which the frequency of the IVUS guidance was low.…”

Section: Discussionmentioning

confidence: 99%

“…Since intravascular sound (IVUS) optimizes percutaneous coronary interventions (PCI), device selection, and lesion evaluation; it has been reported to lower the rates of death, myocardial infarction (MI), TLR, and stent thrombosis after the deployment of DES in bifurcation lesions [12][13][14][15]. However, in studies of bifurcation lesions including [200 patients, IVUS was actually performed in 15-40 % of patients [3][4][5]10].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Everolimus- versus Sirolimus-eluting stents in the provisional Bifurcation stenting guided by intravascular ultrasound: mid-term results of the J-REVERSE registry

Murasato

Kinoshita

Yamawaki

et al. 2015

Cardiovasc Interv and Ther

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This study aimed at comparing the mid-term clinical outcome of everolimus-eluting (EES) with sirolimus-eluting (SES) stents in the provisional bifurcation stenting guided by intravascular ultrasound (IVUS). We compared the clinical outcome up to 9-month follow-up results of the prospective J-REVERSE registry of 300 non-left main bifurcation lesions in 298 patients treated with EES (n = 240) and SES (n = 60). The SB dilation with the kissing balloon technique (KBT) was performed in 54 %. The patient and lesion characteristics of the groups were similar. The incidences of SB dissections, occlusions, stenting, and slow flow were similar. A greater luminal volume gain was achieved in the proximal MV after KBT compared in non-KBT treated lesions in the EES group (7.9 ± 2.4 versus 7.0 ± 2.0 mm(3)/mm, p = 0.002), though not in the SES group. The SB diameter stenosis in the non-KBT treatment at 9 months was greater than the KBT in both groups. The incidence of target lesion revascularisation (TLR) was 5.0 % in the EES versus 8.3 % in the SES group (p = 0.35), and the incidence of major adverse cardiac events, including TLR, myocardial infarction, stent thrombosis, and death was 5.4 % in the EES versus 11.7 % in the SES group (p = 0.15). IVUS-guided provisional stenting with EES achieved a greater luminal gain after than without KBT, and similar clinical outcomes as with SES up to 9-month follow-up.

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“…2) [53][54][55]. A pullback wire technique might be the best practice to facilitate distal rewiring, and imaging devices such as IVUS or OCT may allow the confirmation of the site of re-wiring [50,53,54]. In addition, in case of re-wiring into MVafter implantation of SB stent in culotte technique, re-crossing the wire at the cell located close to the carina is also crucial to avoid unnecessary lengthening of new metallic carina, which may induce more flow disturbance and delayed endothelial coverage of the metallic carina (Fig.…”

Section: Optimizing 2-stenting Techniquesmentioning

confidence: 99%

Stenting of Coronary Bifurcation Lesions: a Literature and Technical Review

et al. 2015

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Newer generation drug-eluting stents have improved outcomes in various subsets of coronary lesions including bifurcation lesions. This article reviews the current literature on various issues in bifurcation percutaneous coronary intervention (PCI). Generally, the provisional approach of placing one stent in the main vessel is the preferred first-line treatment for most bifurcation lesions. However, some lesions require 2-stenting. It is unknown whether 2nd-generation DES have improved outcomes with 2-stenting. The use of fractional flow reserve (FFR) for the assessment of functional significance of the jailed side branch can help avoid unnecessary stenting in complex lesions. Skilled techniques in every step of the 2-stenting process and meticulous use of imaging techniques including IVUS or OCT are warranted to obtain optimal angiographic and clinical results. Dedicated bifurcation stents are feasible treatment options and may change future concepts in bifurcation PCI, although larger trials with control groups are required in order to widely apply these techniques into daily routine practice.

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Intravascular ultrasound‐guided systematic two‐stent techniques for coronary bifurcation lesions and reduced late stent thrombosis

Abstract: The IVUS-guided two-stent technique was associated with significantly reduced late stent thrombosis, with a resultant reduction in ST-elevation MI. © 2012 Wiley Periodicals, Inc.

Cited by 55 publications

References 34 publications

Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents

Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents

Comparison of Everolimus- versus Sirolimus-eluting stents in the provisional Bifurcation stenting guided by intravascular ultrasound: mid-term results of the J-REVERSE registry

Stenting of Coronary Bifurcation Lesions: a Literature and Technical Review

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