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

Vassilev, Dobrin; Dosev, Liubomir; Gil, Robert

doi:10.5603/kp.2017.0024

Cited by 4 publications

(3 citation statements)

References 43 publications

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“…At present, mainly Non-Compliant balloon catheters are used for the pre-dilatation of heavily calcified lesions, post-dilatation of implanted stent to enhance the parameters of expansion, dealing with coronary bifurcation lesion through kissing balloon technique and management of cases with restenosis, particularly in previously implanted stents. [13][14][15] According to several studies, use of Non-Compliant (NC) balloon for Post Dilatation (PD) is found to be associated with optimal expansion hence higher frequency of optimal stent deployment, lower rates of Target Vessel Revascularization (TVR) and better clinical outcomes of the patients going through elective angioplasty. 16 This study focuses on the evaluation of impacts of PD performed with Non-Compliant balloon on angiographical outcome (that is TIMI flow grade) in patients who went through the primary PCI.…”

Section: Discussionmentioning

confidence: 99%

Effect of Post Dilatation on TIMI Flow in Patients Undergoing Primary Percutaneous Coronary Intervention

Abbasi

Samore²,

Ali³

et al. 2022

PAFMJ

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Objective: To evaluate the impact of post dilatation performed with Non- Compliant Balloon on Angiographical outcome (that is TIMI flow grade) in patients who underwent the primary percutaneous coronary intervention. Study Design: Retrospective cross-sectional study. Place and Duration of Study: At Tertiary Cardiac Care Center, Rawalpindi Pakistan from Nov 2020 to Apr 2021. Methodology: The retrospective data of the all the patients with STEMI was assessed via non-probability consecutive sampling technique and analyzed statistically. The study participants were classified into two categories based on whether they underwent post-dilatation or not, i.e., Category-I: patients who underwent post-dilatation with NC balloon and Category-II: patients who did not undergo post-dilatation. The primary study end-point was post-dilatation TIMI flow grade. Continuous study variables were expressed as Mean±S.D and categorical variables as frequencies and percentages. Chi square test was applied to find the association between study variables by keeping 95% CI and 5 % margin of error. p-value <0.05 was considered statistically significant. Results: The study included (n=410) eligible patients in total. Majority were males (n=303; 73.9%), 217 (52.9 %) patients underwent PD procedure. TIMI flow grade did not differ significantly between the two study categories (p-value > 0.05). Postprocedural success rate was 81.3% for patients with PD. Conclusion: The current study illustrates that PD does not adversely affect the final angiographic outcomes when performed after primary angioplasty.

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Section: Discussionmentioning

confidence: 99%

Effect of Post Dilatation on TIMI Flow in Patients Undergoing Primary Percutaneous Coronary Intervention

Abbasi

Samore²,

Ali³

et al. 2022

PAFMJ

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“…Also, several registries have confirmed the feasibility of the Absorb implantation for so-called "off-label" indications [16,17], i.e. acute coronary syndromes [18][19][20], bifurcations [21], saphenous vein grafts [22], chronic total occlusions, etc. However, results of the European multicentre GHOST-EU registry suggest an elevated risk of definite or probable device thrombosis in patients treated with the Absorb in the "real-world" setting (1.5% at 30 days and 2.1% at six months) [23].…”

Section: Absorb Bioresorbable Scaffoldmentioning

confidence: 97%

Current perspectives on the role of bioresorbable scaffolds in the management of coronary artery disease

Dziewierz¹,

Dudek²

2018

Kardiol Pol

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New-generation drug-eluting stents are recommended as the default option in all clinical conditions and lesion subsets in patients undergoing percutaneous coronary intervention (PCI). On the other hand, despite achieving very good results in the rate of restenosis, permanent delivery of a metallic platform is affected by several drawbacks, such as caging of the vessel, side branch jailing, impairment of vasomotion, and the impossibility of lumen enlargement. Also, the presence of residual foreign material may increase the risk of late and very late stent thrombosis and support the need for long-term dual antiplatelet therapy after PCI. These pending limitations of metallic stents can be addressed by the implantation of bioresorbable scaf-folds (BRSs). At present, there are numerous devices available for preclinical or clinical evaluation. This review discusses the evidence for BRS in the management of patients with coronary artery disease.

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“…The most recent data have indicated relatively low rates of stent thrombosis (1.0%), target lesion failure (5.1%), cardiac death (1.8%) and all-cause death (1.8%) 1 year after bifurcation percutaneous coronary intervention (PCI) [5]. Previously, we hypothesized that these improved PCI results are partially associated with improvements in stent technology (platforms, drugs and drug carriers) [6]. With technological advances, interventional technical performance has improved, as clearly indicated by changes in the recommendations of the European Bifurcation Club over time [7,8].…”

Section: Introductionmentioning

confidence: 99%

Intracoronary Electrocardiography-guided Strategy for the Treatment of Coronary Bifurcation Lesions

Vassilev,

Mileva,

Panayotov

et al. 2023

CVIA

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Introduction: Revascularization of bifurcation lesions remains an interventional challenge. Intracoronary electrocardiograms can predict the functional significance of side branch stenosis after bifurcation stenting. Aim: This study was aimed at evaluating the effects of an intracoronary ECG electrocardiography (icECG)-guided revascularization strategy, compared with the currently accepted standard of care, on the clinical outcomes of patients after coronary bifurcation stenting. Methods: Patients with coronary bifurcation lesions who underwent percutaneous revascularization were enrolled in a prospective all-comers’ registry. Clinical outcomes were compared between patients who underwent icECG-guided revascularization versus the current standard of care (SOC), provisional stenting. Results: A total of 768 patients were included in the analysis: 349 were treated with an icECG-guided strategy, and 419 received SOC. The overall all-cause death rate was 23.2%, and the cardiovascular death rate was 15.9%. Patients with icECG guidance had significantly lower all-cause mortality (20.3% vs. 25.5% for icECG vs. SOC, log-rank P = 0.006) and cardiovascular mortality (12.6% vs. 18.6% for icECG vs. SOC, log-rank P = 0.004). The decrease in mortality was most pronounced in patients with no increase or a moderate increase in troponin post-PCI, or with higher-than-normal baseline troponin concentrations. Conclusion: An icECG-guided strategy for coronary bifurcation PCI led to lower patient mortality than the provisional stenting strategy.

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

Cited by 4 publications

References 43 publications

Effect of Post Dilatation on TIMI Flow in Patients Undergoing Primary Percutaneous Coronary Intervention

Effect of Post Dilatation on TIMI Flow in Patients Undergoing Primary Percutaneous Coronary Intervention

Current perspectives on the role of bioresorbable scaffolds in the management of coronary artery disease

Intracoronary Electrocardiography-guided Strategy for the Treatment of Coronary Bifurcation Lesions

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