Long-Term Outcomes After Stenting of Bifurcation Lesions With the “Crush” Technique

Hoye, Angela; Iakovou, Ioannis; Ge, Liang; Mieghem, Carlos A.G. van; Ong, Andrew T.L.; Cosgrave, John; Sangiorgi, Giuseppe; Airoldi, Flavio; Montorfano, Matteo; Michev, Iassen; Chieffo, Alaide; Carlino, Mauro; Corvaja, Nicola; Aoki, Jiro; Rodríguez-Granillo, Gastón A.; Valgimigli, Marco; Sianos, Georgios; Giessen, Willem J. van der; Feyter, Pim J. de; Domburg, Ron T. van; Serruys, Patrick W.; Colombo, Antonio

doi:10.1016/j.jacc.2005.11.083

Cited by 227 publications

(154 citation statements)

References 35 publications

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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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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

Self Cite

277

139

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“…In comparison to other PCIs, bifurcation interventions tend to have lower rates of procedural success, higher resource utilization, and higher rates of clinical and angiographic restenosis. [3][4][5][6][7][8] Stents deployed at low pressure might leave a gap (underdeployment) between the stent and the wall of the proximal vessel that normally have a larger diameter. Guide wires and even a short balloon can go through stent struts (false-true or true-false-true) without an appreciable resistance, and this commonly causes stent crush after balloon inflation.…”

Section: A B C Discussionmentioning

confidence: 99%

Intravascular Ultrasound (IVUS) Guided Fixation of an Accidentally Crushed Coronary Stent

et al. 2008

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SUMMARYStent deployment during coronary intervention has become more and more common recently. Inappropriate stent deployment may lead to unexpected high mortality and morbidity rates. A 62 year-old man with unstable angina presented with a bifurcation lesion after diagnostic coronary angiography. A drug-eluting stent was successfully deployed across the bifurcation lesion. However, after wire exchange and rewiring followed by high pressure balloon postdilatation, the stent was accidentally crushed under IVUS guidance. We used a looping wire technique and successfully redilated the crushed instent portion. This case suggests interventionists should not always change the wire before stent well deployment and should bear in mind the value of IVUS in managing such a complication. ( These complications are also associated with unexpected high morbidity and mortality rates. However, inadvertent stent crush is a rare, yet commonly missed, complication by interventionists if the coronary angiogram is not reviewed very carefully for a lower threshold of intravascular ultrasound (IVUS) use in such situations.2) Here, we describe a bifurcation stenting case that appeared to proceed smoothly, with inadvertent severe stent crush diagnosed and corrected with IVUS guidance. CASE REPORTA 62 year-old man with unstable angina was referred to our institute for coronary angiography. A critical bifurcation stenosis was found at the mid left anteFrom the

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“…Assim, seria ampliado criteriosamente o uso desses dispositivos, e indiscutivelmente se aumentaria a segurança jurídica para atuação do médico. Como exemplificação, seria razoável validar o tratamento, com stents farmacológicos, da reestenose intrastent convencional 24 , de lesões em bifurcações 25 ou em vasos de menor calibre 26 . Essa validação deveria ser acompanhada de ressalva relativa a que, nessas situações, os resultados clínicos poderiam ser distintos dos observados nas indicações habituais, ou seja, as constantes do bulário.…”

Section: A Propósito Da Responsabilidade Médica Na Indicação E No Impunclassified

Conflitos éticos e judiciais no emprego dos stents farmacológicos no Brasil: análise das principais controvérsias para incorporação dessa tecnologia nos sistemas de saúde público e privado no país

Lopes¹,

Filho²,

Gubolino³

et al. 2009

Rev. Bras. Cardiol. Invasiva

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Long-Term Outcomes After Stenting of Bifurcation Lesions With the “Crush” Technique

Cited by 227 publications

References 35 publications

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

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

Intravascular Ultrasound (IVUS) Guided Fixation of an Accidentally Crushed Coronary Stent

Conflitos éticos e judiciais no emprego dos stents farmacológicos no Brasil: análise das principais controvérsias para incorporação dessa tecnologia nos sistemas de saúde público e privado no país

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