Optical coherence tomography for guidance of distal cell recrossing in bifurcation stenting: choosing the right cell matters

Alegría-Barrero, Eduardo; Foin, Nicolas; Chan, Pak Hei; Syrseloudis, Dimitris; Lindsay, Alistair C; Dimopolous, Konstantinos; Alonso‐Gonzalez, Rafael; Viceconte, Nicola; Silva, Ranil de; Mario, Carlo Di

doi:10.4244/eijv8i2a34

Cited by 95 publications

(48 citation statements)

References 26 publications

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“…Second, in case of re-crossing of wire into SB ostium after deploying MV stent, targeting the distal site of side cell opening for entry is also important to ensure sufficient stent strut removal from the SB ostium or adequate apposition of the strut into the wall of SB ostium (Fig. 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].…”

Section: Optimizing 2-stenting Techniquesmentioning

confidence: 99%

“…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%

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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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Section: Optimizing 2-stenting Techniquesmentioning

confidence: 99%

Section: Optimizing 2-stenting Techniquesmentioning

confidence: 99%

Stenting of Coronary Bifurcation Lesions: a Literature and Technical Review

et al. 2015

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“…The ISA is a factor of poor prognosis [5] and the proximal rewiring is a cause of ISA [4] . Okamura T, et al reported using 3D-OCT that, if both the favorable strut configuration and the distal rewiring, ISA after SB dilatation was reduced [3] .…”

Section: Discussionmentioning

confidence: 99%

“…Generally the distal rewiring on a SB ostium has been recommended [4] . The ISA is a factor of poor prognosis [5] and the proximal rewiring is a cause of ISA [4] .…”

Section: Discussionmentioning

confidence: 99%

Instant stent-accentuated three-dimensional optical coherence tomography of a true bifurcation lesion treated with culotte stenting

Nakao

2014

JBGC

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A 65-year-old woman was performed percutaneous coronary intervention for a bifurcation lesion of the left anterior descending artery (LAD) and the first diagonal branch (Dg). After pre-dilatation, the proximal LAD-Dg was stented with the platinum-chromium elevolimus-eluting stent (PtCrEES). After rewiring to LAD, the instant stent-accentuated 3-dimensional optical coherence tomography (iSA3D-OCT) was reconstructed from 2-dimensional OCT (2D-OCT) by ImageJ with self-made macro-program. Classification of overhanging struts in front of the side branch (SB) ostium was the connecting to carina type, and the recrossed wire was confirmed to pass through the large distal cell. After kissing balloon dilatation (KBD), the mid-distal LAD and the proximal-mid LAD were stented with PtCrEESs. After rewiring to Dg, classification of overhanging struts in front of the SB ostium was the free carina type, and the recrossed wire was confirmed to pass through the distal cell, according to iSA3D-OCT. After final KBD, final iSA3D-OCT showed no floating struts.

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“…The coronary guidewire re-crossing position before the final kissing balloon post-dilation is important to reduce the incidence of incomplete stent apposition (3). The 11th consensus document from the European Bifurcation Club recommends the use of the distal cell when re-wiring, which is beneficial to ensure optimal SB re-crossing (4), and the position of the wire re-crossing may be verified by using optical coherence tomography (OCT). The ClearStent Live technique is an enhanced stent visualization system, which can enhance the signal of the stent strut on radiography, and increase the visibility of the stent dramatically during PCI.…”

Section: Introductionmentioning

confidence: 99%

Re-crossing the distal cell in bifurcation verified by using an enhanced stent visualization system and optical coherence tomography: a report of two cases

Jin

2017

J. Thorac. Dis.

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Abstract:The coronary guidewire re-crossing position before the final kissing balloon post-dilation is important to reduce the incidence of incomplete stent apposition in bifurcation lesions. Angiography and intravascular ultrasonography are unreliable at detecting the site of wire re-crossing. The high resolution of optical coherence tomography (OCT) offers the advantage of precise assessment of construction in bifurcation. However, the OCT technique still has some limitations, including the requirement for additional contrast and expense. We present two cases where the ClearStent Live system technique was used to estimate the wire location, which was verified by using OCT. In conclusion, ClearStent can be used with or to replace the intracoronary imaging technique in selected cases. J Thorac Dis 2017;9(3):E197-E201 jtd.amegroups.com angioplasty, a 2.5 mm × 24 mm stent (Partner, Lepu, China) was deployed in the distal LCX coronary artery and a 3.5 mm × 24 mm stent (PROMUS, Boston Scientific, USA) was deployed from the left main artery to the proximal LCX coronary artery ( Figure 1C,D). After re-wiring from the left main artery to the LAD, we used the ClearStent technique, which could enhance the revolution of the strut to estimate the wire location, and found that the wire re-crossed the distal cell ( Figure 1E,F). After the successful final kissing balloon and proximal optimal techniques, the final angiography was performed ( Figure 1G). We used OCT to verify our hypothesis successfully after re-crossing J Thorac Dis 2017;9(3):E197-E201 jtd.amegroups.com the distal cell (Figure 2). The patient was discharged 2 days later. No complications occurred either during the hospital stay or during the follow-up (6 months). Case 2A 55-year-old woman with a history of hypertension and dyslipidaemia was admitted to our hospital because of recurrent chest pain with minimal effort for 1 month. She was pre-treated with aspirin 100 mg and ticagrelor 180 mg per day. The diagnosis was unstable angina pectoris (CCS grade III and Braunwald grade IA). The patient's current coronary angiogram revealed severe stenosis at the middle segment of LAD, involving the ostium of diagonal artery ( Figure 3A). We have obtained written informed consent from patient before the procedure. After successful wiring and balloon angioplasty, a 3.5 mm × 30 mm stent (Resolute, Medtronic, USA) was deployed in the LAD with provisional Figure 3B). After re-wiring from the LAD to the diagonal artery, we used the ClearStent technique to estimate the wire location ( Figure 3C,D). After post dilation with a 4.0-mm balloon, we performed the final angiography ( Figure 3E). We used OCT to verify our hypothesis successfully after re-crossing the distal cell (Figure 4). The patient was discharged 2 days later, and his symptom was relieved obviously. At a 1-year follow-up, the patient was asymptomatic and free from events. DiscussionThe European Bifurcation Club strongly recommends the use of the distal cell when re-wiring because crossing the distal cell of the ...

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Optical coherence tomography for guidance of distal cell recrossing in bifurcation stenting: choosing the right cell matters

Abstract: The rate of strut malapposition was significantly reduced when OCT was used to confirm that wire recrossing was performed in a distal cell of the SB ostium.

Cited by 95 publications

References 26 publications

Stenting of Coronary Bifurcation Lesions: a Literature and Technical Review

Stenting of Coronary Bifurcation Lesions: a Literature and Technical Review

Instant stent-accentuated three-dimensional optical coherence tomography of a true bifurcation lesion treated with culotte stenting

Re-crossing the distal cell in bifurcation verified by using an enhanced stent visualization system and optical coherence tomography: a report of two cases

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