Percutaneous coronary intervention for bifurcation coronary lesions: the 15&lt;sup&gt;th&lt;/sup&gt; consensus document from the European Bifurcation Club

Burzotta, Francesco; Lassen, Jens Flensted; Lefèvre, Thierry; Banning, Adrian; Chatzizisis, Yiannis S.; Johnson, Tom; Ferenc, Mirosław; Rathore, Sudhir; Albiero, Remo; Pan, Manuel; Darremont, Olivier; Hildick‐Smith, David; Chieffo, Alaide; Zimarino, Marco; Louvard, Yves; Stanković, Goran

doi:10.4244/eij-d-20-00169

Cited by 184 publications

(197 citation statements)

References 40 publications

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“…According to EBC recommendations [3][4][5], the minimal treatment for bifurcated coronary lesions is stent implantation in the MV (also called "crossover" stenting) with the stent sized 1:1 according to the distal MV, followed by POT with the balloon sized 1:1 according to the proximal MV.…”

Section: One-stent Technique: Proximal Optimization Techniquementioning

confidence: 99%

“…During one-stent strategies, after stenting the MV, it may become clinically necessary to intervene on the SB. To do this, physicians typically perform SB rewiring, followed by kissing balloon inflation [3][4][5]. Since the SB rewiring site is known to influence final stent deformations [13], we performed side-cell crossing to the SB using a pullback technique [14] in order to facilitate "distal" stent frame rewiring.…”

Section: One-stent Technique: Kissing Balloon Inflationmentioning

confidence: 99%

“…In some specific anatomic conditions, the selection of an "inverted" provisional strategy might considered [3][4][5]. This technique is executed by implanting the stent from the SB into the proximal MV, then following the same steps of provisional (POT, distal rewiring, kissing, and re-POT).…”

Section: One-stent Technique: Kissing Balloon Inflationmentioning

confidence: 99%

“…A culotte procedure may begin by deploying a stent in the MV (according to crossover stenting provisional approach) or covering the SB and proximal MV (according to inverted provisional approach) [3][4][5]. Regardless of beginning strategy, both stents must be appropriately sized to fit each of the distal branches as well as the proximal MV.…”

Section: Two-stent Techniques: Culotte Techniquementioning

confidence: 99%

“…Relative to the implantation of drug-eluting metallic stents, 1-or 2-stent techniques are the standard approaches for PCIs within bifurcation lesions [3][4][5]. These PCIs are often technically complex and associated with higher occurrence of adverse events, both short-and long-term [6].…”

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confidence: 99%

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Assessment of single and double coronary bifurcation stenting techniques using multimodal imaging and 3D modeling in reanimated swine hearts using Visible Heart® methodologies

Valenzuela

Burzotta

Iles

et al. 2021

Int J Cardiovasc Imaging

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Stent implantation in bifurcated coronary lesions is technically challenging so that procedural refinements are continuously investigated. Novel procedure modeling and intracoronary imaging techniques may offer critical insights on stent deformations and stent-wall interactions during bifurcation stenting procedures. Thus, we assessed coronary bifurcation stenting techniques using multimodal imaging and 3D modeling in reanimated swine hearts. Harvested swine hearts were reanimated using Visible Heart® methodologies and (under standard fluoroscopic guidance) used to test 1-stent (provisional and inverted provisional) and 2-stent (culotte, TAP and DK-crush) techniques on bifurcations within various coronary vessels using commercially available devices. Intracoronary angioscopy and frequency-domain optical-coherence-tomography (OCT) were obtained during the procedures. 3D OCT reconstruction and micro-computed tomography 3D modeling (post heart fixations) were used to assess stent deformations and stent-wall interactions. We conducted multiple stenting procedures and collected unique endoscopic and OCT images (and subsequent computational models from micro-CT) to assess stent deformations and device/wall interactions during different steps of bifurcation stenting procedures. Endoscopy, micro-CT and virtual reality processing documented that different 1- and 2-stent techniques, practiced according to experts’ recommended steps, achieve optimal post-intervention stent conformation. As compared with intra-procedural endoscopy, software-generated 3D OCT images accurately depicted stent deformations during 1-stent techniques. On the opposite, during more complex 2-stent techniques, some defects were appreciated at 3D OCT reconstruction despite optimal 2D OCT images. This study provided unique insights regarding both stent deformations occurring in the course of bifurcation stenting and the efficacy of OCT to visualize them.

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Section: One-stent Technique: Proximal Optimization Techniquementioning

confidence: 99%

Section: One-stent Technique: Kissing Balloon Inflationmentioning

confidence: 99%

Section: One-stent Technique: Kissing Balloon Inflationmentioning

confidence: 99%

Section: Two-stent Techniques: Culotte Techniquementioning

confidence: 99%

mentioning

confidence: 99%

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Assessment of single and double coronary bifurcation stenting techniques using multimodal imaging and 3D modeling in reanimated swine hearts using Visible Heart® methodologies

Valenzuela

Burzotta

Iles

et al. 2021

Int J Cardiovasc Imaging

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Double kissing crush stenting: No pain, no gain?

Dangas

Garg

2022

Cathet Cardio Intervent

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Comparison of adenosine‐independent pressure indices to fractional flow reserve in stent‐jailed bifurcation side branches

Altstidl

Achenbach

Marwan

et al. 2022

Cathet Cardio Intervent

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Objectives and Background: This study aims to evaluate whether the high correlation and classification agreement of the instantaneous wave-free ratio (iFR) and the resting distal coronary to aortic pressure ratio (P d /P a ) with the fractional flow reserve (FFR) can be confirmed in stent-jailed side branches (J-SB).Methods: Consecutive patients (n = 49) undergoing provisional stenting were prospectively enrolled and a physiological assessment of the J-SB (n = 51) was performed. FFR, iFR, and P d /P a were measured and the hemodynamic relevance was determined using cutoff values of ≤0.80, ≤0.89, and ≤0.92, respectively.Results: Both iFR (r = 0.75) and P d /P a (r = 0.77) correlated closely with FFR.Classification agreement with FFR was 78% for iFR (81% sensitivity, 77% specificity) and 75% for P d /P a (63% sensitivity and 80% specificity). However, angiographic diameter stenosis and pressure indices correlated poorly. For a threshold of ≥70% stenosis, agreement concerning hemodynamic relevance was found in 59% for FFR, 69% for iFR, and 61% for P d /P a . Conclusion:As reported for other lesion types, FFR and the adenosine-independent pressure indices iFR and P d /P a show close correlation and a high classification agreement of approximately 75%-80% in J-SB. Therefore, iFR can be regarded as a recommendable alternative to FFR for the guidance of provisional stenting in bifurcation lesions.

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Percutaneous coronary intervention for bifurcation coronary lesions: the 15<sup>th</sup> consensus document from the European Bifurcation Club

Cited by 184 publications

References 40 publications

Assessment of single and double coronary bifurcation stenting techniques using multimodal imaging and 3D modeling in reanimated swine hearts using Visible Heart® methodologies

Assessment of single and double coronary bifurcation stenting techniques using multimodal imaging and 3D modeling in reanimated swine hearts using Visible Heart® methodologies

Double kissing crush stenting: No pain, no gain?

Comparison of adenosine‐independent pressure indices to fractional flow reserve in stent‐jailed bifurcation side branches

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