Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club

Burzotta, Francesco; Lassen, Jens Flensted; Banning, Adrian P.; Lefèvre, Thierry; Hildick‐Smith, David; Chieffo, Alaide; Darremont, Olivier; Pan, Manuel; Chatzizisis, Yiannis S.; Albiero, Remo; Louvard, Yves; Stanković, Goran

doi:10.4244/eij-d-18-00357

Cited by 97 publications

(87 citation statements)

References 37 publications

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“…In Nordic-Baltic IV, only a small portion of cases were treated for distal LMCA bifurcation stenosis. Thus, extrapolation of our results to this lesion subset should be done with caution given the specific technical challenges in distal LMCA bifurcation PCI 46…”

Section: Discussionmentioning

confidence: 97%

Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV

et al. 2020

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BackgroundIt is still uncertain whether coronary bifurcations with lesions involving a large side branch (SB) should be treated by stenting the main vessel and provisional stenting of the SB (simple) or by routine two-stent techniques (complex). We aimed to compare clinical outcome after treatment of lesions in large bifurcations by simple or complex stent implantation.MethodsThe study was a randomised, superiority trial. Enrolment required a SB≥2.75 mm, ≥50% diameter stenosis in both vessels, and allowed SB lesion length up to 15 mm. The primary endpoint was a composite of cardiac death, non-procedural myocardial infarction and target lesion revascularisation at 6 months. Two-year clinical follow-up was included in this primary reporting due to lower than expected event rates.ResultsA total of 450 patients were assigned to simple stenting (n=221) or complex stenting (n=229) in 14 Nordic and Baltic centres. Two-year follow-up was available in 218 (98.6%) and 228 (99.5%) patients, respectively. The primary endpoint of major adverse cardiac events (MACE) at 6 months was 5.5% vs 2.2% (risk differences 3.2%, 95% CI −0.2 to 6.8, p=0.07) and at 2 years 12.9% vs 8.4% (HR 0.63, 95% CI 0.35 to 1.13, p=0.12) after simple versus complex treatment. In the subgroup treated by newer generation drug-eluting stents, MACE was 12.0% vs 5.6% (HR 0.45, 95% CI 0.17 to 1.17, p=0.10) after simple versus complex treatment.ConclusionIn the treatment of bifurcation lesions involving a large SB with ostial stenosis, routine two-stent techniques did not improve outcome significantly compared with treatment by the simpler main vessel stenting technique after 2 years.Trial registration numberNCT01496638.

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Section: Discussionmentioning

confidence: 97%

Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV

et al. 2020

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“…The strategy of a single stent to approach percutaneous treatment of the distal LM is usually preferred, especially when there is involvement of a single branch. When the origins of both arteries are involved in distal LM stenosis (Medina 1,1,1), a strategy of two stents (i.e., DK‐crush) in the bifurcation might be the preferred option according to recent expert consensus . A recent study in the context of STEMI compared provisional single stent (57.9% of cases) with 2‐stent technique (24.6%) with no significant differences in mortality.…”

Section: Discussionmentioning

confidence: 99%

Short‐term clinical outcomes of percutaneous coronary intervention of unprotected left main coronary disease in cardiogenic shock

Castro-Mejía

Ortega-Armas

Mejía‐Rentería

et al. 2019

Cathet Cardio Intervent

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Background Percutaneous coronary intervention (PCI) of left main (LM) disease in patients with cardiogenic shock (CS) represents a clinical challenge. Evidence on clinical outcomes according to revascularization strategies in this scenario remains scarce. The objective was to investigate the short‐term outcomes according to treatment strategies for this population. Methods We retrospectively analyzed 78 consecutive patients who underwent PCI of LM in established CS at two experienced centers. Characteristics of PCI and short‐term clinical outcomes were assessed. Results LM stenosis was considered the culprit lesion in 49 patients (62.8%). In the remaining cases, LM stenosis was treated after successful PCI of the culprit vessel because of persistent CS. The majority of patients presented complex coronary anatomy (43.6% had Syntax score > 32). Complete revascularization was performed in 34.6%; a 2‐stents technique in the LM bifurcation was used in 12.8% and intra‐aortic balloon pump (IABP) in 73.1%. In‐hospital mortality was 48.7%. At 90 days follow‐up it was 50% without differences between 1 or 2 stent LM bifurcation‐techniques (p = .319). Mortality was higher in patients with partial revascularization and residual Syntax score ≥ 15 (p < .05 by univariate analysis), and in those with TIMI flow<3 in the left coronary artery at the end of PCI (p < .05 by multivariate analysis). There were no significant differences in the use of IABP in relation to 90‐day mortality (p = .92). Conclusions In patients presenting with cardiogenic shock and LM disease, neither 2‐stents strategy in the LM nor use of IABP displayed a reduced short‐term mortality. However, patients with final TIMI flow <3 presented higher short‐term mortality in our series.

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“…2h ). IVUS examination of the ostium of the circumflex following pullback from the LAD demonstrated only mild plaque burden; therefore, the initial LMS PCI strategy was for provisional stenting [ 22 , 23 ]. The mid LAD lesion was stented with 3.5 × 16 mm Promus Premier (Boston Scientific) and post dilated with a 3.5 × 12 mm NC Quantum Apex balloon.…”

Section: Case Reportmentioning

confidence: 99%

Technical Considerations in Transradial Unprotected Left Main Stem Rotational Atherectomy-Assisted and IVUS-Guided Percutaneous Coronary Intervention Using the 7.5F Eaucath Sheathless Guiding Catheter System

et al. 2018

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Rotational atherectomy-assisted percutaneous coronary intervention (PCI) on unprotected left main stem (LMS) bifurcation lesions is technically challenging. Intravascular ultrasound (IVUS) has become a standard part of the PCI procedure for the treatment of LMS disease. There is limited experience in performing these cases via a transradial approach using a sheathless guiding catheter (SGC) system. We report a case of a symptomatic octogenarian patient with restrictive angina and significant LMS bifurcation disease, who was successfully treated transradially with the use of the 7.5F Eaucath SGC system and we describe the technical challenges encountered with this strategy.

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Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club

Cited by 97 publications

References 37 publications

Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV

Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV

Short‐term clinical outcomes of percutaneous coronary intervention of unprotected left main coronary disease in cardiogenic shock

Technical Considerations in Transradial Unprotected Left Main Stem Rotational Atherectomy-Assisted and IVUS-Guided Percutaneous Coronary Intervention Using the 7.5F Eaucath Sheathless Guiding Catheter System

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