Predictors and Outcomes of Side Branch Occlusion After Main Vessel Stenting in Coronary Bifurcation Lesions

Hahn, Joo Yong; Chun, Woo Jung; Kim, Ji Hwan; Song, Young Bin; Oh, Ju Hyeon; Koo, Bon Kwon; Rha, Seung Woon; Yu, Cheol Woong; Park, Jong Sun; Jeong, Jin Ok; Choi, Seung Hyuk; Choi, Jin Ho; Jeong, Myung Ho; Yoon, Jung Han; Jang, Yangsoo; Tahk, Seung Jea; Kim, Hyo Soo; Gwon, Hyeon Cheol

doi:10.1016/j.jacc.2013.07.041

Cited by 195 publications

(75 citation statements)

References 12 publications

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“…This higher rate of PMI may be explained by a greater percentage of branch occlusions with the subintimal approach (48.2% vs. 16.2%; p < 0.001). Whether branch occlusion-based enzyme elevation has an impact on long-term outcomes remains controversial (22,23) and was not assessed by our data due to the short follow-up of the study.…”

Section: Discussionmentioning

confidence: 90%

Intravascular Ultrasound Analysis of Intraplaque Versus Subintimal Tracking in Percutaneous Intervention for Coronary Chronic Total Occlusions and Association With Procedural Outcomes

Song

Maehara

Finn

et al. 2017

JACC: Cardiovascular Interventions

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OBJECTIVES Using intravascular ultrasound (IVUS), the authors compared outcomes by observed wire position (intraplaque vs. subintimal) achieved during successful chronic total occlusion (CTO) lesion treatment. BACKGROUND Recent successes in CTO percutaneous coronary intervention (PCI) have used both intraluminal and subintimal wire tracking to improve procedural success. IVUS may be used to determine the course of wire tracking after crossing a CTO. METHODS From March 2014 to March 2016, data were collected into a single-center database from 219 patients undergoing CTO PCI with concomitant IVUS imaging. IVUS-visualized wire tracking patterns were then retrospectively examined. Clinical outcomes with a composite in-hospital cardiovascular endpoint of all-cause death, periprocedural myocardial infarction, and in-hospital target lesion revascularization were analyzed along with IVUS-detected vascular injury. RESULTS Of the 524 lesions assessed, 219 patients with successfully recanalized CTO lesions had adequate IVUS imaging and were included. Subintimal tracking was detected in 52.1% of overall cases (86.7% dissection re-entry, 27.9% wire escalation). Minimal stent area of the CTO segment and prevalence of significant edge dissection were similar in the 2 groups. In the subintimal tracking group, there was a higher rate of the composite endpoint, mostly driven by periprocedural myocardial infarction. Subintimal tracking was associated with significantly greater IVUS-detected vascular injury, angiographic dye staining/extravasation, and branch occlusion. CONCLUSIONS IVUS-detected subintimal tracking is observed in approximately one-half of all successful CTO PCI cases and is associated with an expected higher, yet acceptable, event rate with no difference in minimal stent area or edge dissection among patients undergoing contemporary hybrid CTO PCI.

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Section: Discussionmentioning

confidence: 90%

Intravascular Ultrasound Analysis of Intraplaque Versus Subintimal Tracking in Percutaneous Intervention for Coronary Chronic Total Occlusions and Association With Procedural Outcomes

Song

Maehara

Finn

et al. 2017

JACC: Cardiovascular Interventions

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“…All cine coronary angiograms were reviewed and analyzed quantitatively at the angiographic core laboratory (Cardiac and Vascular Center, Samsung Medical Center, Seoul, Korea) with an automated edge-detection system (Centricity CA 1000; GE, Waukesha, WI). Two experienced technicians who were blinded to patient information reviewed the cine angiograms 11 ; interobserver variability was 0.81 (0.73-0.87), and intraobserver variability was 0.97 (0.97-0.98).…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

Glycemic Control Status After Percutaneous Coronary Intervention and Long-Term Clinical Outcomes in Patients With Type 2 Diabetes Mellitus

Hwang

Lee

Song

et al. 2017

Circ: Cardiovascular Interventions

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C ardiovascular disease is the major cause of mortality in patients with type 2 diabetes mellitus.1 Although intensive therapy to lower glucose has consistently been reported to reduce microvascular complications of type 2 diabetes mellitus, 2,3 whether intensive glycemic control reduces macrovascular complications and improves clinical outcomes remains controversial. 4,5 Limited data are available regarding the effect of intensive glycemic control for secondary prevention in patients with established cardiovascular disease, especially in those undergoing percutaneous coronary intervention (PCI). The association between baseline glycosylated hemoglobin A (HbA1c) at the time of PCI and clinical outcomes among diabetic patients was reported in a few studies with conflicting results. 6,7 Moreover, it is not known if glycemic control after PCI can improve cardiovascular outcomes, which is a more important issue than glycemic status at the time of PCI. Because diabetic patients account for more than a quarter of all patients undergoing PCI and have worse outcomes compared with nondiabetic patients, 8,9 determining the optimal strategy for glycemic control in these patients after PCI has substantial clinical implications. Therefore, we investigated the association between glycemic status as estimated by HbA1c measured 2 years after PCI and long-term cardiovascular outcomes in type 2 diabetic patients undergoing PCI using drug-eluting stents (DES).Background-Data on the association between glycemic control after percutaneous coronary intervention and clinical outcomes are limited and controversial in diabetic patients. Methods and Results-We studied 980 patients with type 2 diabetes mellitus undergoing percutaneous coronary intervention using drug-eluting stents. Based on 2-year glycosylated hemoglobin A (HbA1c) levels, we divided patients into 2 groups of HbA1c<7.0 (n=489) and HbA1c≥7.0 (n=491). Propensity score-matched analysis was performed in 322 pairs. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of cardiac death, myocardial infarction, repeat revascularization, or stroke. Median follow-up duration was 5.4 years. The 7-year incidence of MACCE was lower in the HbA1c<7.0 group than in the HbA1c≥7.0 group (26.9% versus 40.3%; adjusted hazard ratio, 0.75; 95% confidence interval, 0.57-0.98; P=0.03). After propensity score matching, the 7-year incidence of MACCE was still lower in the HbA1c<7.0 group than in the HbA1c≥7.0 group (27.5% versus 37.4%; hazard ratio, 0.71; 95% confidence interval, 0.52-0.97; P=0.03), mainly because of a reduction in repeat revascularization (19.9% versus 29.5%; hazard ratio, 0.66; 95% confidence interval, 0.47-0.93; P=0.02). In subgroup analyses, the benefit of glycemic control for MACCE was more prominent in patients with residual SYNTAX score (Synergy Between PCI With Taxus and Cardiac Surgery) >4 than in those with the residual SYNTAX score ≤4 (P interaction =0.004). Conclusions-HbA1c<7.0 measured 2 years after percutaneous cor...

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“…Hahn JY et al reported that the presence of a stenotic lesion at the SB and proximal MV are independent predictors of SB occlusion after MV stenting [2]. In our case, the lesion had both findings and was considered at high risk for SB occlusion.…”

Section: Discussionmentioning

confidence: 60%

Bailout technique to rescue the abruptly occluded side branch with collapsed true lumen after main vessel stenting

Funatsu

Hirokawa

Nakamura

2016

Cardiovasc Interv and Ther

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Guidewire recrossing into the abruptly occluded side branch (SB) after main vessel (MV) stenting in the coronary bifurcation is difficult, particularly if the SB has a dissection because the true lumen of SB is collapsed by a hematoma and the second guidewire easily goes into the false lumen. This paper reports a bailout technique to rescue the occluded SB that was complicated by a hematoma because of an unsuccessful guidewire recrossing after MV stenting using a small balloon dilation in the collapsed SB true lumen behind the stent strut and wire penetration.

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Predictors and Outcomes of Side Branch Occlusion After Main Vessel Stenting in Coronary Bifurcation Lesions

Abstract: Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes..

Cited by 195 publications

References 12 publications

Intravascular Ultrasound Analysis of Intraplaque Versus Subintimal Tracking in Percutaneous Intervention for Coronary Chronic Total Occlusions and Association With Procedural Outcomes

Intravascular Ultrasound Analysis of Intraplaque Versus Subintimal Tracking in Percutaneous Intervention for Coronary Chronic Total Occlusions and Association With Procedural Outcomes

Glycemic Control Status After Percutaneous Coronary Intervention and Long-Term Clinical Outcomes in Patients With Type 2 Diabetes Mellitus

Bailout technique to rescue the abruptly occluded side branch with collapsed true lumen after main vessel stenting

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