Provisional side branch‐stenting for coronary bifurcation lesions

Mylotte, Darren; Routledge, Helen; Harb, Talal; Garot, Philippe; Hovasse, Thomas; Benamer, Hakim; Unterseeh, Thierry; Chevalier, Bernard; Morice, Marie‐Claude; Louvard, Yves; Lefèvre, Thierry

doi:10.1002/ccd.24901

Cited by 29 publications

(4 citation statements)

References 19 publications

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“…Furthermore, diameters (balloon/vessel ratio) and patterns of balloons during FKBI (as short overlapping as possible in the MV) were not fixed in the previous studies, 1 – 5 which also influences the short- and long-term results. 14 Bench tests 14 , 15 and clinical analysis 16 have addressed the importance of the proximal optimization technique after FKBI to improve immediate and 1-year results; the technique was proposed before the start of either Nordic Bifurcation study 5 or the DKCRUSH-II study. Consequently, the routine use of the proximal optimization technique should be recommended in further clinical studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of Coronary Artery Bifurcation Lesions

Chen

Santoso

Zhang

et al. 2017

Circ: Cardiovascular Interventions

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Background—Provisional stenting is effective for anatomic simple bifurcation lesions. Double kissing crush stenting reduces the 1-year rate of target lesion revascularization. This study aimed to investigate the 5-year clinical results of the DKCRUSH-II study (Randomized Study on Double Kissing Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions).Methods and Results—A total of 370 patients with coronary bifurcation lesions who were randomly assigned to either the double kissing crush or provisional stenting group in the DKCRUSH-II study were followed for 5 years. The primary end point was the occurrence of a major adverse cardiac event at 5 years. Patients were classified by simple and complex bifurcation lesions according to the DEFINITION criteria (Definitions and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents). At 5 years, the major adverse cardiac event rate (23.8%) in the provisional stenting group was insignificantly different to that of the double kissing group (15.7%; P=0.051). However, the difference in the target lesion revascularization rate between 2 groups was sustained through the 5-year follow-up (16.2% versus 8.6%; P=0.027). The definite and probable stent thrombosis rate was 2.7% in each group (P=1.0). Complex bifurcation was associated with a higher rate of target lesion revascularization (21.6%) at 5 years compared with 11.1% in patients with a simple bifurcation (P=0.037), with an extremely high rate in the provisional stenting group (36.8% versus 12.5%, P=0.005) mainly because of final kissing balloon inflation (19.4% versus 5.2%; P=0.036).Conclusions—The double kissing crush stenting technique for coronary bifurcation lesions is associated with a lower rate of target lesion revascularization. The optimal stenting approach based on the lesions’ complexity may improve the revascularization for patients with complex bifurcations.Clinical Trial Registration—URL: http://www.chictr.org. Unique identifier: ChiCTR-TRC-0000015.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of Coronary Artery Bifurcation Lesions

Chen

Santoso

Zhang

et al. 2017

Circ: Cardiovascular Interventions

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“… 26) It also improves a proximal MV stent apposition and eccentricity. 27) According to the Murray's law, POT is mandatory when SB size large than 2.3 mm, for the discrepancy between PV and MV size is mostly larger than 1.0 mm. The subgroup analysis of COBIS II registry showed that the POT significantly reduced the restenosis rate in MV in the bifurcation lesions with SB size ≥2.5 mm in core-lab quantitative coronary angiography (unpublished data).…”

Section: Mechanisms Of Sb Compromise and How To Avoid Itmentioning

confidence: 99%

Understanding the Coronary Bifurcation Stenting

Gwon

2018

Korean Circ J

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Coronary bifurcation stenting is still complex and associated with a high risk of stent thrombosis and restenosis even with contemporary techniques. Although provisional approach has been proved to be the standard strategy of treatment, There is still lack of evidences for multiple steps of the procedure. For so many years we have been focused on the optimization of side branch (SB), but the clinical outcome is mostly dependent on the main vessel (MV) stenting. The optimal expansion of MV stent without the compromise of SB is the ultimate goal to achieve in the coronary bifurcation stenting. Understanding the anatomy and physiology of coronary bifurcation lesion should be the most important step to this goal. The relationship of vessel diameter between branches and the anatomical and functional significance of plaque shift and carina shift are two most important concepts to understand. They are the science behind the predictors of SB occlusion, and the rationale of proximal optimization technique and final kissing ballooning. This specific review will be devoted to review those concepts as well as clinical evidences to support them.

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“…The clinical effects of renal denervation could already be detectable one month after the procedure , but it often takes several weeks to months before reaching peak effectiveness suggesting that a slowly progressive resetting of sympathetic neural regulation occurs [4][5][6]9,10,16,19 . Therefore, these deadlines are advisable to collect data of home BP and to check office BP, ambulatory blood pressure monitoring (ABPM) is also recommended.…”

Section: High-volume Interventional Radiology/cardiology Experiencementioning

confidence: 99%

Follow-up, study design and outcome parameters

Volpe¹,

Battistoni²

2013

EuroIntervention

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Renal sympathetic denervation has shown promise in treating hypertension resistant to drug therapy. This procedure lowers blood pressure via targeted attenuation of renal sympathetic tone. Up to now, it has also shown a favourable safety profile. Despite this, there is reason for cautious optimism, since longer follow-up is needed to address whether these effects may be considered definitive and to detect long-term side effects. To assess this, patients who have undergone this procedure should be submitted to a specific follow-up in centres of excellence in treating resistant hypertension.

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Provisional side branch‐stenting for coronary bifurcation lesions

Abstract: Together, contemporary techniques and newer generation DES appear to improve outcomes and are both recommended for widespread uptake in patients undergoing provisional SB stenting for coronary bifurcation lesions.

Cited by 29 publications

References 19 publications

Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of Coronary Artery Bifurcation Lesions

Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of Coronary Artery Bifurcation Lesions

Understanding the Coronary Bifurcation Stenting

Follow-up, study design and outcome parameters

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