Randomized Study of the Crush Technique Versus Provisional Side-Branch Stenting in True Coronary Bifurcations

Colombo, Antonio; Bramucci, Ezio; Saccà, Salvatore; Violini, Roberto; Lettieri, Corrado; Zanini, Roberto; Sheiban, Imad; Paloscia, Leonardo; Grube, Eberhard; Schofer, Joachim; Bolognese, Leonardo; Orlandi, Mario; Niccoli, Giampaolo; Latib, Azeem; Airoldi, Flavio

doi:10.1161/circulationaha.108.808402

Cited by 468 publications

(103 citation statements)

References 22 publications

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“…Thus far, six randomised controlled trials (RCT) have compared the use of two stents versus a single-stent approach in the treatment of BL [15][16][17][18][19][20]. The BBC-ONE trial showed a clinical benefit favouring the single-stent technique, which was mainly driven by a reduction in periprocedural MI, of which clinical consequences are still a matter of debate [21,22].…”

Section: Discussionmentioning

confidence: 99%

Six-month clinical outcomes of the Tryton Side Branch Stent for the treatment of bifurcation lesions

et al. 2012

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Aims Percutaneous coronary intervention (PCI) of a bifurcation lesion (BL) is still associated with poorer clinical outcomes when compared with PCI of a non-BL. Therefore, several dedicated coronary bifurcation stents, such as the Tryton Side Branch Stent™ (Tryton Medical, Durham, NC, USA), were developed to improve clinical outcomes. We investigated 6-month clinical outcomes after placement of a Tryton stent in 91 patients treated for 93 BLs in our centre. Methods and results All consecutive patients who have undergone PCI of a BL treated with the Tryton stent in our centre were included. Outcomes were defined as any death, cardiac death, myocardial infarction (MI), any revascularisation, ischaemia-driven target vessel revascularisation (TVR), ischaemia-driven target lesion revascularisation (TLR), stent thrombosis, and target vessel failure (TVF; composite of cardiac death, MI, and ischaemia-driven TVR). Event rates were estimated using the Kaplan-Meier method. Thirty-eight (42 %) patients with acute coronary syndrome (ACS) were included (16 % ST-segment elevation MI (STEMI)). The 6-month event rates were 5.4 % (death), 4.3 % (cardiac death), 2.2 % (MI), 4.5 % (any revascularisation), 4.5 % (TVR), 4.5 % (TLR) and 9.7 % (TVF). ConclusionIn a real-world all-comers single-centre registry, the use of the Tryton Side Branch Stent was associated with acceptable procedural and promising clinical outcomes at 6 months, including ACS and STEMI patients.

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Section: Discussionmentioning

confidence: 99%

Six-month clinical outcomes of the Tryton Side Branch Stent for the treatment of bifurcation lesions

et al. 2012

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“…As previously reported [8,10], bifurcation lesions were defined as presence of >50% diameter stenosis in a major epicardial coronary vessel, involving coronary bifurcation. Main vessel diameter had to be between 2.5 and 4.5 mm, while side branch had to be between 2.25 and 4.5 mm.…”

Section: Clinical Outcomes and Definitionsmentioning

confidence: 99%

Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

Roversi

Biondi‐Zoccai

Romagnoli

et al. 2013

International Journal of Cardiology

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Background: Coronary artery disease is most common in older patients, but may occur in younger subjects. The outlook of young patients after percutaneous coronary intervention (PCI) of challenging lesion subsets such as coronary bifurcations, is not established. We thus aimed to appraise the early and long-term results of PCI for bifurcations in young patients. Methods: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between 2002 and 2006 in 22 Italian centers. Patients were divided in 2 groups: age ≤45 years, and age >45 years. The primary end-point was long-term rate of major adverse cardiac events (MACE). Results: 4,314 patients were included: 195 (4.5%) in the younger group, and 4119 (95.5%) in the older group. 30-day outcomes did not show significant differences in MACE rates, with 1.0% in the ≤45 years group and 2.1% in the >45 years group (p=0.439), with death in 0.5% and 1.2% (p=0.388). At long-term follow-up (24.4± 15.1 months), younger patients showed similar rates of MACE, (12.8% vs. 16.6%, p=0.161), myocardial infarction (3.1% vs. 3.7%, p=0.633), target lesion revascularization (11.3% vs. 12.5%, p =0.627), or stent International Journal of Cardiology xxx (2012) xxx-xxx ☆ All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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“…Main-branch stenting associated with provisional side-branch stenting is the current strategic technique of choice in PCI for LMCA bifurcation lesions in selected patients [5,6,13].Using this procedure poses the challenge of acute SB occlusion, which occurs in about 6-15% of cases [7,8,14].While the crush stenting technique is useful to avoid such acute SB occlusion [9], it has a higher side-branch restenosis rate than the culotte stenting technique [10]. Consequently, the ballooncushion technique has been devised to incorporate the culotte stenting technique into an LMCA bifurcation intervention, using a 3-step procedure with the following rationales.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent data from randomized and registry cohort studies suggest that percutaneous coronary intervention (PCI) for unprotected LMCA stenosis is a feasible alternative to bypass surgery [1][2][3][4]. Main branch stenting associated with provisional sidebranch (SB) stenting is the current strategic technique of choice in PCI for bifurcation lesions [5,6]. Using this procedure in the complex setting of an LMCA true bifurcation, however, poses the challenge of acute sidebranch (SB) occlusion, which occurs in about 6-15% of cases and can potentially lead to catastrophic events, such as massive myocardial infarction or death [7,8].…”

Section: Introductionmentioning

confidence: 99%

Incorporation of a Balloon-Cushion Stenting Technique into the Culotte Stenting Technique in Left Main Coronary Artery Bifurcation Interventions

Ku¹

2012

J Clin Exp Cardiolog

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Background: Percutaneous coronary intervention (PCI) for a left main coronary artery (LMCA) with its distal bifurcation lesions remains a challenge. Acute sidebranch occlusion after main branch stenting can potentially lead to catastrophic events. Here we describe a novel balloon-cushion stenting technique to be incorporated into the culotte stenting technique for true LMCA bifurcation lesions to prevent acute sidebranch occlusion.Methods and Results: 1) Predilatation with 2 balloons with kissing for better sidebranch preparation. 2) Balloonstent simultaneous kissing inflation, with a stent in the dominant artery and a 1.5/20 mm balloon from LMCA to the sidebranch. 3) After the stent deployment, a Crusade microcatheter was introduced via wire in the dominant vessel for wire re-crossing of the stent strut. The standard culotte technique and final kissing balloon inflation were then performed. Twelve patients were treated with this balloon-cushion stenting technique (Group A) and 18 patients with the conventional double-stent techniques (Group B). One case of acute sidebranch occlusion occurred in Group B. The amount of contrast medium and procedural time did not differ statistically between the 2 groups. Conclusions:The present study suggests that incorporation of the balloon-cushion stenting technique into the culotte stenting technique for LMCA bifurcation intervention is feasible and effective in avoiding acute sidebranch occlusion.

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Randomized Study of the Crush Technique Versus Provisional Side-Branch Stenting in True Coronary Bifurcations

Cited by 468 publications

References 22 publications

Six-month clinical outcomes of the Tryton Side Branch Stent for the treatment of bifurcation lesions

Six-month clinical outcomes of the Tryton Side Branch Stent for the treatment of bifurcation lesions

Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

Incorporation of a Balloon-Cushion Stenting Technique into the Culotte Stenting Technique in Left Main Coronary Artery Bifurcation Interventions

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