Side Branch is the Main Determinant Factor of Bifurcation Lesion Complexity: Critical Review with a Proposal Based on Single-centre Experience

Sheiban, Imad; Figini, Filippo; Gasparetto, Valeria; D’Ascenzo, Fabrizio; Moretti, Claudio; Leonardo, Filippo

doi:10.17925/hi.2021.15.2.67

Cited by 7 publications

(4 citation statements)

References 40 publications

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“…DES implantation in bifurcation lesions, as with any current stenting strategy, has an impact on the regional arterial geometry, thereby causing modifications to local flow conditions and damages to the SB ostium [ 19 , 20 ]. Hahn et al demonstrated that after DES implantation for bifurcation lesions, 8.4% of patients experienced SB occlusion, and those with SB occlusion had a higher incidence of cardiac death or MI compared to those without SB occlusion (aHR: 2.34; 95% CI 1.15 to 4.77; p = 0.02) [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of angiographic change in side-branch ostium after drug-coated balloon vs. drug-eluting stent vs. medication for the treatment of de novo coronary bifurcation lesions

Her,

Kim,

Kim

et al. 2024

Eur J Med Res

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Objectives Data on side-branch (SB) ostial effect after drug-coated balloon (DCB) treatment in the context of de novo coronary bifurcation lesions are limited. We aimed to investigate the angiographic outcomes of SB ostium after DCB treatment compared with drug-eluting stents (DESs) implantation in the main vessel (MV) or optimal medical therapy (OMT) for the treatment of de novo coronary bifurcation lesions. Methods Serial angiographic changes in the SB ostium were compared between DCB, DES, and medication alone for MV treatment. Δ value was calculated by subtracting the follow-up value from the pre-procedure value. Results A total of 132 bifurcation lesions were included for analysis (44 lesions in DCB group; 38 lesions in DES group; 50 lesions in OMT group). The minimal lumen diameter (MLD) of SB ostium showed an increase at follow-up in the DCB group, whereas a decrease was observed in both the DES and OMT groups (ΔMLD: −0.16 ± 0.45 mm for DCB group vs. 0.50 ± 0.52 mm for DES group vs. 0.08 ± 0.38 mm for OMT group, p < 0.001). The diameter stenosis (DS) of SB ostium showed a marked decrease at follow-up in the DCB group, in contrast to an increase observed in both the DES and OMT groups (ΔDS: 8.01 ± 18.96% for DCB group vs. −18.68 ± 18.60% for DES group vs. −2.05 ± 14.58% for OMT group, p < 0.001). Conclusions In de novo coronary bifurcation lesions, DCB treatment on the MV demonstrated favorable angiographic outcomes in the SB ostium at 6–9 month follow-up compared to DES implantation or OMT.

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Section: Discussionmentioning

confidence: 99%

Comparison of angiographic change in side-branch ostium after drug-coated balloon vs. drug-eluting stent vs. medication for the treatment of de novo coronary bifurcation lesions

Her,

Kim,

Kim

et al. 2024

Eur J Med Res

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“…As Kim et al showed, a significant SB-specific FFM can reasonably be identified by a SB vessel length of ≥73 mm [24] . Furthermore, side branches ≥2.5 mm and longer than 100 mm will be probably supply a significant FFM > 10 % according to the proposed treatment algorithm in patients with bifurcation [15] . The QFR software and its recommended viewing angles calculate the anatomical vessel length (VL) and MLD.…”

Section: Discussionmentioning

confidence: 99%

“…Especially given, that a bifurcation-PCI is still constrained by higher long-term adverse events, such as in-stent-re-stenosis, and particularly periprocedural myocardial infarction, compared to non-true bifurcations [14] . For this reason, it would be useful to know, prior to PCI and preferably noninvasive, whether the target side branch supplies a relevant fractional myocardial mass (amount of myocardium which benefits from a revascularization, %FFM > 10 %), especially considering that side branches ≥2.5 mm and longer than 100 mm will probably supply FFM > 10 %, as the proposed treatment algorithm in patients with bifurcation lesions in Sheiban et al showed [15] . Thus, our PCI-strategy could be adjusted, or an unnecessarily complicated bifurcation-PCI could be avoided.…”

Section: Introductionmentioning

confidence: 99%

Standardized angiographic projections allow evaluation of coronary artery side branches with quantitative flow ratio (QFR)

Antoniadis,

Blum,

Ussat

et al. 2024

IJC Heart & Vasculature

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“…The RESOLVE score, proposed by Dou et al [16], incorporates several factors to assess the possibility of side branch occlusion. These factors include plaque distribution (on the opposite or same side as the side branch), pre-procedural TIMI flow grade, bifurcation angle, diameter ratio between the main vessel and side branch, and stenosis degree at the level of bifurcation core and side branch [16,17].…”

Section: What Is the Risk Of Side Branch Occlusion In A Bifurcation C...mentioning

confidence: 99%

A Perspective on a Two-stent Approach in Bifurcation Cases

Gherasie,

Chioncel

2024

Romanian Journal of Cardiology

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Bifurcation lesions are the cause of 20% of all percutaneous coronary interventions, representing a complex category associated with lower procedure success rates and higher restenosis rates. However, the optimal approach to bifurcation needs further research. This paper aims to determine the optimal method for implementing a two-stent strategy in bifurcation cases. It desires to identify the characteristics that can guide our approach and the outcomes that can be expected. This paper also highlights relevant trials that support the findings. In nontrue bifurcation cases (Medina 1-1-0, 1-0-0, 0-1-0, 0-0-1), a one stent strategy, eventually with the provisional approach, is preferable. When treating a left main or non-left main bifurcation in a Medina classification of 1-1-1, 1-0-1, or 0-1-1 without meeting at least one major and two minor criteria and of DEFINITION II Classification (simple true bifurcation), the layered provisional approach is the appropriate strategy. In cases of left main or non-left main complex true bifurcation (Medina 1-1-1, 1-0-1, 0-1-1) meeting the Definition II Classification criteria, a two-stent strategy could be a suitable option in cases where the SB is more than 2.5 mm and has a lesion length of more than 16 mm.

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Side Branch is the Main Determinant Factor of Bifurcation Lesion Complexity: Critical Review with a Proposal Based on Single-centre Experience

Cited by 7 publications

References 40 publications

Comparison of angiographic change in side-branch ostium after drug-coated balloon vs. drug-eluting stent vs. medication for the treatment of de novo coronary bifurcation lesions

Comparison of angiographic change in side-branch ostium after drug-coated balloon vs. drug-eluting stent vs. medication for the treatment of de novo coronary bifurcation lesions

Standardized angiographic projections allow evaluation of coronary artery side branches with quantitative flow ratio (QFR)

A Perspective on a Two-stent Approach in Bifurcation Cases

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