Simple and complex stent strategies for bifurcated coronary arterial stenosis involving the side branch origin

Pan, Manuel; Lezo, José Suárez de; Medina, Alfonso; Romero, Miguel; Hernández, Enrique; Segura, José; Castroviejo, Joaquín Ruiz de; Pavlovic, Djordje; Melián, Francisco; Ramírez, Alejandra; Castillo, Juan Carlos

doi:10.1016/s0002-9149(99)00093-4

Cited by 110 publications

(48 citation statements)

References 20 publications

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“…All those studies have concordantly shown that as compared with the 2-stent technique, the 1-stent technique is associated with a better 17,18 or a trend toward better clinical outcomes. 10,19,20 Considering the results of those studies together with the findings of this study, it is tempting to speculate that the 1-stent strategy followed by final kissing balloon postdilation is superior to the 2-stent strategy in treating bifurcation lesions and in particular distal ULMCA stenosis.…”

Section: Discussionmentioning

confidence: 88%

Impact of Bifurcation Technique on 2-Year Clinical Outcomes in 773 Patients With Distal Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents

Palmerini

Marzocchi

Tamburino

et al. 2008

Circ: Cardiovascular Interventions

114

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Background-Distal unprotected left main coronary artery (ULMCA) stenosis represents a technical challenge for interventional cardiologists. In this study, we compared 2-year clinical outcomes of different stenting strategies in patients with distal ULMCA stenosis treated with drug-eluting stents. Methods and Results-The survey promoted by the Italian Society of Invasive Cardiology on ULMCA stenosis was an observational study on patients with ULMCA stenosis treated with percutaneous coronary intervention. In this study, we selected patients with distal ULMCA stenosis treated with drug-eluting stents. Seven hundred seventy-three patients were eligible for this study: 456 were treated with 1 stent (group 1) and 317 with 2 stents (group 2). The primary end point of the study was the incidence of major adverse cardiac events (MACEs), defined as the occurrence of mortality, myocardial infarction, and target lesion revascularization. During a 2-year follow-up, risk-adjusted survival free from MACE was significantly higher in patients in group 1 than in patients in group 2. The propensity-adjusted hazard ratio for the risk of 2-year MACE in patients in group 1 versus group 2 was 0.53 (95% CI, 0.37 to 0.76). The propensity-adjusted hazard ratio for the risk of 2-year cardiac mortality and myocardial infarction in patients in group 1 versus group 2 was 0.38 (95% CI, 0.17 to 0.85). Conclusions-Compared with the 2-stent technique, the 1-stent technique is associated with a better 2-year MACE-free survival. The stenting strategy is a prognostic factor that should be taken into account when deciding the optimal revascularization treatment.

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Section: Discussionmentioning

confidence: 88%

Impact of Bifurcation Technique on 2-Year Clinical Outcomes in 773 Patients With Distal Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents

Palmerini

Marzocchi

Tamburino

et al. 2008

Circ: Cardiovascular Interventions

114

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“…All events occurring during the procedure were recorded, especially those adverse events that could indicate myocardial ischemia. An event included chest pain of duration > 5 minutes, prolonged alterations of electrocardiographic parameters over a period of 5 minutes, appearance of transitory slow flow (TIMI flow I, II that, in all cases, reverted following intracoronary administration of nitroglycerin), compromised lateral branches following the stent implant (narrow lateral branches of < 2 mm diameter that, because of their low numbers, do not require other treatments), 11) and appearance of coronary angiographic dissections provoked during the angioplasty and which persisted after implantation of the stent without coronary flow compromise. Finally, the TIMI 3 flow rate was obtained at the end of the procedure.…”

Section: Methodsmentioning

confidence: 99%

Coronary Arterial Plaque Characterized by Multislice Computed Tomography Predicts Complications Following Coronary Intervention

Kinohira

Akutsu

et al. 2007

Int. Heart J.

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SUMMARYBackground: A reliable, noninvasive assessment of plaque configuration would constitute an important step forward for predicting complications following percutaneous coronary intervention (PCI). Multislice computed tomography (MSCT) holds promise with respect to allowing for differentiation of coronary lesion configuration. However, it has not yet been clarified whether the characteristics of coronary artery plaque measured by MSCT predict complications after PCI. The aim of this study was to investigate the relationship between plaque configuration and complications after coronary intervention in patients with stable angina pectoris.Methods: MSCT was performed in patients with angina pectoris who were scheduled for PCI prospectively, and 26 patients (70 ± 11 years, 18 males) with coronary artery plaque in a stenotic coronary artery measured by MSCT were recruited for this study. Thirty-five plaques in the stenotic coronary lesions were divided into 3 groups based on the CT density as soft, intermediate, and hard, and were compared with the complications after PCI. Results:The soft plaque group before PCI (n = 11) was significantly associated with the appearance of slow flow (n = 4) or a compromised side branch (n = 1) after PCI, whereas the hard plaque group before PCI (n = 17) was associated with the appearance of dissection (n = 2) or perforation (n = 1) after PCI (P = 0.004). The intermediate plaque group (n = 7) had only one complication, a compromised side branch (n = 1). Conclusion:Coronary arterial plaque characterized by MSCT can predict interventionrelated complication. It may be important for the risk stratification of the patients scheduled to undergo PCI to investigate plaque configuration by MSCT.(Int Heart J 2007; 48: [25][26][27][28][29][30][31][32][33]

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“…Furthermore, patients with long sidebranch lesions were systematically excluded from the randomized trials [4]. Registries, though available in greater numbers [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], are of variable quality and use different lesion classification systems, quantitative coronary angiography (QCA) measurements performed in unclear technical conditions, with identical technical strategies bearing different names or different techniques grouped under a single name. Other than the comparison between stent deployment in one versus two branches, a meta-analysis of these various reports has proven quite impossible.…”

Section: Introductionmentioning

confidence: 99%

Classification of coronary artery bifurcation lesions and treatments: Time for a consensus!

Louvard

Thomas

Džavík

et al. 2007

Cathet Cardio Intervent

Self Cite

277

139

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Background: Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains a subject of debate. Many studies have been published in this setting. They are often small scale and display methodological flaws and other shortcomings such as inaccurate designation of lesions, heterogeneity, and inadequate description of techniques implemented. Methods: The aim is to propose a consensus established by the European Bifurcation Club (EBC), on the definition and classification of bifurcation lesions and treatments implemented with the purpose of allowing comparisons between techniques in various anatomical and clinical settings. Results: A bifurcation lesion is a coronary artery narrowing occurring adjacent to, and/or involving, the origin of a significant side branch. The simple lesion classification proposed by Medina has been adopted. To analyze the outcomes of different techniques by intention to treat, it is necessary to clearly define which vessel is the distal main branch and which is (are) the side branche(s) and give each branch a distinct name. Each segment of the bifurcation has been named following the same pattern as the Medina classification. The classification of the techniques (MADS: Main, Across, Distal, Side) is based on the manner in which the first stent has been implanted. A visual presentation of PCI techniques and devices used should allow the development of a software describing quickly and accurately the procedure performed. Conclusion: The EBC proposes a new classification of bifurcation lesions and their treatments to permit accurate comparisons of well described techniques in homogeneous lesion groups. '

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Simple and complex stent strategies for bifurcated coronary arterial stenosis involving the side branch origin

Cited by 110 publications

References 20 publications

Impact of Bifurcation Technique on 2-Year Clinical Outcomes in 773 Patients With Distal Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents

Impact of Bifurcation Technique on 2-Year Clinical Outcomes in 773 Patients With Distal Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents

Coronary Arterial Plaque Characterized by Multislice Computed Tomography Predicts Complications Following Coronary Intervention

Classification of coronary artery bifurcation lesions and treatments: Time for a consensus!

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