The “side-BASE technique”: Combined side branch anchor balloon and balloon assisted sub-intimal entry to resolve ambiguous proximal cap chronic total occlusions

2017 ◽  
Vol 92 (1) ◽  
pp. E15-E19 ◽  
Author(s):  
James Roy ◽  
Jonathan Hill ◽  
James C. Spratt
Keyword(s):  
Side Branch ◽  
Chronic Total Occlusions ◽  
Base Technique

Real-life Bifurcation – Challenges and Potential Complications

2011 ◽  
Vol 7 (4) ◽  
pp. 283
Author(s):  
Inga Narbute ◽  
Sanda Jegere ◽  
Indulis Kumsars ◽  
Dace Juhnevica ◽  
Agnese Knipse ◽  
...  
Keyword(s):  
Stent Thrombosis ◽  
Real Life ◽  
Coronary Intervention ◽  
Side Branch ◽  
The Body ◽  
Chronic Total Occlusions ◽  
Vein Grafts ◽  
Procedural Complications ◽  
Drug Eluting ◽  
Bifurcation Lesions

Together with calcified lesions, saphenous vein grafts, chronic total occlusions and unprotected left main lesions, bifurcation lesions are complex lesions that remain among the outstanding challenges of treatment with percutaneous coronary intervention. Bifurcation lesions are associated with increased rates of procedural complications, restenosis and adverse events than lesions in the body of the vessel. The introduction of drug-eluting stents for the treatment of bifurcation lesions has dramatically decreased restenosis rates, especially in patients suffering from diabetes. However, abrupt side branch closure, side branch ostial restenosis and stent thrombosis remain areas where further improvement is needed. Although a provisional T-stent strategy is most often used when side branch stenting is required, there are true bifurcation lesions where the selected use of more complex bifurcation approaches (such as the crush technique, T-stenting or the culotte technique) seem appropriate, particularly when the main branch and side branch are larger vessels with more diffuse side branch disease. The major challenge with any technique is to ensure that the side branch is protected and there is a satisfactory final result. Many technical questions rise in trying to ensure this outcome and lower the risk of intra- and post-procedural complications such as side branch closure and restenosis, stent thrombosis, dissection and fracture of a jailed wire: how can difficult side branch access be solved? How can unfavourable side branch anatomy be re-wired after main vessel stent placement? How can fracture of a jailed wire be avoided? Is side-strut dilation beneficial?

scholarly journals The Role of Self-expanding Stents in Patients with Atypical Coronary Anatomy

2011 ◽  
Vol 9 (1) ◽  
pp. 11 ◽  
Author(s):  
Robert-Jan van Geuns ◽  
Katherin Awad ◽  
Alexander IJsselmuiden ◽  
Karel Koch ◽  
◽  
...  
Keyword(s):  
Vessel Diameter ◽  
Side Branch ◽  
Coronary Anatomy ◽  
Chronic Total Occlusions ◽  
St Segment Elevation ◽  
St Segment ◽  
Bifurcation Lesions ◽  
New Generation ◽  
Distal Embolisation

Despite advances with new generation stents, there remains some atypical coronary anatomy where optimal stenting continues to be a challenge; such as stent sizing in large, ectatic or aneurysmal vessels; tapered vessels; and in vasoconstricted arteries such as in ST-segment elevation myocardial infarction or chronic total occlusions. Balloon-expandable stents are tubular and cannot easily accommodate vessel diameter variations; thrombotic vessels increase the risk of distal embolisation and no-reflow; positive remodelling and vasodilation often result in subsequent malapposition; and patients with bifurcation lesions have a higher risk of adverse events. The STENTYS BMS and DES(P)stents have a self-expanding design, which enables a better anatomical fit to the vessel, even with diameter variations (up to 6.0 millimetres [mm]), and can adapt to changes in vessel size over time. The stents deploy atraumatically from distal to proximal, which could reduce distal embolisation and contain disconnectable bridges, which can be opened up at a side branch. Self-apposing technology could therefore provide a potential solution to current challenges with balloon-expandable stent technology.

Percutaneous coronary intervention for chronic total occlusions: the role of side-branch obstruction

2009 ◽  
Vol 4 (5) ◽  
pp. 600-606 ◽  
Author(s):  
Ioannis Paizis ◽  
Athanassios Manginas ◽  
Vassilis Voudris ◽  
Gregory Pavlides ◽  
Konstantinos Spargias ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Side Branch ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary

scholarly journals Predictors and complications of side branch occlusion after recanalization of chronic total occlusions complicated with bifurcation lesions

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yunfei Guo ◽  
Hongyu Peng ◽  
Yejing Zhao ◽  
Jinghua Liu
Keyword(s):  
Risk Factors ◽  
Chronic Total Occlusion ◽  
Perioperative Complications ◽  
Side Branch ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Main Vessel ◽  
Bifurcation Lesions ◽  
Periprocedural Myocardial Infarction ◽  
The Relationship

AbstractData on risk factors and periprocedural complications associated with side branch (SB) occlusion after chronic coronary total occlusion (CTO) recanalization are limited. The aims of this study were to identify independent predictors of side branch (SB) occlusion after chronic total occlusion (CTO) recanalization and assess the relationship between SB occlusion and perioperative complications. 245 patients with CTO bifurcation lesions (BFLs) who underwent successful CTO recanalization were included in the study. In the occlusion group, most of the SB occlusions were observed after the implantation of the stents and lack of SB protection was more common. However, there was no significant between-group difference in the angles between the main vessel (MV) and SB. SB occlusion was associated with a higher risk of periprocedural myocardial infarction and a higher composite periprocedural complication rate. Identified as predictors of SB occlusion were no SB protection, use of a dissection-reentry strategy, ostial SB stenosis, and proximal MV stenosis of 50% or more.

scholarly journals The importance of side branch preservation in the treatment of chronic total occlusions with bifurcation lesions

2021 ◽  
Vol 36 ◽  
pp. 100873
Author(s):  
Yuya Adachi ◽  
Yoshihisa Kinoshita ◽  
Akira Murata ◽  
Yoshiaki Kawase ◽  
Munenori Okubo ◽  
...  
Keyword(s):  
Side Branch ◽  
Chronic Total Occlusions ◽  
Bifurcation Lesions

Real-life Bifurcation – Challenges and Potential Complications

2011 ◽  
Vol 6 (2) ◽  
pp. 145
Author(s):  
Inga Narbute ◽  
Sanda Jegere ◽  
Indulis Kumsars ◽  
Dace Juhnevica ◽  
Agnese Knipse ◽  
...  
Keyword(s):  
Stent Thrombosis ◽  
Real Life ◽  
Coronary Intervention ◽  
Side Branch ◽  
The Body ◽  
Chronic Total Occlusions ◽  
Vein Grafts ◽  
Procedural Complications ◽  
Drug Eluting ◽  
Bifurcation Lesions

Together with calcified lesions, saphenous vein grafts, chronic total occlusions and unprotected left main lesions, bifurcation lesions are complex lesions that remain among the outstanding challenges of treatment with percutaneous coronary intervention. Bifurcation lesions are associated with increased rates of procedural complications, restenosis and adverse events than lesions in the body of the vessel. The introduction of drug-eluting stents for the treatment of bifurcation lesions has dramatically decreased restenosis rates, especially in patients suffering from diabetes. However, abrupt side branch closure, side branch ostial restenosis and stent thrombosis remain areas where further improvement is needed. Although a provisional T-stent strategy is most often used when side branch stenting is required, there are true bifurcation lesions where the selected use of more complex bifurcation approaches (such as the crush technique, T-stenting or the culotte technique) seem appropriate, particularly when the main branch and side branch are larger vessels with more diffuse side branch disease. The major challenge with any technique is to ensure that the side branch is protected and there is a satisfactory final result. Many technical questions rise in trying to ensure this outcome and lower the risk of intra- and post-procedural complications such as side branch closure and restenosis, stent thrombosis, dissection and fracture of a jailed wire: how can difficult side branch access be solved? How can unfavourable side branch anatomy be re-wired after main vessel stent placement? How can fracture of a jailed wire be avoided? Is side-strut dilation beneficial?

Real-life Bifurcation – Challenges and Potential Complications

2012 ◽  
Vol 7 (2) ◽  
pp. 95 ◽  
Author(s):  
Inga Narbute ◽  
Sanda Jegere ◽  
Indulis Kumsars ◽  
Dace Juhnevica ◽  
Agnese Knipse ◽  
...  
Keyword(s):  
Stent Thrombosis ◽  
Real Life ◽  
Coronary Intervention ◽  
Side Branch ◽  
The Body ◽  
Chronic Total Occlusions ◽  
Vein Grafts ◽  
Procedural Complications ◽  
Drug Eluting ◽  
Bifurcation Lesions

Together with calcified lesions, saphenous vein grafts, chronic total occlusions and unprotected left main lesions, bifurcation lesions are complex lesions that remain among the outstanding challenges of treatment with percutaneous coronary intervention. Bifurcation lesions are associated with increased rates of procedural complications, restenosis and adverse events than lesions in the body of the vessel. The introduction of drug-eluting stents for the treatment of bifurcation lesions has dramatically decreased restenosis rates, especially in patients suffering from diabetes. However, abrupt side branch closure, side branch ostial restenosis and stent thrombosis remain areas where further improvement is needed. Although a provisional T-stent strategy is most often used when side branch stenting is required, there are true bifurcation lesions where the selected use of more complex bifurcation approaches (such as the crush technique, T-stenting or the culotte technique) seem appropriate, particularly when the main branch and side branch are larger vessels with more diffuse side branch disease. The major challenge with any technique is to ensure that the side branch is protected and there is a satisfactory final result. Many technical questions rise in trying to ensure this outcome and lower the risk of intra- and post-procedural complications such as side branch closure and restenosis, stent thrombosis, dissection and fracture of a jailed wire: how can difficult side branch access be solved? How can unfavourable side branch anatomy be re-wired after main vessel stent placement? How can fracture of a jailed wire be avoided? Is side-strut dilation beneficial?

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