The Impact of Side Branch Predilatation on Procedural and Long-term Clinical Outcomes in Coronary Bifurcation Lesions Treated by the Provisional Approach

2014 ◽  
Vol 67 (10) ◽  
pp. 804-812 ◽  
Author(s):  
Pil Sang Song ◽  
Young Bin Song ◽  
Jeong Hoon Yang ◽  
Joo-Yong Hahn ◽  
Seung-Hyuk Choi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Side Branch ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Bifurcation Lesions ◽  
The Impact

Comparison of coronary bifurcation lesions stenting techniques- a network meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Barrett ◽  
L Hadad ◽  
Y Abramowitz ◽  
C Cafri ◽  
G Rosenstein ◽  
...  
Keyword(s):  
Observational Studies ◽  
Side Branch ◽  
Mixed Treatment Comparison ◽  
Cardiac Events ◽  
Coronary Bifurcation ◽  
Medline Search ◽  
Treatment Comparison ◽  
Coronary Bifurcation Lesions ◽  
Bifurcation Lesions

Abstract Background Coronary bifurcations lesions (CBL) are account for 15–20% of all percutaneous coronary interventions (PCI) and constitute a major challenge for interventionists in terms of procedural success rate and long-term cardiac events. Based on data from multiple randomized trials and registries, current guidelines advocate the use of provisional side branch (SB) stenting strategy for the majority of CBL's. However, for true or complex CBL's (long side branches lesions, difficult side branches access or high risk of side branches compromise), which account for up to 25% of CBL's, this strategy may by unsafe and ineffective due to a potential risk of intraprocedural or long-term occlusion of a significant side branch and a two-stenting technique may be needed in order to achieve optimal results. Up to date, the optimal two- stenting technic for CBL remains in debate. Accordingly, our aim was to compare different stenting techniques in coronary bifurcation lesions. Methods We performed a MEDLINE search for randomized controlled trials (RCT) and observational studies comparing stenting techniques in CBL's with reported clinical outcomes. Mixed treatment comparison model generation was performed to directly and indirectly compare culotte, T and protrusion (TAP), crush and provisional techniques Results A total of 13 RCT and 12 observational studies were identified including 6806 patients, among whom 1,201 were treated with cullotte, 2,731 with crush, 797 with TAP and 2077 with provisional stenting. The Bayesian hierarchical random-effects model demonstrated a significant reduction in target lesion revascularization (TLR) rate with crush techniques compared with provisional technique (OR 0.64 95% CI 0.42–0.97) along with a trend for reduction in major adverse cardiovascular (MACE) events (OR 0.75, 95% CI 0.55–1.02). TAP and culotte techniques did not show similar results. Equality of other endpoints, including mortality, myocardial infarction and re-stenosis was found between all CBL's techniques (Figure 1). Discussion Our findings suggest improved outcomes with crush technique compared to other double stenting techniques in terms of TLR with a trend towards MACE reduction. Further research is required to determine the optimal stenting technique for coronary bifurcations lesions along with the utility of imaging and physiology in this complex subset. Figure 1. Comparison of double stentin techniques Funding Acknowledgement Type of funding source: None

Final kissing ballooning and long-term clinical outcomes in coronary bifurcation lesions treated with 1-stent technique: results from the COBIS registry

Heart ◽  
2011 ◽  
Vol 98 (3) ◽  
pp. 225-231 ◽  
Author(s):  
Hyeon-Cheol Gwon ◽  
Joo-Yong Hahn ◽  
Bon-Kwon Koo ◽  
Young Bin Song ◽  
Seung-Hyuk Choi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Bifurcation Lesions

scholarly journals Impact of Lesion Preparation Technique on Side Branch Compromise in Calcified Coronary Bifurcations: A Subgroup Analysis of the PREPARE-CALC Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Abdelhakim Allali ◽  
Mohamed Abdel-Wahab ◽  
Hussein Traboulsi ◽  
Rayyan Hemetsberger ◽  
Nader Mankerious ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Side Branch ◽  
Cardiac Biomarkers ◽  
Preparation Technique ◽  
Coronary Bifurcation ◽  
Group 13 ◽  
Coronary Bifurcation Lesions ◽  
Bifurcation Lesions ◽  
The Impact

Objectives. To analyze the impact of different techniques of lesion preparation of severely calcified coronary bifurcation lesions. Background. The impact of different techniques of lesion preparation of severely calcified coronary bifurcation lesions is poorly investigated. Methods. We performed an as-treated analysis on 47 calcified bifurcation lesions treated with scoring/cutting balloons (SCB) and 68 lesions treated with rotational atherectomy (RA) in the PREPARE-CALC trial. Compromised side branch (SB) as assessed in the final angiogram was the primary outcome measure and was defined as any significant stenosis, dissection, or thrombolysis in myocardial infarction flow <3. Results. True bifurcation lesions were present in 49% vs. 43% of cases in the SCB and RA groups, respectively. After stent implantation, SB balloon dilatation was necessary in around one-third of cases (36% vs. 38%; p = 0.82 ), and a two-stent technique was performed in 21.3% vs. 25% ( p = 0.75 ). At the end of the procedure, the SB remained compromised in 15 lesions (32%) in the SCB group and 5 lesions (7%) in the RA group ( p = 0.001 ). Large coronary dissections were more frequently observed in the SCB group (13% vs. 2%; p = 0.02 ). Postprocedural levels of cardiac biomarkers were significantly higher in patients with a compromised SB at the end of the procedure. Conclusions. In the PREPARE-CALC trial, side branch compromise was more frequently observed after lesion preparation with SCB as compared with RA. Consequently, in calcified bifurcation lesions, an upfront debulking with an RA-based strategy might optimize the result in the side branch.

Sign in / Sign up

Export Citation Format

Share Document