scholarly journals ABSORB BVS Implantation in Bifurcation Lesions – Current Evidence and Practical Recommendations

2011 ◽  
Vol 9 (2) ◽  
pp. 84
Author(s):  
Robin P Kraak ◽  
Maik J Grundeken ◽  
Robbert J de Winter ◽  
◽  
◽  
...  
Keyword(s):  
Case Reports ◽  
Interventional Cardiology ◽  
Side Branch ◽  
Current Evidence ◽  
Bioresorbable Vascular Scaffold ◽  
Novel Device ◽  
Coronary Bifurcation Lesions ◽  
Bifurcation Stenting ◽  
Bifurcation Lesions ◽  
Absorb Bvs

The introduction of the ABSORB bioresorbable vascular scaffold (BVS) provides a new tool for stenting in interventional cardiology. Initially, relatively simple coronary artery lesions were treated with this novel device; nowadays, we are gaining clinical experience when treating a wide variety of lesions with the ABSORB BVS, including bifurcation lesions. Unfortunately, data are limited in terms of the use of the ABSORB BVS in coronary bifurcation lesions, so little is known about the safety and feasibility of these procedures. Bench testing and case reports showed that single provisional scaffold placement is feasible with fenestration of the scaffold towards the side branch and sequential non-compliant balloon inflation in the side and main branches. However, no prospective randomised clinical data with optical coherence tomography (OCT) imaging for different bifurcation stenting techniques are available. Based on the available data and our own experience we would recommend the use of the provisional single scaffold technique and only to fenestrate the scaffold if a severely pinched ostium combined with impaired flow seen on angiogram.

scholarly journals Coronary bifurcation lesions: current techniques for endovascular treatment

2021 ◽  
Vol 25 (2) ◽  
pp. 38
Author(s):  
T. K. Eraliev ◽  
D. A. Khelimskii ◽  
A. G. Badoian ◽  
O. V. Krestyaninov
Keyword(s):  
Endovascular Treatment ◽  
Conflict Of Interest ◽  
Interventional Cardiology ◽  
Evidence Base ◽  
Current Evidence ◽  
Coronary Bifurcation Lesions ◽  
Current Evidence Base ◽  
Bifurcation Stenting ◽  
Bifurcation Lesions ◽  
Artery Disease

<p>Bifurcation lesions are among the most challenging issues in interventional cardiology, occurring in approximately 15% – 20% of all types of coronary artery disease. Challenges in the endovascular treatment of such lesions include anatomical variability, different treatment approaches, difficulties in physiological assessment of the bifurcation branches, and a high risk of restenosis. Current bifurcation classifications are unable to prognose long-term clinical outcomes. Provisional T-stenting can be used in most cases, including in complex bifurcation lesions.  This article aimed to review the current classification of bifurcation lesions, describe the available bifurcation stenting techniques, and discuss the current evidence base.</p><p>Received 27 December 2020. Revised 9 March 2021. Accepted 12 March 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

Dedicated Bifurcation Stents Strategy

2009 ◽  
Vol 4 (1) ◽  
pp. 70
Author(s):  
Chen Shao-Liang ◽  
Imad Sheiban ◽  
◽  
Keyword(s):  
Interventional Cardiology ◽  
Daily Practice ◽  
Side Branch ◽  
Control Groups ◽  
Coronary Bifurcation ◽  
Percutaneous Approach ◽  
Coronary Bifurcation Lesions ◽  
Drug Eluting ◽  
Bifurcation Lesions ◽  
Provisional Stenting

Coronary bifurcation lesions represent an area of ongoing challenges in interventional cardiology, mainly due to the higher rate of residual stenosis and restenosis at the side branch ostium. Multiple two-stent bifurcation strategies, including T-stenting, V-stenting, simultaneuos kissing stenting, culotte stenting and classic crush techniques, have no advantages over one-stent techniques. This led to provisional stenting being considered as a mainstream approach, based on the results of numerous randomised trials. Dedicated bifurcation stents have been designed specifically to treat coronary bifurcations with the aim of addressing some of the shortcomings of the conventional percutaneous approach and facilitating the provisional approach. The development of more drug-eluting platforms and larger studies with control groups demonstrating their clinical applicability, efficacy and safety are required before these stents are widely incorporated into daily practice.

Analysis of Side Branch Access During Bifurcation Stenting

2008 ◽  
Author(s):  
Peter Mortier ◽  
Matthieu De Beule ◽  
Denis Van Loo ◽  
Benedict Verhegghe ◽  
Pascal Verdonck
Keyword(s):  
Side Branch ◽  
Local Blood Flow ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Clinical Literature ◽  
Bifurcation Stenting ◽  
Common Technique ◽  
Flow Through ◽  
Bifurcation Lesions ◽  
Stenotic Arteries

A common technique to improve the local blood flow through stenotic arteries involves the implantation of a metallic scaffold known as a stent. These devices have shown excellent results in unbranched vessels. However, the treatment of coronary bifurcation lesions remains an enormous challenge and is generally associated with an increased complication rate. Many different techniques have been proposed in clinical literature, but all the suggested methodologies have specific limitations [1]. In many cases, a stent is deployed in the main branch (MB) and logically, this compromises the side branch (SB) patency. This is a frequently encountered situation that can be improved by balloon dilatation through the side of the MB stent (fig. 1). However, such balloon inflation may result in unwanted distortions of the stent [2].

scholarly journals AXXESS– Stent: Delivery Indications and Outcomes

2015 ◽  
Vol 10 (2) ◽  
pp. 85 ◽  
Author(s):  
Rawlins John ◽  
Din Jehangir ◽  
Talwar Suneel ◽  
O–Kane Peter ◽  
◽  
...  
Keyword(s):  
Interventional Cardiology ◽  
Outcome Data ◽  
Side Branch ◽  
Implantation Technique ◽  
Published Data ◽  
Cardiac Events ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Conical Structure ◽  
Bifurcation Lesions

The successful treatment of coronary bifurcation lesions remains one of the challenges of interventional cardiology. The current consensus of the European Bifurcation Club based on published data advocates a provisional strategy, treating the main vessel (MV) with a single stent covering the side branch (SB), with bailout SB stenting as required. The success of this approach may be limited by failure to attain SB access after MV stenting but is preferred in most situations over routine SB plus MV stent techniques, which are associated with a significant increase in the rate of major adverse cardiac events. The AXXESS self-expanding biolimus-eluting stent has been developed as a solution to these challenges within the coronary circulation and maintains provisional MV stent approach but with added assurance of maintained SB access. It has a unique conical structure that is positioned spanning the carina, with scaffold extending into the carina of both the MV and SB. The purpose of this article is to describe the indication, implantation technique and outcome data supporting the use of the AXXESS stent in the treatment of coronary bifurcation lesions.

scholarly journals Morphological studies of stented coronary artery bifurcations on anatomical preparations of the heart

2019 ◽  
Vol 18 (3) ◽  
pp. 29-34
Author(s):  
D. A. Starchik ◽  
K. L. Kozlov ◽  
A. N. Shishkevich ◽  
S. S. Mikhailov ◽  
Z. M. Abdullaev ◽  
...  
Keyword(s):  
Coronary Arteries ◽  
Morphological Analysis ◽  
Interventional Cardiology ◽  
Side Branch ◽  
Lateral Branch ◽  
Point Of View ◽  
Morphological Studies ◽  
Bifurcation Stenting ◽  
Bifurcation Lesions ◽  
Comprehensive Study

Introduction. One of the most difficult and completely unsolved problems of modern interventional cardiology is bifurcation stenting of the coronary arteries. This problem requires a comprehensive study, including using the possibility of morphological analysis.Material and methods. Stenting of the bifurcation lesions of the coronary arteries on 46 cadaveric hearts was performed using the bifurcation and conventional stents with subsequent plating and study of the preparations obtained.Results. From the point of view of the safety of the lateral branch, T-stenting is optimal, especially when implanting a BIOSS stent. When using the Tryton stent with the culotte stenting technique, there was never a stenosis of the side branch, due to the stent in the lumen, but there was always an excessive metal saturation in the main branch before the bifurcation. When using conventional stent with a provisional T-stenting technique residual, stenosis of the mouth of the lateral branch was also observed. In addition, in all cases there was a deformation of the stent beams near the mouth of the lateral branch.Conclusions. Morphological studies of stented coronary arteries on anatomical preparations of the heart, plastized with epoxy resin, make it possible to obtain new results that cannot be obtained with traditional morphological and clinical research methods (histological, corrosive, radiological, etc.).  

scholarly journals Drug coated balloons for coronary artery bifurcation lesions: A systematic review and focused meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0251986
Author(s):  
Natasha H. Corballis ◽  
Sophie Paddock ◽  
Tharusha Gunawardena ◽  
Ioannis Merinopoulos ◽  
Vassilios S. Vassiliou ◽  
...  
Keyword(s):  
Observational Studies ◽  
Case Reports ◽  
Meta Analysis ◽  
Target Lesion ◽  
Side Branch ◽  
Attractive Alternative ◽  
Coronary Bifurcation Lesions ◽  
Late Lumen Loss ◽  
Alternative Treatment Strategy ◽  
Bifurcation Lesions

Objectives We sought to systematically review the evidence supporting the role of drug coated balloons (DCBs) in the treatment of coronary bifurcation lesions. Background DCBs are emerging as an attractive alternative treatment strategy for treating coronary bifurcations due to simplifying the approach and reducing rates of stent related complications. We systematically reviewed the evidence for DCB use in coronary bifurcations and conducted a focused meta-analysis on late lumen loss in the side branch comparing DCB and plain old balloon angioplasty (POBA). Methods This study was conducted in line with the PRISMA statement. All studies (including both RCTs and observational studies, excluding case reports) using DCB as part of a bifurcation strategy were included in this review. A literature search identified a total of ten studies for inclusion. A focused meta-analysis was undertaken for the use of DCB in side-branch compared with POBA. Mean late lumen loss was used with a random effects model due to heterogeneity. Results DCB was found to be superior to POBA for side branch treatment in bifurcations (p = 0.01). There are four studies that investigated the use of DCB for main branch treatment in a bifurcation, with evidence supporting its safety in main branches of bifurcation lesions, while prospective observational studies have demonstrated favourable target lesion revascularisation rates. Conclusion Although there is a lack of robust RCTs comparing DCBs with current generation DES, DCBs appear safe in main branch bifurcation lesions with improved side branch late lumen loss when compared with DES or POBA.

Side branch long lesion with main vessel vulnerable plaques by optical coherence tomography predict target-vessel myocardial infarction after provisional stenting in patients with coronary bifurcation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.L Chen
Keyword(s):  
Side Branch ◽  
Lesion Group ◽  
Lesion Length ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Vulnerable Plaques ◽  
Main Vessel ◽  
Bifurcation Lesions ◽  
Provisional Stenting ◽  
One Year

Abstract Background Provisional side branch (SB) stenting is correlated with target-vessel myocardial infarction (TVMI) in patients with coronary bifurcation lesions. However, the underlying mechanisms remain unknown. Objectives We aimed to determine the correlation of SB lesion length with vulnerable plaques using optical coherence tomography (OCT) and TVMI in patients with coronary bifurcation lesions treated by a provisional approach. Methods A total of 405 patients with 405 bifurcation lesions who underwent pre-PCI OCT imaging of both main vessel (MV) and SB was prospectively enrolled. Patients were defined as Long-SB lesion (SB lesion length ≥10 mm) and Short-SB lesion (SB lesion length &lt;10 mm) groups according to quantitative coronary analysis and were also stratified by the presence of vulnerable plaques based on OCT findings. The primary endpoint was the occurrence of TVMI after provisional stenting at one-year follow-up. Results 178 (43.9%) patients had long SB lesions. Vulnerable plaques predominantly localized in the main vessel (MV) and more frequently in the Long-SB lesion group (42.7%) compared to 24.2% in the Short-SB lesion group (p&lt;0.001). At one-year follow-up after provisional stenting, there were 31 (8.1%) TVMIs, with 11.8% in the Long-SB lesion group and 4.4% in the Short-SB lesion group (p=0.009), leading to significant difference in target lesion failure between two groups (15.2% vs. 6.6%, p=0.007). The rate of cardiac death, revascularization, and stent thrombosis was comparable between study groups. By multivariate regression analysis, long SB lesion length (p=0.011), presence of vulnerable plaques in the polygon of confluence (p=0.001), and true coronary bifurcation lesions (p=0.004) were three independent factors of TVMI. Conclusions Long-SB lesion length with MV vulnerable plaques predict increased TVMI after provisional stenting in patients with true coronary bifurcation lesions. Further study is warranted to identify the better stenting techniques for coronary bifurcation lesions with long lesion in the SB Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): NSFC

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