scholarly journals Contemporary Management of Isolated Ostial Side Branch Disease: An Evidence-based Approach to Medina 001 Bifurcations

2021 ◽  
Vol 16 ◽  
Author(s):  
Suleiman Suleiman ◽  
JJ Coughlan ◽  
George Touma ◽  
Richard Szirt
Keyword(s):  
Treatment Strategies ◽  
Interventional Cardiology ◽  
Side Branch ◽  
Interventional Treatment ◽  
Published Data ◽  
Evidence Based ◽  
Cardiac Events ◽  
Management Options ◽  
Increased Risk ◽  
Bifurcation Lesions

The optimal management of bifurcation lesions has received significant interest in recent years and remains a matter of debate among the interventional cardiology community. Bifurcation lesions are encountered in approximately 21% of percutaneous coronary intervention procedures and are associated with an increased risk of major adverse cardiac events. The Medina classification has been developed in an attempt to standardise the terminology when describing bifurcation lesions. The focus of this article is on the management of the Medina 0,0,1 lesion (‘Medina 001’), an uncommon lesion encountered in <5% of all bifurcations. Technical considerations, management options and interventional techniques relating to the Medina 001 lesion are discussed. In addition, current published data supporting the various proposed interventional treatment strategies are examined in an attempt to delineate an evidence-based approach to this uncommon lesion.

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.

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.

scholarly journals Carina Bifurcation Angle and Side Branch Occlusion in Coronary Bifurcation Lesions Intervention: Angiographic Lesions Characteristic Role in Determining Its Relation

2018 ◽  
Vol 28 (02) ◽  
pp. 137-141 ◽  
Author(s):  
Bogie Putra Palinggi ◽  
Doni Firman
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Side Branch ◽  
Coronary Bifurcation ◽  
Cross Sectional ◽  
Bifurcation Angle ◽  
Coronary Bifurcation Lesions ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions

AbstractSide branch occlusion has been implicated as a complication after percutaneous coronary intervention in coronary bifurcation lesions. The role of carina bifurcation angle as one of the characteristics of the coronary bifurcation lesions in causing side branch occlusion after percutaneous coronary intervention is still debated. This study aims to assess the correlation between carina bifurcation angles as one of the characteristics of the coronary bifurcation lesions and side branch occlusion in elective percutaneous coronary intervention. This is a cross-sectional study which utilizes CAAS 5.1 software to measure carina bifurcation angle. We collected 113 lesions in 108 patients that met the inclusion criteria from January 2016 to October 2016. Side branch occlusion occurred in 15 lesions (13.3%), with median carina bifurcation angle 19.17 degrees (p < 0.001). Multivariate analysis showed there is a correlation between carina bifurcation angle with side branch occlusion, OR (odds ratio) 0.86 (95% CI [confidence interval]: 0.80–0.92) with ≤ 33.71 degrees cut off value. Increased risk of side branch occlusion was found in small carina bifurcation angle.

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

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 Left Main Disease and Bifurcation Percutaneous Coronary Intervention: Focus on Antithrombotic Therapy

2021 ◽  
Vol 15 ◽  
Author(s):  
Charalampos Varlamos ◽  
Ioannis Lianos ◽  
Despoina-Rafailia Benetou ◽  
Dimitrios Alexopoulos
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antithrombotic Therapy ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Left Main ◽  
Thrombotic Risk ◽  
P2y12 Inhibitors ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions

Revascularization of both left main and bifurcation lesions is currently considered an important feature of complex percutaneous coronary intervention (PCI), whereas stenting distal left main bifurcation is fairly challenging. Recent evidence shows that such lesions are associated with an increased risk of ischemic events. There is no universal consensus on the optimal PCI strategy or the appropriate type and duration of antithrombotic therapy to mitigate the thrombotic risk. Prolonged dual antiplatelet therapy or use of more potent P2Y12 inhibitors have been investigated in the context of this high-risk subset of the population undergoing PCI. Thus, while complex PCI is a growing field in interventional cardiology, left main and bifurcation PCI constitutes a fair amount of the total complex procedures performed recently, and there is cumulative interest regarding antithrombotic therapy type and duration in this subset of patients, with decision-making mostly based on clinical presentation, baseline bleeding, and ischemic risk, as well as the performed stenting strategy.

scholarly journals Management of COVID-19 in cancer patients receiving cardiotoxic anti-cancer therapy. Future recommendations for cardio-oncology

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Hasan Kobat ◽  
Islam Elkonaissi ◽  
Mehmet Tevfik Dorak ◽  
Shereen Nabhani-Gebara
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Immune Suppression ◽  
Treatment Modalities ◽  
Evidence Based ◽  
Supportive Treatment ◽  
Cardiac Events ◽  
Increased Risk ◽  
Anti Cancer ◽  
Lung Functions

Cardiotoxicity induced by anti-cancer treatment has become a significant threat as the number of cardiotoxic anti-cancer agents is growing. Cancer patients are at an increased risk of contracting coronavirus disease 2019 (COVID-19) because of immune suppression caused by anti-cancer drugs and/or supportive treatment. Deterioration in lung functions due to COVID-19 is responsible for many cardiac events. The presence of COVID-19 and some of its treatment modalities may increase the chance of cardiotoxicity development in cancer patients receiving potentially cardiotoxic agents. This review provides evidence-based information on the cardiotoxicity risk in cancer patients clinically diagnosed with COVID-19 who are receiving potentially cardiotoxic anti-cancer agents. Proposed strategies relating to the management of this patient cohorts are also discussed.

scholarly journals Effect of Balloon Embedded Bifurcating Stenting with Single Stent Strategy for Side Branch Protection

2021 ◽  
Vol 36 (1) ◽  
pp. 17-23
Author(s):  
Bishnu Pada Saha ◽  
Mir Jamal Uddin ◽  
Sabina Hashem ◽  
Priyanka Adhikary ◽  
Mohammad Arifur Rahman ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Adverse Events ◽  
Coronary Intervention ◽  
Side Branch ◽  
Inflated Balloon ◽  
Acute Occlusion ◽  
Bifurcation Lesion ◽  
Increased Risk ◽  
Bifurcation Stenting ◽  
Bifurcation Lesions

Background: Intervention for bifurcation lesions is associated with increased risk of adverse events and includes acute side branch (SB) occlusion during main branch (MB) stenting. This acute occlusion of side branch can often be catastrophic for the patient. We here in describe our experience in National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh with a technique which can be incorporated into bifurcation stenting to reduce or almost eliminate the incidence of side branch occlusion or catastrophe. Methods: A prospective, observational, non-blinded study in patients from a single tertiary referral cardiac center National Institute of Cardiovascular Diseases & Hospital (NICVD), Dhaka, Bangladesh. Patients with an indication for percutaneous coronary intervention (PCI) of a denovo bifurcation lesion were screened. The study included 51 patients who underwent coronary angiogram in our institution and had bifurcation lesions suitable for single stent strategy between March 2017 to September 2018. Results: 51 patients with bifurcation lesion were included in the study and underwent a balloon embedded bifurcation stenting with a semi inflated balloon placed across the SB ostium. Angiographic success was achieved in all the patients but procedural success was achieved in 88.2% of the patients. TIMI 3 flow of main branch (MB) was achieved 96.08% and side branch (SB) was achieved 88.2%. Incidence of dissection was 5.9%, acute occlusion of SB was 2.0% and MACE was 3.9%. Mean fluoroscopy time and contrast volume was similar to that of conventional bifurcation stenting. The jailed SB balloon and wire could be successfully removed in all patients. Conclusion: The present study suggests that balloon embedded bifurcation stenting with a semi inflated balloon to protect the SB is feasible, with minimal procedural adverse events and successful in minimizing or almost eliminating the incidence of acute side branch occlusion or dissection as well as MACE. Bangladesh Heart Journal 2021; 36(1): 17-23

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 Randomized non-inferiority TrIal comParing reverse T And Protrusion versus double-kissing and crush Stenting for the treatment of complex left main bifurcation lesions

2021 ◽  
Author(s):  
Maximilian Olschewski ◽  
Helen Ullrich ◽  
Maike Knorr ◽  
Giulio Makmur ◽  
Majid Ahoopai ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Side Branch ◽  
Interventional Treatment ◽  
Syntax Score ◽  
Left Main ◽  
Group 14 ◽  
Coronary Bifurcation Lesions ◽  
Stent Expansion ◽  
Procedural Time ◽  
Bifurcation Lesions

Abstract Background The treatment of left main bifurcation stenoses remains challenging. Aims We compare the “Reverse T and Protrusion” (reverse-TAP) technique to Double-Kissing and crush (DK-crush). Methods The study was designed as non-inferiority trial, the primary endpoint was percentage stent expansion in the ostial side branch at optical coherence tomography. Results 52 consecutive patients (13 females, 17 diabetics, Syntax score 25 [22–29]) with complex coronary bifurcation lesions of the left main were randomized in a 1:1 ratio to Reverse-TAP or DK-crush stenting. The intervention was performed according to protocol in all patients in both randomization groups. Side branch stent expansion was 75 [67–90]% in the DK-crush group and 86 [75–95]% in the reverse-TAP group (one-sided 97.5% lower parametric confidence interval: − 0.28%; P < 0.01 for non-inferiority; P = 0.037 for superiority). Side branch balloon pressure during final kissing was higher in the DK-crush group (14 [12–16] vs. reverse-TAP: 13 [12–14]; P = 0.043). Procedural time was shorter with reverse-TAP (DK-crush: 32 [24–44] min vs reverse–TAP: 25 [22–33] min; P = 0.044). Other procedural parameters were not different between groups. There was no difference in any of the safety endpoints up to 1 month. Conclusions A reverse-TAP strategy for the interventional treatment of complex coronary lesions was non-inferior and superior to DK-crush for the primary endpoint side branch expansion while requiring less time. A larger study testing long-term clinical outcomes is warranted. Trail Registration NCT: NCT03714750. Graphical abstract

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