scholarly journals TCT-464 Outcomes of Patients With Bifurcation Lesions: Preliminary Results From the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (PROGRESS-BIFURCATION) Registry

2021 ◽  
Vol 78 (19) ◽  
pp. B191
Author(s):  
Judit Karacsonyi ◽  
Spyridon Kostantinis ◽  
Alessandra Gutierrez ◽  
Vennela Avula ◽  
Bahadir Simsek ◽  
...  
Keyword(s):  
Preliminary Results ◽  
Bifurcation Lesion ◽  
Bifurcation Lesions ◽  
Global Registry

scholarly journals Stentless Strategy by Drug-Coated Balloon Angioplasty following Directional Coronary Atherectomy for Left Main Bifurcation Lesion

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Norihiro Kobayashi ◽  
Masahiro Yamawaki ◽  
Shinsuke Mori ◽  
Masakazu Tsutsumi ◽  
Yohsuke Honda ◽  
...  
Keyword(s):  
De Novo ◽  
Artery Bypass ◽  
The Other ◽  
Bleeding Complications ◽  
Left Main ◽  
Other Hand ◽  
Bifurcation Lesion ◽  
Bifurcation Lesions ◽  
Directional Coronary Atherectomy ◽  
Drug Coated Balloon

Aims. We aimed to evaluate the efficacy of stentless strategy by drug-coated balloon (DCB) angioplasty following directional coronary atherectomy (DCA) for left main (LM) bifurcation lesions. Methods. A total of 38 patients who underwent DCB angioplasty following DCA for LM bifurcation lesions were retrospectively enrolled. The primary endpoint was target vessel failure (TVF) at 12 months. Secondary endpoints included procedure-related major events during the hospitalization, major adverse cardiac events at 12 months, ischemia-driven target lesion revascularization (TLR) at 12 months, and bleeding complications defined as the Bleeding Academic Research Consortium criteria ≥2 at 12 months. Results. Among these 38 lesions, 31 lesions were de novo LM bifurcation lesions and 7 lesions were stent edge restenosis at the left anterior descending (LAD) ostium. The mean % plaque area (%PA) after DCA was 44.0 ± 7.4%. TVF at 12 months occurred in 1 lesion (3.2%) of de novo LM bifurcation lesion and in 3 lesions (42.9%) of stent edge restenosis at the LAD ostium. All events of TVF were ischemia-driven TLR by percutaneous coronary intervention. Among 4 TLR cases, %PA after DCA was high (55.9%) in the de novo LM bifurcation lesions; on the other hand, %PA after DCA was low (42.4%, 38.7%, and 25.7% in the 3 cases) in stent edge restenosis at the LAD ostium. No procedure-related major events were observed during hospitalization. There was no cardiac death, no myocardial infarction, no coronary artery bypass grafting, and no bleeding complications at 12 months. Conclusions. Stentless strategy by DCB angioplasty following DCA for de novo LM bifurcation lesions resulted in acceptable outcomes. On the other hand, its efficacy was limited for stent edge restenosis at the LAD ostium even after aggressive debulking by DCA.

scholarly journals Coronary Bifurcation Lesion–Management

2020 ◽  
Vol 5 (02) ◽  
pp. 137-154
Author(s):  
Maddury Jyotsna
Keyword(s):  
Management Strategy ◽  
Cardiac Events ◽  
Coronary Bifurcation ◽  
Bifurcation Lesion ◽  
Adverse Cardiac Events ◽  
Drug Eluting ◽  
Bifurcation Lesions ◽  
Coronary Bifurcation Lesion ◽  
Modern Era

AbstractCoronary bifurcation lesion management is challenging even in this modern era of drug-eluting stents (DES). A debate always exists as to what mode of treatment is better–one-stent or two-stent strategy. As in hospital and major adverse cardiac events (MACE) are more in the follow-up, what improvements in management strategy are required in relation to bifurcation lesions? We have more questions than answers for this type of lesion. In this article, we try to analyze these issues.

P5753Jailed pressure wire to assess the side branch result for bifurcation lesions treated by provisional stenting strategy: iFR as a new index

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Romero ◽  
F Hidalgo ◽  
S Ojeda ◽  
J Segura ◽  
J Suarez De Lezo ◽  
...  
Keyword(s):  
Side Branch ◽  
Diagonal Branch ◽  
Coronary Syndrome ◽  
Bifurcation Lesion ◽  
Pressure Wire ◽  
Bifurcation Lesions ◽  
Microscopic Damage ◽  
The Wire ◽  
Provisional Stenting

Abstract Purpose To analyze the feasibility and efficacy of the jailed pressure wire technique for bifurcation lesions treated by provisional stenting strategy and to assess the physiological side branch (SB) result using instantaneous wave free ratio (iFR). Methods Between June 2017 and December 2018, 50 patients who presented a bifurcation lesion considered appropriate for provisional stenting strategy were included in the study. Pressure wire was passed to side branch before treatment. Main vessel (MV) and side branch (SB) was predilated at the operator criteria. iFR determination was obtained in the SB baseline and after MV stenting (leaving the pressure wire jailed). Afterwards, the wire was removed to MV ostium to discard the possibility of drift. SB postdilation was performed if SB iFR was less than 0,89 (according to vessel thresholds established in clinical trials), evaluating the result by a new iFR determination. Results The mean age was 64±10 years. Sixteen patients (32%) had diabetes. Clinical presentation was stable angina in 26 patients (52%), non-STEMI in 19 patients (38%) and STEMI (non culprit lesion) in 5 patients (10%). The most frequent bifurcation type according to Medina classifications was 1,1,0 (21 patients, 42%). Seventeen patients (34%) had a true bifurcation lesion. The MV and SB reference diameter was 3,0±0,5 mm and 2,25±0,5 mm respectively. Most of the bifurcations were located at the left anterior descending artery/diagonal branch (27 bifurcations, 54%). Ten patients (20%) presented a distal left main bifurcation. Baseline SB iFR was 0,78±0,2. Under continuous SB iFR monitoring MV stenting was performed by trapping the pressure wire. After MV stenting, the SB iFR changed to 0,90±0,1. We confirmed the presence of drift in 5 patients (10%). In these cases, recalibration of the wire and SB rewiring was performed in 4 cases. In the remaining patient, rewiring was not possible even using specific coronary wires. According to SB IFR, postdilation was necessary in 14 patients (28%). Final SB iFR was 0,94±0,03. A second stent was not necessary in any patient because final SB iFR was higher than 0.89 in all cases. We observed discordance between angiographic and physiological result in 17 cases (34%). All the wires could be removed. Forty wires (80%) were microscopically analyzed. Some grade of microscopic damage was found in 32 wires (80%), all of them distal to the pressure sensor. However, only one of these wires (2%) presented severe damage, and no case of fracture was observed. After a mean follow up time of 10±6 months only one patient (2%) presented a major cardiac adverse event (acute coronary syndrome due to voluntary cessation of dual antiplatelet therapy). Conclusions The use of jailed pressure wire to monitor SB results for bifurcations treated by provisional stenting seems to be safe. The iFR index seems to provide new physiological information about the significance of the SB stenosis.

scholarly journals Retrograde Balloon Dilation outside the Main Branch Stent to Restore the Occlusion of Side Branch in Chronic Total Occlusion Bifurcation Lesions

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Gao Hao-kao ◽  
Li Cheng-xiang
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Balloon Dilation ◽  
Coronary Intervention ◽  
Side Branch ◽  
Total Occlusion ◽  
Bifurcation Lesion ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions

Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) can be challenging when a bifurcation is present at the distal cap. We described a case of retrograde balloon outside the main branch stent to restore the occlusion of side branch in CTO bifurcation lesion through the jailed wire.

Pediatric angioedema: Essential features and preliminary results from the Hereditary Angioedema Global Registry in Italy

2020 ◽  
Vol 31 (S24) ◽  
pp. 22-24
Author(s):  
Mauro Cancian ◽  
Francesca Perego ◽  
Riccardo Senter ◽  
Francesco Arcoleo ◽  
Tiziana De Pasquale ◽  
...  
Keyword(s):  
Hereditary Angioedema ◽  
Preliminary Results ◽  
Global Registry

scholarly journals Transfer of Low-Density Lipoproteins in Coronary Artery Bifurcation Lesions with Stenosed Side Branch: Numerical Study

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Zhenmin Fan ◽  
Xiao Liu ◽  
Peng Zhang ◽  
Jiang Gu ◽  
Xia Ye ◽  
...  
Keyword(s):  
Adverse Events ◽  
Concentration Polarization ◽  
Side Branch ◽  
Low Density Lipoproteins ◽  
The Other ◽  
Low Density ◽  
Luminal Surface ◽  
Bifurcation Lesion ◽  
Bifurcation Lesions ◽  
Degree Of Risk

Evidence from clinical data suggests that the stenotic side branch (SB) is one of the key predictors for SB occlusion-based adverse events. In this study, we hypothesized that coronary bifurcations with stenotic SB might lead to severe concentration polarization of atherogenic lipids, such as the low-density lipoproteins (LDL), motivating the adverse events in the clinic. To confirm this hypothesis, this work numerically investigated the transport of LDL in different bifurcation lesions based on the Medina classification with various location and stenosis severities. The results showed that the coronary bifurcations with stenotic SB might be suffering more serious concentration polarization of LDL on the luminal surface of the SB due to higher level of LDL concentrations. Moreover, compared to the other bifurcation lesion types, the type (1,0,1) had the highest luminal surface LDL concentration along the SB and the highest degree of risk to enhance the process of atherosclerosis. In addition, this study also showed that the luminal surface LDL concentration increased with elevated stenosis severity. The type (1,0,1) with the severe stenosis (75% diameter reduction) had the highest concentration at the SB. In conclusion, these results suggested that both location of lesions and stenosis severities had great influence on the distribution of LDL on the luminal surface of the SB. Therefore, the estimation of disease severity and the interventional therapy should be carried out not only according to the stenosis severities in clinic. Moreover, compared to the other bifurcation lesion types, the type (1,0,1), rather than the type (1,1,1) as usually considered, had the highest luminal surface LDL concentration along the SB and the highest degree of risk to enhance the process of atherosclerosis.

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