AS-139: Impact of Treatment Strategy on Target Vessel Revascularization Rate in Coronary Bifurcation Lesions

Abstract Background Bifurcation lesions represent 20% of all coronary lesions treated by percutaneous coronary interventions (PCI). Although provisional technique with 1 stent in the main branch and balloon angioplasty of the side branch is considered the standard approach, the implantation of 2 stents is often being pursued with a wide variety of bifurcation stenting techniques. We thus conducted a systematic review and network meta-analysis of randomized clinical trials (RCTs) to compare clinical cardiovascular outcomes involving stenting techniques in coronary bifurcation lesions. Methods We searched on Pubmed, Google Scholar, Embase and Cochrane Library, up to October 2018 for published and unpublished RCTs that compared clinical cardiovascular outcomes in patients with bifurcation lesions treated with 7different techniques (crush [Cr]; culotte [Cu]; double kissing crush [DKCr], mini-crush [mCr], routine T-stenting [RTS], T-stenting and small protrusion [TAP], and provisional (1 stent technique)). We performed a frequentist fixed-effect network meta-analysis to estimate relative risks (RR) of major adverse cardiovascular events (“MACE”, typically defined as death, myocardial infarction and target vessel revascularization), target vessel revascularization (TVR), target lesion revascularization (TLR), and stent thrombosis (ST). Results We identified 14 studies, yielding data on 4285 patients. DKCr and mCr yielded significant reductions in MACE, TVR, and TLR when compared with the 1-stent technique (RR 0.31–0.55 [all P<0.01] and RR 0.42–0.45 [all P<0.02], respectively) and with the rest of the bifurcation techniques (RR 0.44–0.55 [all P<0.05] for DKCr and RR 0.37–0.45 [all P<0.05] for mCr). On the other hand, Cu and Cr were associated with an increased risk for ST compared to 1-stent technique (RR 3.25–4.27 [both P<0.05]) and to DKCr (RR 3.02–3.99 [both P<0.05]). We found no heterogeneity nor inconsistency between studies. Conclusions The various PCI bifurcation stenting techniques are associated with different cardiovascular outcomes, with double kissing crush and mini crush being more effective than others, including the 1-stent approach, whereas culotte and crush are associated with increased risk of stent thrombosis. Acknowledgement/Funding None

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1081-50 Predictors of target vessel revascularization after stenting coronary bifurcation lesions: Insights from a large prospective single-center database

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(04)90247-1 ◽

2004 ◽

Vol 43 (5) ◽

pp. A59

Author(s):

Gunasekaran Sengottuvel ◽

Thierry Lefèvre ◽

André Kokis ◽

Yves Louvard ◽

Samer Mansour ◽

...

Keyword(s):

Target Vessel ◽

Single Center ◽

Coronary Bifurcation ◽

Target Vessel Revascularization ◽

Coronary Bifurcation Lesions ◽

Bifurcation Lesions

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Treatment effects of systematic two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: rationale and design of a prospective, randomised and multicentre DEFINITION II trial

BMJ Open ◽

10.1136/bmjopen-2017-020019 ◽

2018 ◽

Vol 8 (3) ◽

pp. e020019 ◽

Cited By ~ 4

Author(s):

Jun-Jie Zhang ◽

Xiao-Fei Gao ◽

Ya-Ling Han ◽

Jing Kan ◽

Ling Tao ◽

...

Keyword(s):

Informed Consent ◽

Target Lesion ◽

Target Vessel ◽

Coronary Bifurcation ◽

Coronary Bifurcation Lesions ◽

Stent Restenosis ◽

Institutional Review ◽

Bifurcation Lesions ◽

Provisional Stenting ◽

Target Lesion Failure

IntroductionProvisional stenting (PS) for simple coronary bifurcation lesions is the mainstay of treatment. A systematic two-stent approach is widely used for complex bifurcation lesions (CBLs). However, a randomised comparison of PS and two-stent techniques for CBLs has never been studied. Accordingly, the present study is designed to elucidate the benefits of two-stent treatment over PS in patients with CBLs.Methods and analysisThis DEFINITION II study is a prospective, multinational, randomised, endpoint-driven trial to compare the benefits of the two-stent technique with PS for CBLs. A total of 660 patients with CBLs will be randomised in a 1:1 fashion to receive either PS or the two-stent technique. The primary endpoint is the rate of 12-month target lesion failure defined as the composite of cardiac death, target vessel myocardial infarction (MI) and clinically driven target lesion revascularisation. The major secondary endpoints include all causes of death, MI, target vessel revascularisation, in-stent restenosis, stroke and each individual component of the primary endpoints. The safety endpoint is the occurrence of definite or probable stent thrombosis.Ethics and disseminationThe study protocol and informed consent have been approved by the Institutional Review Board of Nanjing First Hospital, and accepted by each participating centre. Written informed consent was obtained from all enrolled patients. Findings of the study will be published in a peer-reviewed journal and disseminated at conferences.Trial registration numberNCT02284750; Pre-results.

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The Effective and Safe Way to Use Crusade Microcatheter-Facilitated Reverse Wire Technique to Solve Bifurcated Lesions with Markedly Angulated Target Vessel

Journal of Interventional Cardiology ◽

10.1155/2019/2579526 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Jingang Cui ◽

Xiaowei Jiang ◽

Shubin Qiao ◽

Lijian Gao ◽

Jiansong Yuan ◽

...

Keyword(s):

Cardiac Event ◽

Guide Wire ◽

Coronary Intervention ◽

Distal Segment ◽

Target Vessel ◽

Coronary Bifurcation ◽

Significant Stenosis ◽

Coronary Bifurcation Lesions ◽

Percutaneous Coronary ◽

Bifurcation Lesions

Objectives. We aim to present a new way to introduce reverse wire in crusade microcatheter-facilitated reverse wire technique to solve markedly angulated bifurcated lesions. Background. Markedly angulated coronary bifurcation lesions are still one of the considerable challenges of treatment with percutaneous coronary intervention especially with severe proximal stenosis. Microcatheter-facilitated reverse wire technique improved the efficacy of crossing a guide wire to such an extremely angulated complex targeted vessel. However, there has been a debate regarding what kind of curve was the best to introduce reverse guide wire in this technique. Methods. We analyzed 7 patients who were admitted to Fuwai Hospital and underwent antegrade wiring which failed. Crusade microcatheter-facilitated reverse wire technique with simple short tip one round curve was used successfully to solve in all 7 bifurcation lesions. We investigated the bifurcation lesion’s characteristics and details of the reverse wire technique procedures. Results. All 7 bifurcations exhibit both a smaller take-off angle and a larger carina angle and severe proximal significant stenosis. After having suitable size of balloon predilation, reverse wire with simple short distal one curve was delivered to distal segment of targeted vessel successfully. We performed all PCI procedures without any complications and no major adverse cardiac event was observed during hospitalization. Conclusions. In solving markedly angulated bifurcated lesions, especially with severe proximal stenosis, crusade microcatheter-facilitated reverse wire technique with simple short tip one curve is an effective and safe way of wiring.

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Placement of tryton side branch stent only; A new treatment strategy for Medina 0,0,1 coronary bifurcation lesions

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.24811 ◽

2013 ◽

pp. n/a-n/a ◽

Cited By ~ 1

Author(s):

Maik J. Grundeken ◽

Pierfrancesco Agostoni ◽

Maciej Lesiak ◽

Karel T. Koch ◽

Michiel Voskuil ◽

...

Keyword(s):

Treatment Strategy ◽

Side Branch ◽

Coronary Bifurcation ◽

Coronary Bifurcation Lesions ◽

Bifurcation Lesions ◽

New Treatment

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Dedicated Bifurcation Stents Strategy

Interventional Cardiology Review ◽

10.15420/icr.2009.4.1.70 ◽

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.

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