Abstract 430: A Novel Tram Stent Method in the Treatment of Coronary Bifurcation Lesions

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Mark Arokiaraj
Keyword(s):  
Side Branch ◽  
Coronary Bifurcation ◽  
Element Analysis ◽  
Coronary Bifurcation Lesions ◽  
Bifurcation Lesion ◽  
Bifurcation Lesions ◽  
Provisional Stenting ◽  
Coronary Bifurcation Lesion ◽  
Von Mises ◽  
Von Mises Stresses

Aims: A novel stent was designed for the treatment of coronary bifurcation lesion, and it was investigated for its performance by finite element analysis. This study was performed in search of a novel method of treatment of bifurcation lesion with provisional stenting. Methods: A coronary bifurcation model was created with the proximal vessel of 3.2 mm diameter, and the distal vessel after the side branch (2.3 mm) was 2.7 mm. A novel stent was designed with connections that had a profile of a tram. Laser cutting and shape setting of the stent was performed, and thereafter it was crimped and deployed over a balloon. The contact pressure, stresses on the arterial wall, stresses on the stent, the maximal principal log strain of the main artery and the side-branch were studied. Also multiple designs were tested in the tram area to suite the standard crimping. The study was performed in Abaqus. A firm lesion model with a stenosis of about 75% was then created with a discrete lesion in the sidebranch and the main vessel. The accompanying figure shows the model used for evaluation. Results: The stresses on the main branch and the distal branch were minimally increased after deployment of this stent. The side branch was preserved, and the stresses on the side branch were lesser; and at the confluence of bifurcation on either side of the side branch origin the Von Mises stresses were marginally increased as shown in figure. However, the stresses at the bifurcation and in the main branch were significantly lesser than the stresses by the existing techniques used in the treatment of bifurcation lesions. Conclusions: There is a potential for a novel Tram-stent method in the treatment of coronary bifurcation lesions.

Abstract 301: A Novel Tram Stent Method in Treatment of Coronary Bifurcation Lesions

2015 ◽  
Vol 117 (suppl_1) ◽  
Author(s):  
Mark C Arokiaraj
Keyword(s):  
Finite Element ◽  
Side Branch ◽  
Coronary Bifurcation ◽  
Element Analysis ◽  
Coronary Bifurcation Lesions ◽  
Main Vessel ◽  
Bifurcation Lesions ◽  
Coronary Bifurcation Lesion ◽  
Von Mises ◽  
Von Mises Stresses

Aims: A novel coronary stent was designed for the treatment of coronary bifurcation lesion, and it was investigated for its performance by finite element analysis. Methods and Results: A coronary bifurcation model was created with the proximal vessel of 3.2 mm diameter, and the distal vessel after the side branch (2.3 mm) was 2.7 mm. A novel stent was designed with connections that had a profile of a tram. Laser cutting and shape setting of the stent was performed, and thereafter the stent was deployed over a balloon. The contact pressure, stresses on the artery wall, stresses on the stent, the maximal principal log strain of the main artery and the side-branch were studied. The finite element study was performed in Abaqus, Simulia.The stresses on the main branch and the distal branch were minimally increased after deployment of this novel stent. The side branch was preserved, and the stresses on the side branch were lesser. At the confluence of the bifurcation on either side of the side branch origin the Von Mises stresses were marginally increased. However, the stresses at the bifurcation were significantly lesser than the stresses of the currently existing techniques used in the treatment of bifurcation lesions. Further, the tram area was studied parametrically to reduce the stresses. A firm lesion model with a stenosis of 80% was then created with a discrete lesion in side-branch and the main vessel. The stent was deployed in the main branch and the side branch was stented at the ostium. The stresses at the bifurcation and the main vessel was further reduced and the stent deployed well. Conclusions: There is a potential for a novel Tram-stent method 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.

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 <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<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

Abstract 12311: Side Branch Angle Influences the Neointimal Coverage of Drug-Eluting Stent in Coronary Bifurcation Lesions: An Optical Coherence Tomography Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Makoto Watanabe ◽  
Shiro Uemura ◽  
Youko Dote ◽  
Yu Sugawara ◽  
Yutaka Goryo ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Side Branch ◽  
Drug Eluting Stent ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Branch Angle ◽  
Bifurcation Lesion ◽  
Drug Eluting ◽  
Bifurcation Lesions ◽  
Neointimal Coverage

Background: Stent implantation for coronary bifurcation is intrinsically accompanied with inappropriate strut apposition around side branch (SB), which has potential risk for future development of stent thrombosis. Previous experimental studies indicated that side branch angle (SBA) influences the local flow turbulence and wall shear stress. The purpose of this study was to investigate the relation between SBA and the neointimal coverage of drug-eluting stent (DES) which were implanted in coronary bifurcation lesions. Methods: Forty-seven bifurcation lesions treated with DES were evaluated with FD-OCT in 39 patients (mean age; 65.7±13.9 y.o) at follow-up angiography. Each lesions were divided into the bifurcation lesions without kissing balloon technique (KBT) after stent implantation (non-KBT group; 28 lesions) and those with KBT (KBT group; 19 lesions). Neointimal coverage was assessed based on cross-sectional OCT images containing SB at 0.4mm interval, and separately evaluated in terms of jailing struts over the SB ostium (SO) and non-jailing struts attaching to the vessel wall (VW). BA was measured on the longitudinal reconstruction images of FD-OCT before stent implantation. Incidence of uncovered struts and neointimal thickness were measured. Results: In non-KBT group, the percentage of uncovered struts was significantly higher in lesions with SBA≦60°compared with those with SBA>60°at both SO and VW region (56.9±39.8% vs. 25.6±26.8%, p<0.05; 10.6±7.6% vs. 3.3±4.4%, p<0.01, respectively) and significant negative correlation was found between SBA and the percentage uncovered struts at both SO and VW regions (r=–0.55, p<0.01; r=–0.47, p<0.05, respectively). In KBT group, the percentage of uncovered struts was not significant difference between lesions with SBA≦60°and those with SBA>60°at both SO and VW region (36.7±35.3% vs. 36.6±34.8%; 10.9±10.4% vs. 8.6±12.7%, respectively) and no correlation was found between SBA and the percentage of uncovered struts at both SO and VW region. Conclusions: The neointimal coverage of DES was affected by in bifurcation lesion without KBT, but is not affected in bifurcation lesion with KBT. KBT has potential benefit for neointimal coverage of DES at coronary bifurcation lesion with narrow SBA.

Predictors of ostial side branch damage during provisional stenting of coronary bifurcation lesions not involving the side branch origin: an ultrasonographic study

2012 ◽  
Vol 7 (10) ◽  
pp. 1147-1154 ◽  
Author(s):  
Javier Suárez de Lezo ◽  
Alfonso Medina ◽  
Pedro Martín ◽  
José Novoa ◽  
José Suárez de Lezo ◽  
...  
Keyword(s):  
Side Branch ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Bifurcation Lesions ◽  
Provisional Stenting

Coronary bifurcation stenting: state of the art

2010 ◽  
pp. 292-313
Author(s):  
Yves Louvard ◽  
Thierry Lefèvre
Keyword(s):  
Bare Metal Stents ◽  
Clinical Importance ◽  
Side Branch ◽  
Metal Stents ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Randomized Studies ◽  
Bifurcation Lesion ◽  
Bifurcation Lesions ◽  
The Difference

The difference between a coronary bifurcation lesion and an ordinary lesion lies in the presence of a side branch (SB). Such branches are particularly instrumental in the development of atheroma because of local blood flow patterns and are also a predictive factor of peri-procedural myocardial infarction (MI) when percutaneous coronary angioplasty (PCI) is performed. The clinical importance of a SB depends on its diameter which is strongly correlated with its flow and the muscular mass that it vascularizes; the diameter of the SB, main branch (MB), and of proximal segment of the MB are indeed interdependent as evidenced by Murray’s law. Therefore, a coronary bifurcation should be divided into three segments, each with its own reference diameter. Before the advent of coronary stenting, and later with bare-metal stents (BMS), PCI of coronary bifurcation lesions was associated with a lower success rate, a higher risk of complications, and a higher restenosis rate compared to non-bifurcation lesions. Although the use of drug-eluting stents (DES) has resulted in reduced restenosis rates and reintervention, coronary bifurcation lesions remain a higher risk setting especially when the bifurcation is proximal. Over the past few years, the subject of many debates has been the identification of optimal BMS or DES strategies for improving angiographic success, reducing the risk of peri-procedural complications, and decreasing the rate of restenosis and reintervention. The vast majority of registry studies (BMS and DES) and randomized studies (DES) have demonstrated that the systematic stenting of both branches is not superior to the strategy of ‘provisional side-branch stenting’. Indications for systematic double stenting as well as the type of strategy to be implemented are still being debated because of heterogeneous studies with respect to lesion type, and of the multiplicity of inadequately described or applied techniques. Adapting the technique to the lesion, as reported by several recent randomized studies, is complicated by the emergence of a new prognostic factor, namely the angle or angles of the bifurcation, which are still very difficult to measure precisely. Various types of ‘dedicated’ stents specifically designed for bifurcation lesions have been included in debates about the adaptation of the technique (or stent) to the type of bifurcation lesion to be treated. Finally, stenting of bifurcation lesions has been shown to be a risk factor of acute, late, or very late stent thrombosis and the influence of the technique or its imperfect implementation, has not been adequately assessed. The purpose of the present chapter is to provide an overview of coronary bifurcation lesions and their current treatment and address the fundamental as well as practical issues inherent in this setting.

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