Abstract 3346: Percutaneous Treatment Of Unprotected Left Main Coronary Stenoses With Paclitaxel-eluting Stents. Mid-term Results Of A French Prospective Multicenter Study (friend Register)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Didier Carrié ◽  
Hélène Eltchaninoff ◽  
Thierry Lefèvre ◽  
Marc Silvestri ◽  
Gérard Levy ◽  
...  
Keyword(s):  
Percutaneous Treatment ◽  
Target Lesion ◽  
Side Branch ◽  
Left Main ◽  
Balloon Inflation ◽  
Global Rate ◽  
Stent Length ◽  
Mid Term Results ◽  
Q Wave

Purpose : We assessed early and mid-term results of patients (pts) treated for ULMCA disease in the FRIEND registry. Methods: After ethical committee approval and informed consent, all consecutive pts with unprotected left main stenoses treated with Taxus stents were included in a multicenter prospective study from 23 centers. Major adverse cardiacl events (MACCE) : death, myocardial infarction, stroke, target lesion (TLR), target vessel revascularisation (TVR), acute, sub-acute and late thrombosis were adjudicated at 1and 6 months by an independent committee. Immediate and 9-month angiographic results were assessed by a central core lab. For the distal lesion of ULMCA, a strategy of main branch stenting with provisional T-stenting of the side branch followed by kissing balloon inflation was strongly recommanded. Results : From December 2005 to July 2006, 155 pts were included, mean age 68 ± 11 years, 83 % male, 31 % unstable angina, 25% diabetics, 46 % 3-vessel disease. The mean Euroscore was 4.2 ± 2.8 (estimated in-hospital mortality rate after surgery 4.1%). The LM reference diameter was 3.6 ± 0.5mm. LM lesion was ostial-proximal in 28 %,mid shaft 18 % and distal 66%. In this group, 72 % were located at the bifurcation including LAD, LCX or both ostia affected. All patients were successfully treated on the LM (stent length 15.7 ± 5.2 mm) and a final kissing balloon inflation was performed in 90%. Apart from the LM stenosis, a total of 1.2 ± 0.8 lesions were treated during the hospitalisation (total stent length 47 ± 16mm). In-hospital MACCE rate was 4.5 % : death in 2.6% (3 acute stent thrombosis at day 2, 3, 5 and 1 before PCI) ; 2 Pts had asymptomatic non-Q-wave MI,1 pt Q-wave MI and 1CABG. At 9-month follow-up (122 pts) there was one extra-cardiac death, no cardiac failure and 3 pts (2.5 %) had recurrence of symptoms. The global rate of event-free survival was 93.5 % with a very low angiographic restenosis rate of 3 %. Conclusion: LM PCI using the TAXUS stent is feasible and safe. Preliminary results showed favourable 9-month follow-up. Stenting deserves to be considered a safe and effective alternative to CABG in institutions performing large numbers of PCIs. Adjudicated clinical and angiographic long-term (9-month) data are warranted and will be available for presentation.

Percutaneous Intervention in Diffuse Coronary Disease: Overlapping Versus Single Very Long Stent Technique. Results From the OVERLONG Registry

Angiology ◽  
2021 ◽  
pp. 000331972110146
Author(s):  
Martín Negreira-Caamaño ◽  
José Abellán-Huerta ◽  
Fernando Lozano-Ruiz-Poveda ◽  
Ignacio Sánchez-Pérez ◽  
María T. López-Lluva ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Percutaneous Treatment ◽  
Cardiovascular Death ◽  
Target Lesion ◽  
Major Adverse Cardiovascular Events ◽  
Diffuse Coronary Artery Disease ◽  
Contrast Volume ◽  
Stent Length ◽  
Artery Disease

Background: Both stent length and stent overlap are associated with worse outcomes in the percutaneous treatment of diffuse coronary artery disease (dCAD). However, evidence comparing these issues is scarce. We aimed to compare the results between the use of single very long stent (VLS) and ≥2 overlapping stents (OS) in the treatment of dCAD. Methods: Seven hundred twenty-four consecutive lesions were included: 275 treated with a single VLS (≥40 mm) and 449 with ≥2 OS. Procedural characteristics were assessed, and survival analysis was performed to compare the incidence of major adverse cardiovascular events (MACE; composite of cardiovascular death, nonfatal myocardial infarction, target lesion revascularization [TLR], or stent thrombosis) during a median follow-up of 31 months. Results: Procedures with VLS required less contrast volume (268 ± 122 vs 302 ± 113 cm3; P < .01), fluoroscopy time (16 ± 8 vs 21 ± 16 minutes; P < .01), and procedure duration (37 ± 18 vs 47 ± 27 minutes; P < .01) than the OS procedures. The VLS group showed lower incidence of MACE (4.4% vs 10.7%; P < .01), driven mainly by lower TLR rate (1.1% vs 4.7%; P < .01). The use of OS was an independent predictor of MACE. Conclusions: In this study, the use of VLS for the treatment of dCAD was associated with better outcomes compared to OS.

scholarly journals Precise Percutaneous Coronary Intervention of LAD Ostial Stenosis by Using Afzal’s Technique: An easy but Innovative Procedure

2016 ◽  
Vol 9 (1) ◽  
pp. 49-54
Author(s):  
Afzalur Rahman ◽  
Farhana Ahmed ◽  
Mohammad Arifur Rahman ◽  
Syed Nasir Uddin ◽  
Md Zillur Rahman ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
De Novo ◽  
Coronary Revascularization ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Special Technique ◽  
Stent Deployment ◽  
Percutaneous Coronary ◽  
Stent Length

Background: The ostial left anterior descending coronary artery (LAD) lesion is an important target for coronary revascularization because its location subtends a large territory of myocardium. Ostial lesions have a reputation of being fibrotic, calcified, and relatively rigid. Greater degraees of rigidity and recoil resulted in lower acute gain and higher rates of target lesion revascularization (TLR) following percutaneous coronary intervention (PCI). In addition, procedural complications such as dissections, vessel closure and myocardial infarction were more frequent. Aim of the study was to evaluate a simple but innovative technique to deal with significant LAD ostial lesion.Methods: This prospective study was conducted between January 2010 and February 2013. Patients with significant angiographic de novo ostial LAD artery stenoses were identified and screened for study eligibility. An ostial stenosis was defined as an angiographic narrowing of e” 70% located within 3 mm of the vessel origin. Study included all consecutive patients with ostial lesions who underwent elective PCI and stent deployment. The study population consisted of 36 patients.Results: Among 36 patients 27 (75%) were male. mean age was 55.75 ± 8.07 years. 21 (58.3%) had diabetes, 15 (41.7%) hypertension, 21 (58.3%) hypercholesterolemia, 24 (66.66%) were smoker and 18 (50%) had F/H of CAD. Among them 6 (16.7%) had STEMI, 9 (25%) had NSTEMI, 12 (33.3%) had UA and 9 (25%) CSA. CAG showed 15 (41.7%) SVD, 15 (41.7%) DVD and 6 (16.7%) were TVD. LAD ostial stenosis were 83.16 ± 10.14%. Considering procedural characteristics, DES were 33 (91.7%) and BMS were 3 (8.3%). DES polymers were Evarolimus 15 (41.7%), Zotarolimus 12 (33.3%) and Biolimus 6 (16.7%). Mean stent length were 21.75 ± 8.07 mm. Mean stent diameter were 2.83 ± 0.28 mm. Minimum follow up time was 9 months and maximum follow up time was 44 months. There were no MACE but Angina (CCS II) were 2 (5.55%) and LVF (NYHA II) were 1(2.77%).Conclusion: Precise placement of LAD ostial stent is always challenging. Several technique applied but results not always satisfactory. Our strategies were precise location of stent implantation at ostium by adopting special technique of simultaneous balloon placement from distal LM to proximal LCX preventing unwanted stent movement during its placement and also properly guiding us for precise stent placement at the ostium. Parked balloon from distal LM to LCX will also be helpful for quick measure for any plaque shifting into LCX.Cardiovasc. j. 2016; 9(1): 49-54

scholarly journals One-year clinical and angiographic outcomes after percutaneous coronary interventions in ostial versus distal left main lesions – a retrospective single center study

2019 ◽  
Author(s):  
Tilman Stephan ◽  
Nadine Goldberger ◽  
Mirjam Keßler ◽  
Dominik Felbel ◽  
Manuel Rattka ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Primary Outcome Measure ◽  
Left Main ◽  
Cardiac Events ◽  
Percutaneous Coronary

Abstract Background: Percutaneous coronary intervention (PCI) of left main coronary artery disease (LMD) is associated with appropriate clinical and angiographic outcomes, resulting in a class I recommendation in patients with less complex coronary anatomy. Due to higher SYNTAX scores and worse clinical outcomes, PCI in distal LMD is accomplished with a lower strength of recommendations for revascularization compared to ostial LM lesions. We compare angiographic and clinical outcomes of ostial/midshaft lesions versus distal lesion in LMD after PCI. Methods: This retrospective study included 176 patients with LMD undergoing PCI with drug-eluting stents. The study population was divided into 34 patients with ostial/midshaft LMD and 142 patients with distal LMD. Patients were routinely scheduled for 9 months of angiographic and 12 months of clinical follow-up. Quantitative coronary analysis (QCA) was performed for all lesions, using an 11-segment model. Primary outcome was MACE (major adverse cardiac events) defined as a composite of cardiac death, myocardial infarction and target lesion revascularization (TLR). Results: The primary outcome measure was comparable in both cohorts after 12 months follow-up (20.6% in ostial/midshaft LMD vs. 17.6% in distal LMD, P=0.71). As expected, TLR rates were increased in distal LM lesions compared to ostial LM lesions, but without reaching statistical significance (14.1% vs. 5.9%, P=0.15). Late lumen loss (LLL) in ostial/midshaft LMD was 0.42±0.33mm. In distal LM lesions value for LLL in the main vessel was 0.42±0.97 mm, with the highest values observed in segments adjacent to the bifurcation (0.37±1.13mm and 0.37±0.73 mm). On cox proportional regression analysis LLL in a bifurcation segment (P=0.03, HR 1.68 [1.1-2.7]) and diabetes mellitus (P=0.046, HR 2.77 [1.0-7.5] were independent correlates for occurrence of MACE. Conclusion: PCI of distal LM lesions result in comparable angiographic and clinical outcomes compared to ostial LM lesions. Highest rates for binary restenosis were observed in segments nearest to the bifurcation.

scholarly journals Left Main Trifurcation and Its Percutaneous Treatment

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
Mila Kovacevic ◽  
Francesco Burzotta ◽  
Sameh Elharty ◽  
George Besis ◽  
Cristina Aurigemma ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Surgery ◽  
Anatomic Variation ◽  
Coronary Intervention ◽  
Percutaneous Treatment ◽  
Left Main ◽  
Balloon Inflation ◽  
Percutaneous Coronary ◽  
Wide Variability ◽  
Branch Size

In humans, the most common anatomic variation of the left main (LM) stem is represented by its distal division in 3 branches (LM trifurcation) instead of 2. LM trifurcation disease accounts for ≈10% to 15% of all LM diseases and is often managed by cardiac surgery. Over the last decades, due to the improvement of interventional material and techniques, percutaneous coronary intervention started gaining acceptance to treat patients with LM disease including those with trifurcated anatomy. Yet, LM trifurcation stenosis with its intrinsic anatomic complexity (3 branches, at least 4 angles, wide variability in branch size and disease) is recognized as a challenging lesion subset for percutaneous coronary intervention. In this review, we summarize available data about LM trifurcation anatomy, its influence on percutaneous coronary intervention feasibility, and the evidence collected regarding the different technical options (including trissing balloon inflation).

Sex-differences in outcomes after PCI or CABG for left main disease: from the DELTA registries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Moroni ◽  
A Beneduce ◽  
G Giustino ◽  
I Breite ◽  
S.J Park ◽  
...  
Keyword(s):  
Lower Risk ◽  
Significant Interaction ◽  
Total Population ◽  
Left Main Coronary Artery ◽  
Coronary Revascularization ◽  
Target Lesion ◽  
Left Main ◽  
Left Main Disease ◽  
Risk Of Death

Abstract Background Women have worse outcomes than men after PCI, with some studies suggesting a lower mortality of CABG vs PCI in females. Purpose To assess the outcomes of CABG and PCI according to sex in a large registry population of patients with unprotected left main coronary artery (ULMCA) disease. Methods The DELTA and DELTA 2 registries are two multicentric, prospective registries evaluating the outcomes of subjects undergoing coronary revascularization for ULMCA disease. Results Total population was 6253 patients, 27% women. Table 1 shows baseline clinical characteristics. Median follow up was of 880 days. Women undergoing CABG had lower incidence of death, myocardial infarction (MI) or cerebrovascular accidentc (CVA) (HR 0.53, 95% CI 0.35–0.79) and a lower risk of death (HR 0.40, 95% CI 0.24–0.67). No significant differences were observed in men (Figure 1A). SIgnificant interaction was observed between sex and revascularization strategy for both outcomes (p&lt;0.01-Figure 1B). CABG was associated with lower risk of target-vessel and target-lesion revascularization consistently inwomen and men (pint=0.49 and pint=0.89, respectively–Figure 1B). Conclusions In women undergoing coronary revascularization for ULMCA disease, CABG is associated to lower risk of death, MI or CVA. Further dedicated studies are needed to determine the optimal revascularization strategy in women with ULMCA disease. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals A Short Term Clinical Outcome of Provisional versus Routine Kissing Balloon Technique after Main Vessel Crossover Stenting for Coronary Bifurcation Lesions

2020 ◽  
pp. 83-93
Author(s):  
Mohamed Ahmed Khalil ◽  
Fatehia Ahmed Elsheshtawy ◽  
Medhat Mohamed Ashmawy ◽  
Samiah Mahmoud Sharaf El-Din ◽  
Ayman Mohamed Elsaeed
Keyword(s):  
Clinical Outcome ◽  
Side Branch ◽  
Balloon Inflation ◽  
Short Term ◽  
Coronary Bifurcation Lesions ◽  
Main Vessel ◽  
Kissing Balloon Technique ◽  
Balloon Technique ◽  
Bifurcation Lesions

Background: Kissing Balloon Inflation (KBI) technique was the first technique for percutaneous intervention in bifurcation lesions. It's the standard strategy in the two-stent procedure. Its benefit in one-stent approach remains uncertain. Several trials comparing KBI strategy with the No-KBI strategy in one-stent technique did not show any advantages in the clinical outcome. Clinical outcome and the follow up of ischemic symptoms is a useful method to compare the effectiveness of both strategies. Aims: To study the short-term clinical outcome (3and 6 months) of provisional versus routine kissing‑balloon technique after main vessel stenting for coronary bifurcation lesions. Patients and Methods: The study included sixty consecutive patients. They were randomized to receive different side branch (SB) intervention strategies: group I (provisional final kissing balloon inflation group - PFKBI) (FKBI only when SB Flow less than TIMI 3) and group II (routine final kissing balloon inflation group – RFKBI). Results: 1- Dissection of side branch and conversion to two stent strategy was significantly higher in PFKBI group (14,3%) than in RFKBI group (0) 2-The amount of dye, total procedure time and time of admission was significantly higher in RFKBI group. 3-Chest pain immediately after the procedure was significantly higher in PFKBI group while at 3 and 6 months follow up no significant difference between both groups was noticed. 4- MACE, target lesion revascularization (TLR) and stent thrombosis were similar between both groups at 3 and 6 months. Conclusions: Main vessel stenting with and without final kissing balloon dilatation was associated with favorable and similar 3 and 6-month clinical outcomes.

scholarly journals Effect of Drug-Coated Balloon in Side Branch Protection for de novo Coronary Bifurcation Lesions: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Yawei Zheng ◽  
Jie Li ◽  
Lingzhun Wang ◽  
Peng Yu ◽  
Haibo Shi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
De Novo ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Target Lesion ◽  
Side Branch ◽  
Significant Difference ◽  
Drug Coated Balloon

Background: At present, there are a variety of treatment strategies for percutaneous coronary intervention. The role of drug-coated balloon (DCB) in the treatment of side branch for de novo coronary bifurcated lesions (CBL) is unclear.Objective: To examine the effect of DCB in side branch protection for de novo CBL.Methods: Electronic databases, including Pubmed, Embase, the Web of science, Cochrance library, CNKI, CBM, WanFang Data and VIP were searched for studies that compared DCB with non-drug-coated balloon (NDCB) in side branch protection for de novo CBL from inception through July 7th, 2021. The primary outcome was target lesion revascularization (TLR). Secondary clinical outcomes included myocardial infarction (MI), cardiac death (CD). The angiographic outcomes included side branch late lumen loss (LLL), minimum lumen diameter (MLD), diameter stenosis (DS) and binary restenosis (BR). The target lesion failure (TLF) was also analyzed.Results: A total of 10 studies, including 5 randomized controlled trials and 5 non-randomized observational studies, with 934 patients were included. Meta-analysis results of angiographic outcomes suggested that DCB group had the less LLL, DS and BR and the higher MLD compared with NDCB group at follow-up (P &lt; 0.05). Meta-analysis results of clinical outcomes suggested that the significant difference in the TLR, MI and CD between DCB group and NDCB group has not been found yet (P &gt; 0.05). However, the MACE of DCB group was significantly less than that of NDCB group at 9-month follow-up [OR = 0.21, 95%CI (0.05, 0.84), P = 0.03] and 12-month follow-up [OR = 0.45, 95%CI (0.22, 0.90), P = 0.02]. In addition, there was no significant difference in TLF between DCB group and NDCB group (P &gt; 0.05).Conclusions: DCB had great effect in side branch protection for de novo CBL at short and medium-term follow-up with no reduction in the procedural success rate.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=267426, PROSPERO [Identifier: CRD42021267426].

Abstract 3350: Long-Term Outcomes After Drug-Eluting Stenting of Bifurcation Lesions With the Simultaneous Kissing Stents (SKS) Technique

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Samin K Sharma ◽  
Madhu Prattipati ◽  
Angelica M Mares ◽  
Oana C Ivan ◽  
Vatsal Inamdar ◽  
...  
Keyword(s):  
Stent Thrombosis ◽  
De Novo ◽  
Side Branch ◽  
Left Main ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Drug Eluting ◽  
Bifurcation Lesions

Percutaneous coronary interventions (PCI) of bifurcation lesions using simultaneous kissing stents (SKS) technique have shown to have good short-term and mid-term results. Limited data are available regarding long-term outcome with this strategy. Methods: We analyzed the long-term outcome of 300 consecutive patients treated with drug-eluting stenting using SKS technique for 305 de novo bifurcation lesions. Cypher stents were used in 265 lesions and Taxus stents were used in 40 lesions, from May 2003 to September 2006 at Mount Sinai Hospital. Clinical follow-up was obtained in 98.6%. All pts were given Aspirin and Plavix 75 mg daily for one year and GP IIb/IIIa inhibitors were used in 72% of cases. Results: Overall procedural success was 99% for main vessel (MV) and 98% for side-branch (SB), with one case of intra-procedural stent thrombosis of left main bifurcation. 30-day MACE (MI, death, repeat target vascularization or stent thrombosis) occurred in 5% of cases. Long-term follow-up results at a mean of 14 ± 5 months are shown in the Table . Overall incidence of stent thrombosis was 1.7% (1.5% for Cypher vs. 2.5% for Taxus). Multivariate predictors of TVR were left main (LM) intervention (odds ratio [OR] 4.97; 95% confidence interval [CI] 2.00 to 12.37, p = 0.01) and diabetes mellitus (OR 4.21; 95% CI 1.15 to 18.56, p = 0.04) and of follow-up MACE were LM intervention (OR 3.79; 95% CI 1.76 to 8.14, p = 0.01) and acute MI (OR 3.24; 95% CI 0.95 to 15.32, p = 0.02). Conclusions: The SKS technique for bifurcation lesions using Cypher or Taxus DES is associated with long-term favorable outcomes in this complex, high-risk PCI group. Delayed stent thrombosis with dual antiplatelet therapy remains within acceptable limits. Further work is needed to lower the event rates in some specific subgroups such as LM lesions and AMI settings (perhaps by IVUS guidance and Plavix 75 mg twice a day).

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