scholarly journals Double kissing inflation outside the stent secures the patency of small side branch without rewiring

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hongbo Yang ◽  
Yanan Song ◽  
Jiatian Cao ◽  
Xueyi Weng ◽  
Feng Zhang ◽  
...  
Keyword(s):  
Guide Wire ◽  
Optimization Technique ◽  
Side Branch ◽  
Lumen Diameter ◽  
Modified Technique ◽  
Minimal Lumen Diameter ◽  
Bifurcation Lesions ◽  
The Mean ◽  
Procedural Success ◽  
Small Side

Abstract Background The jailed balloon technique is widely used for coronary bifurcation lesions, but a residual risk of SB occlusion remains, necessitating SB rewiring and further interventions, including balloon inflation or stenting, which may result in failure and SB loss. This study introduced a novel modified technique of small side branch (SB) protection, namely, double kissing inflation outside the stent (DKo) technique, for coronary bifurcations without the need for SB rewiring. Methods We performed the DKo technique in consecutive patients in our center from 1/2019 to 12/2019. The procedure was as follows. We inserted a guide wire into both branches followed by proper preparation. The SB balloon was simultaneously inflated with main vessel (MV) stenting. The SB balloon remained in situ until it was kissing inflated with postdilation of the bifurcation core, which is different from traditional strategies. The proximal optimization technique was performed with a short noncompliant balloon strictly not exceeding the bifurcation. Rates of SB loss and in-hospital outcomes were evaluated. Results The technique was successfully performed in all 117 enrolled patients without any rewiring or SB loss. The mean lesion lengths of the MV and SB were 38.3 ± 19.9 mm and 11.7 ± 7.1 mm, respectively. On average, 1.5 ± 0.6 stents were used per patient, while the mean pressure of the SB balloon was 7.4 ± 3.1 atm. DKo achieved excellent procedural success in the proximal and distal MVs: increased minimal lumen diameter (0.64 ± 0.58 mm to 3.05 ± 0.38 mm, p < 0.001; 0.57 ± 0.63 mm to 2.67 ± 0.35 mm, p < 0.001) and low residual stenosis (11.4 ± 3.4%; 7.2 ± 4.6%). DKo secured the patency of the SB without any rewiring and improved the SB stenosis with minimal lumen diameter (0.59 ± 0.48 mm to 1.20 ± 0.42 mm, p < 0.001) and stenosis (71.9 ± 19.4% to 42.2 ± 14.0%, p < 0.001). No MACE was noted in the hospital. Conclusions DKo for bifurcation lesions was shown to be acceptable with high procedural success and excellent SB protection.

scholarly journals OCT-guided Percutaneous Coronary Intervention in Bifurcation Lesions

2018 ◽  
Vol 14 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Luca Longobardo ◽  
Alessio Mattesini ◽  
Serafina Valente ◽  
Carlo Di Mario ◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Guide Wire ◽  
Coronary Intervention ◽  
Side Branch ◽  
Wire Crossing ◽  
Percutaneous Coronary ◽  
Bifurcation Stent ◽  
Bifurcation Stenting ◽  
Bifurcation Lesions ◽  
Procedural Success

Coronary artery bifurcation lesions remain challenging despite significant advancements in stent technology and development of specific bifurcation stenting approaches. Optical coherence tomography (OCT) is the intracoronary imaging technique with the highest resolution and can generate automatically contoured lumen areas across the variable geometry of bifurcation lesions. Knowledge of plaque severity and composition facilitates planning of the best strategy for percutaneous coronary intervention (PCI) and stenting. In particular, the provisional stent strategy preferred in this context can be modified when there is high risk of side-branch compromise at the ostium after main vessel stenting. OCT is unique because it allows the identification of the site of guide wire crossing, an important determinant of the final result. OCT can also be used to assess the procedural success of new dedicated bifurcation stent technologies and for the evaluation at follow-up of potential predictors of stent thrombosis, including stent malapposition, stent under-expansion and stent-edge dissection. Finally, the development of 3D OCT allows a better evaluation of coronary anatomy – particularly of side branch ostium that is difficult to visualise by 2D OCT – further improving the value of this technique in guiding PCI in these patients.

Bifurcation Stenting – Have We Made Progress in the Last 10 Years?

2009 ◽  
Vol 4 (1) ◽  
pp. 64
Author(s):  
Joanna Wykrzykowska ◽  
Willem J van der Giessen ◽  
◽  
Keyword(s):  
Side Branch ◽  
Cardiac Events ◽  
Fractional Flow ◽  
Branch Coverage ◽  
3D Angiography ◽  
Flow Reserve ◽  
Bifurcation Stent ◽  
Bifurcation Stenting ◽  
Bifurcation Lesions ◽  
Procedural Success

Bifurcation stenting is one of the unsolved challenges for interventional cardiologists. Patients with bifurcation lesions tend to have more advanced disease and multiple co-morbidities. Over the last 10 years we have come to understand the importance and made progress in bifurcation imaging for planning the procedure and for assessment of procedural success, from 3D angiography and multislice computed tomography (MSCT) to fractional flow reserve (FFR) and optical coherence tomography (OCT). Recent clinical trials have shown improved results with selective use of a two-stent strategy and drug-eluting stents. Rates of major adverse cardiac events (MACE) and peri-procedural myocardial infarction (MI) for bifurcation lesions still remain high. Many challenges such as side-branch access, wire-trapping, incomplete side-branch coverage and restenosis still remain. No single dedicated bifurcation stent design thus far has been able to solve them all. More long-term, prospective, efficacious studies of these novel stent designs with concomitant imaging are needed for the field to progress.

Proximal side optimization in crush stenting. A step-by-step technical approach

2020 ◽  
Vol 30 (3) ◽  
pp. 382-388
Author(s):  
Francesco Lavarra ◽  
Davide Davide Sala ◽  
Vasile Sirbu
Keyword(s):  
Guide Wire ◽  
Standard Of Care ◽  
Vessel Diameter ◽  
Side Branch ◽  
Lesion Length ◽  
Technical Approach ◽  
Balloon Inflation ◽  
Technical Consideration ◽  
The Core ◽  
Bifurcation Lesions

In simple bifurcation lesions provisional single stent strategy remains the standard of care. While complex bifurcations, defined based on the 1) Side Branch (SB) lesion length of > 10 mm and 2) SB ostial diameter stenosis of >70% are approached with a 2-DES strategy upfront. The Crush techniques which are composed of the classic Crush, mini-Crush and double kissing Crush (DK-Crush) share the core principle of protruding the SB DES within the Main Branch (MB) to minimize the risk of ostial SB restenosis, which remains the most prevalent etiology of stent failure during 2-stent approach in bifurcations. Proximal SB optimization (PSO) is an additional technical consideration to further optimize the protruding SB struts enabling 1) optimal SB strut accommodation to the larger MB vessel diameter, 2) strut enlargement that will further facilitate effortless rewiring for kissing balloon inflation (KBI) avoiding unfavorable guide wire advancement in the peri-ostial SB area.

Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 146
Author(s):  
Osman Tansel Darcin ◽  
Mehmet Kalender ◽  
Ayse Gul Kunt ◽  
Okay Guven Karaca ◽  
Ata Niyazi Ecevit ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Therapeutic Option ◽  
Complete Recovery ◽  
Aortic Aneurysms ◽  
Thoracoabdominal Aorta ◽  
Mortality And Morbidity ◽  
Early Results ◽  
The Mean ◽  
Procedural Success

<p><b>Background:</b> Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.</p><p><b>Methods:</b> From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.</p><p><b>Results:</b> All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.</p><p><b>Conclusion:</b> Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.</p>

Real-life Bifurcation – Challenges and Potential Complications

2011 ◽  
Vol 7 (4) ◽  
pp. 283
Author(s):  
Inga Narbute ◽  
Sanda Jegere ◽  
Indulis Kumsars ◽  
Dace Juhnevica ◽  
Agnese Knipse ◽  
...  
Keyword(s):  
Stent Thrombosis ◽  
Real Life ◽  
Coronary Intervention ◽  
Side Branch ◽  
The Body ◽  
Chronic Total Occlusions ◽  
Vein Grafts ◽  
Procedural Complications ◽  
Drug Eluting ◽  
Bifurcation Lesions

Together with calcified lesions, saphenous vein grafts, chronic total occlusions and unprotected left main lesions, bifurcation lesions are complex lesions that remain among the outstanding challenges of treatment with percutaneous coronary intervention. Bifurcation lesions are associated with increased rates of procedural complications, restenosis and adverse events than lesions in the body of the vessel. The introduction of drug-eluting stents for the treatment of bifurcation lesions has dramatically decreased restenosis rates, especially in patients suffering from diabetes. However, abrupt side branch closure, side branch ostial restenosis and stent thrombosis remain areas where further improvement is needed. Although a provisional T-stent strategy is most often used when side branch stenting is required, there are true bifurcation lesions where the selected use of more complex bifurcation approaches (such as the crush technique, T-stenting or the culotte technique) seem appropriate, particularly when the main branch and side branch are larger vessels with more diffuse side branch disease. The major challenge with any technique is to ensure that the side branch is protected and there is a satisfactory final result. Many technical questions rise in trying to ensure this outcome and lower the risk of intra- and post-procedural complications such as side branch closure and restenosis, stent thrombosis, dissection and fracture of a jailed wire: how can difficult side branch access be solved? How can unfavourable side branch anatomy be re-wired after main vessel stent placement? How can fracture of a jailed wire be avoided? Is side-strut dilation beneficial?

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.

Provisional and Complex Techniques for Bifurcation Treatment – Trading Apposition for Scaffolding?

2012 ◽  
Vol 7 (1) ◽  
pp. 44
Author(s):  
Nicolas Foin ◽  
Eduardo Alegria-Barrero ◽  
Ryo Torii ◽  
Pak H Chan ◽  
Ajay K Jain ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
New Technology ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Side Branch ◽  
Simultaneous Increase ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
Stent Coverage ◽  
Bifurcation Lesions

Provisional T-stenting with stenting of the main branch and optional side branch (SB) stenting in the case of significant SB occlusion with thrombolysis in myocardial infarction (TIMI) flow <3 is the strategy chosen nowadays by most interventionalists for treating simple bifurcation lesions. Percutaneous coronary intervention (PCI) of complex true bifurcation lesions remains, however, the subject of debate: treatment of complex bifurcation lesions requires more time than treatment of simple bifurcations and can lead to significantly higher rates of restenosis, target lesion revascularisation and myocardial infarction. Current bifurcation techniques often fail to ensure continuous stent coverage of the SB ostium and of the two bifurcation branches without a simultaneous increase in the rate of malapposed struts. Stent struts left unapposed in the lumen disturb blood flow and are increasingly recognised as increasing the risk of stent thrombosis and focal in-stent restenosis, limiting the success of stent procedures in these lesions. New technology and dedicated designs may, in the near future, overcome such limitations of conventional two-stent bifurcation strategies.

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