Sodium nitroprusside injection immediately before balloon inflation during percutaneous coronary intervention

Coronary bifurcations are prone to the development of atherosclerosis. They pose technical difficulties for angioplasty treatment and are a predictor of stent thrombosis and restenosis. Treatment of coronary bifurcations is still subject to debate, especially when the side branch (SB) is large, not easily accessible and narrowed by a long lesion. There is currently no indexed treatment for this type of lesion (Medina classification), as the strategy of provisional SB stenting with drug-eluting stents (DES) has proved to be equally efficient as the dualstent technique. Complex techniques are associated with poor outcome in certain lesion types, such as T-stenting when the angle between the two distal branches is small or the crush and culotte technique in the presence of an open angle. Provisional SB stenting may be used when primary dual stenting is required, with a low risk of failure provided that the following guidelines are implemented: stenting of the main branch through the protected SB with a stent diameter adapted to the distal main branch, immediate optimisation of the proximal stent segment (Finet’s law), guidewire exchange, kissing balloon inflation with non-compliant balloons selected according to the diameter of the distal branches and T-stenting of the SB before final kissing inflation.

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Contemporary approaches to bifurcation stenting

JRSM Cardiovascular Disease ◽

10.1177/2048004021992190 ◽

2021 ◽

Vol 10 ◽

pp. 204800402199219

Author(s):

Claire E Raphael ◽

Peter D O’Kane

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Stent Design ◽

Cardiac Events ◽

Balloon Inflation ◽

Intracoronary Imaging ◽

Percutaneous Coronary ◽

Bifurcation Stenting ◽

Bifurcation Lesions ◽

Provisional Stenting

Bifurcation lesions are common and associated with higher risks of major cardiac events and restenosis after percutaneous coronary intervention (PCI). Treatment requires understanding of lesion characteristics, stent design and therapeutic options. We review the evidence for provisional vs 2-stent techniques. We conclude that provisional stenting is suitable for most bifurcation lesions. We detail situations where a 2-stent technique should be considered and the steps for performing each of the 2-step techniques. We review the importance of lesion preparation, intracoronary imaging, proximal optimization (POT) and kissing balloon inflation

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Use of sodium nitroprusside in retrograde percutaneous coronary intervention for chronic total occlusion

Medicine ◽

10.1097/md.0000000000011498 ◽

2018 ◽

Vol 97 (29) ◽

pp. e11498

Author(s):

He Huang ◽

Yao-Jun Zhang ◽

Yong-Zhen Fan ◽

Xi Wu ◽

Christos V. Bourantas

Keyword(s):

Percutaneous Coronary Intervention ◽

Sodium Nitroprusside ◽

Chronic Total Occlusion ◽

Coronary Intervention ◽

Total Occlusion ◽

Percutaneous Coronary

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Acute Effect of Sodium Nitroprusside on Microvascular Dysfunction in Patients Who Underwent Percutaneous Coronary Intervention for Acute ST-segment Elevation Myocardial Infarction

International Heart Journal ◽

10.1536/ihj.53.337 ◽

2012 ◽

Vol 53 (6) ◽

pp. 337-340 ◽

Cited By ~ 6

Author(s):

Kotaro Morimoto ◽

Shigenori Ito ◽

Kosuke Nakasuka ◽

Satoru Sekimoto ◽

Kazuyuki Miyata ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Sodium Nitroprusside ◽

Microvascular Dysfunction ◽

Coronary Intervention ◽

Acute Effect ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Percutaneous Coronary

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Left Main Trifurcation and Its Percutaneous Treatment

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009872 ◽

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).

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