Treatment of Bifurcation Coronary Artery Disease with the Dedicated Cappella Sideguard® Stent

2011 ◽  
Vol 6 (1) ◽  
pp. 25
Author(s):  
Mamas A Mamas ◽  
Farzin Fath-Ordoubadi ◽  
◽  
Keyword(s):  
Significant Proportion ◽  
Coronary Intervention ◽  
Success Rates ◽  
Low Profile ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions ◽  
Artery Disease ◽  
Procedural Success ◽  
Provisional Stenting ◽  
Event Rates

Bifurcation coronary lesions represent a significant proportion of percutaneous coronary intervention (PCI) procedures and are often technically challenging with both lower procedural success rates and higher adverse event rates than those observed in non-bifurcation lesions. Conventional techniques used to treat bifurcation lesions, including provisional stenting and various two-stent approaches, have several shortcomings. Dedicated bifurcation stents such as the Cappella Sideguard® have been developed to overcome the problems associated with the current available techniques. This review focuses on the utility of the nitinol Sideguard stent in the treatment of bifurcation lesions and discusses the benefits of its trumpet-shaped design, self-expanding properties and low-profile delivery system. Treatment of bifurcation lesions using the Sideguard stent is straightforward and not subject to some of the limitations associated with conventional PCI techniques. Several trials are currently on the way to assess the safety and clinical efficacy of this very promising stent platform.

scholarly journals Overview of Technical and Cost Considerations in Complex Percutaneous Coronary Intervention

2011 ◽  
Vol 9 (1) ◽  
pp. 17 ◽  
Author(s):  
J Raider Estrada ◽  
Jonathan D Paul ◽  
Atman P Shah ◽  
Sandeep Nathan ◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Saphenous Vein Graft ◽  
Significant Proportion ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Chronic Total Occlusions ◽  
Percutaneous Coronary ◽  
Complex Percutaneous Coronary Intervention ◽  
Artery Disease ◽  
Procedural Success

Complex percutaneous coronary intervention (PCI), encompassing an ever-expanding range of challenging lesion sets and patient populations, accounts for a significant proportion of PCI procedures being performed currently. Specific lesion types associated with lower rates of procedural success and higher rates of recurrence or major adverse cardiac events (MACE) include multivessel disease, unprotected left main coronary artery disease, fibrocalcific or undilatable lesions, chronic total occlusions, degenerated saphenous vein graft lesions, thrombotic lesions, and bifurcation disease. Validated tools and technical strategies currently exist to address most procedural scenarios encountered and should be familiar to the complex PCI operator. Anticipated clinical outcomes, projected resource utilization, and cost considerations should all factor into the decisions of when, how, and in whom to intervene.

scholarly journals Contemporary approaches to bifurcation stenting

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

The Impact of Peripheral Artery Disease in Chronic Total Occlusion Percutaneous Coronary Intervention (Insights From PROGRESS-CTO Registry)

Angiology ◽  
2019 ◽  
Vol 71 (3) ◽  
pp. 274-280 ◽  
Author(s):  
Iosif Xenogiannis ◽  
Fotis Gkargkoulas ◽  
Dimitri Karmpaliotis ◽  
Khaldoon Alaswad ◽  
Oleg Krestyaninov ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Peripheral Artery ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
History Of ◽  
Artery Disease ◽  
Procedural Success ◽  
The Impact ◽  
Complex Lesions

The impact of peripheral artery disease (PAD) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We reviewed 3999 CTO PCIs performed in 3914 patients between 2012 and 2018 at 25 centers, 14% of whom had a history of PAD. We compared the clinical and angiographic characteristics and procedural outcomes of patients with versus without history of PAD. Patients with PAD were older (67 ± 9 vs 64 ± 10 years, P < .001) and had a higher prevalence of cardiovascular risk factors. They also had more complex lesions as illustrated by higher Japanese CTO score (2.7 ± 1.2 vs 2.4 ± 1.3, P < .001). In patients with PAD, the final crossing technique was less often antegrade wire escalation (40% vs 51%, P < .001) and more often the retrograde approach (23 vs 20%, P < .001) and antegrade dissection/reentry (20% vs 16%, P < .001). Technical success was similar between the 2 study groups (84% vs 87%, P = .127), but procedural success was lower for patients with PAD (81% vs 85%, P = .015). The incidence of in-hospital major adverse cardiac events was higher among patients with PAD (3% vs 2%, P = .046). In conclusion, patients with PAD undergoing CTO PCI have more comorbidities, more complex lesions, and lower procedural success.

scholarly journals Methods for endovascular treatment of bifurcation lesions of coronary arteries: commonly used techniques

2020 ◽  
Vol 4 (Issue 4) ◽  
Author(s):  
Zairbek Syrgaev ◽  
Abai Turdubaev
Keyword(s):  
Coronary Arteries ◽  
Percutaneous Coronary Interventions ◽  
Success Rates ◽  
Artery Wall ◽  
Effective Technique ◽  
New Techniques ◽  
Treatment Techniques ◽  
Percutaneous Coronary ◽  
Bifurcation Lesions ◽  
Procedural Success

In everyday operating practice, the endovascular surgeon often encounters complex lesions of the coronary arteries, in particular bifurcation lesions. Percutaneous coronary interventions (PCI) is technically difficult in these cases and has always been associated with lower procedural success rates and poorer clinical outcomes than non-bifurcation lesions. The introduction of antiproliferative coated stents into clinical practice significantly improved the results and gave impetus to the development of various treatment techniques. The provisional technique for implanting one stent into the main branch remains the approach of choice for most bifurcation lesions. The choice of the most effective technique for each individual bifurcation is important. The use of a two-stent technique is an acceptable approach for some forms of bifurcation lesions. However, a large amount of metal in the artery wall, as a rule, remains uncovered in the lumen of the vessel during this tactic, which is especially true for the risk of stent thrombosis. New techniques and special bifurcation stents may possibly overcome some limitations of the using two stents and revolutionize the management of PCI of bifurcation lesions of the coronary arteries in the future.

scholarly journals Cardiovascular Disease Continuum

2021 ◽  
Vol 45 (2) ◽  
pp. 151-156
Author(s):  
Blaženka Miškić ◽  
Vesna Ćosić ◽  
Marjana Knežević Praveček ◽  
Domagoj Vučić ◽  
Domagoj Mišković ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Smoking Habit ◽  
Coronary Intervention ◽  
The Body ◽  
Negative Consequences ◽  
Percutaneous Coronary ◽  
The Future ◽  
Healthy Control ◽  
Artery Disease ◽  
Procedural Success

Peripheral artery disease (PAD) is an occlusive disease of extremities, which used to be diagnosed and treated as an isolated disease of the limbs or other parts of the body. Nowadays, the role of PAD transcends the affected limb; instead, the cardiovascular system must be observed as a whole, with PAD having a prognostic role. About 200 million people are affected by PAD worldwide. The prevalence of PAD is likely to increase steadily in the future due to the global aging of the population and the predominantly sedentary lifestyle, along with the expected universal increase in the major PAD risk factors such as smoking habit, diabetes mellitus, dyslipidemia and hypertension. Patients with PAD are at a higher risk of coronary disease and cardiovascular events in comparison to healthy control subjects. The severity of PAD correlates with the development and complications of cardiovascular disease. In PAD patients, percutaneous coronary intervention is more demanding, associated with more comorbidities, more complex lesions, and poorer procedural success as compared with PAD-free patients. For a year now, the use of antiplatelet therapy with acetylsalicylic acid in combination with low (vascular) dose of a direct oral anticoagulant has been recommended for cardiovascular and lower limb protection in PAD patients. In the future, we expect a better understanding of atherosclerotic disease, stronger modulation of systemic inflammation, and the discovery of new therapies. In the meantime, it is necessary to identify the risk population and aggressively treat the classic factors – control of blood pressure, glycemia and lipids with antiplatelet and new anticoagulant therapy. The goal is to protect the limb and preserve the cardiovascular continuum. The negative consequences of COVID- 19 on treatment CVD will be estimated in the following years.

Abstract 13499: Percutaneous Coronary Intervention for Bifurcation Lesions in Patients With Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
RAHUL CHOUDHARY ◽  
Surender Deora ◽  
Atul Kaushik ◽  
Jai B Sharma
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Side Branch ◽  
Stent Group ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Bifurcation Stenting ◽  
Bifurcation Lesions ◽  
Provisional Stenting

Introduction: Percutaneous coronary intervention (PCI) for the treatment of bifurcation lesions in acute coronary syndrome (ACS) setting is a high-risk procedure and is associated with higher periprocedural complications and a lower procedural success rate. Hypothesis: We assessed the hypothesis that PCI for bifurcation stenting in ACS is safe and effective as in non ACS condition. Methods: Out of 986 patients who underwent PCI for ACS, 144 (14.6%) patients having bifurcation lesion were included in study. Provisional stenting was favored whenever feasible (86.8%), elective bifurcation stenting (2 stent strategy) was reserved for significant long segment side branch involvement (13.2%). Occurrence of major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis, was observed during follow up. Results: LAD bifurcation was the most common lesion (49.3%), most common Medina class was 1, 1, 1 (52.1%), 70.8% of the procedures were done transradially, angiographic success rate for main vessel was 97.9% and there was no periprocedural mortality or stroke. There was no significant difference regarding risk factors (age, hypertension, diabetes mellitus, dyslipidemia and smoking history; p > 0.05) between 1 stent and 2-stent groups. Median Syntax score was 14(IQR 10-20) in 1 stent group and 22(IQR 17-25) in 2 stent group. The 2-stent group had higher proportion of left main coronary involvement as compared to 1 stent group (47.4 vs 24.8%). Crush was preferred elective 2-stent strategy as compared to TAP in provisional approach (used in 73.7 and 62.5%). Final kissing balloon inflation was used in 38.4% patients in 1- stent group, while it was utilised in all patients with 2- stent approach. Post procedural side branch diameter stenosis (by QCA) differed significantly between the 2 groups (1-stent vs 2-stent, 34.9 vs 6.4%).The rate of MACE was similar in both groups ( total 7 MACE events; median follow-up of 18 months) but radiation dose and contrast volume utilization were significantly more in 2-stent group. Conclusions: PCI for bifurcation lesions had acceptable success and MACE rate even during ACS settings and whenever feasible, provisional stenting should be preferred approach.

scholarly journals High Bleeding Risk (HBR) patients Percutaneous Coronary Intervention-a Challenge to Deal with

2021 ◽  
Vol 36 (2) ◽  
pp. 133-138
Author(s):  
AHM Waliul Islam ◽  
AQM Reza ◽  
Sham Munwar ◽  
Shahabuddin Talukder
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Mortality And Morbidity ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Procedural Complication ◽  
Artery Disease ◽  
Procedural Success ◽  
High Bleeding Risk

Coronary artery disease (CAD) is one of the leading causes of death in our patient population. In the era of cardiovascular intervention, Percutaneous coronary intervention (PCI) is one of the most important modalities in treating these group of patients. Several CAD risks factors and co-morbid conditions are key responsible factor of procedural success. High bleeding risk (HBR) patients undergoing PCI is not an uncommon phenomenon. Incidences and prevalence of HBR patients with CAD and their management by PCI is not well addressed in our literature. PCI in HBR patients carries potential risk of intracranial hemorrhage (ICH) and lifethreatening bleeding. Therefore, careful pre-PCI assessment of possible risk or threats of post-PCI complications in patients with HBR are deem necessitate to understand. We recommend forming multicenter common consensus and to form a guideline in treating HBR patient by PCI. Thus, to reduce post procedural complication and subsequent improvement of mortality and morbidity in HBR patients undergoing PCI in both ST segment elevated myocardial infarction (STEMI) and as well as non-STEMI. Bangladesh Heart Journal 2021; 36(2): 133-138

scholarly journals Advances in the Post-coronary Artery Bypass Graft Management of Occlusive Coronary Artery Disease

2021 ◽  
Vol 16 ◽  
Author(s):  
Mohammed Shamim Rahman ◽  
Ruben de Winter ◽  
Alex Nap ◽  
Paul Knaapen
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Success Rates ◽  
Total Occlusion ◽  
Adequate Information ◽  
Percutaneous Coronary ◽  
Artery Disease

Revascularisation of chronic total occlusion (CTO) represents one of the most challenging aspects of percutaneous coronary intervention, but advances in equipment and an understanding of CTO revascularisation techniques have resulted in considerable improvements in success rates. In patients with prior coronary artery bypass grafting (CABG) surgery, additional challenges are encountered. This article specifically explores these challenges, as well as antegrade methods of CTO crossing. Techniques, equipment that can be used and reference texts are highlighted with the aim of providing potential CTO operators adequate information to tackle additional complexities likely to be encountered in this cohort of patients. This review forms part of a wider series where additional aspects of patients with prior CABG should be factored into decisions and methods of revascularisation.

scholarly journals Procedural Results and In-Hospital Adverse Outcomes Following Multivessel Percutaneous Coronary Intervention (PCI)

1970 ◽  
Vol 5 (2) ◽  
pp. 66-70
Author(s):  
Md Harisul Hoque ◽  
Sufia Rahman ◽  
Md Abu Siddique ◽  
Syed Ali Ahsan ◽  
CM Ahmed ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Single Vessel ◽  
Increased Risk ◽  
Vessel Stenosis ◽  
Percutaneous Coronary ◽  
The Difference ◽  
Artery Disease ◽  
Procedural Success

Several Studies have reported specific factors associated with increased risk of adverse outcome following balloon angioplasty. These factors include advanced age, female Sex, unstable angina, congestive heart failure, diabetes and multivessel Coronary artery disease. By this time, Studies have been shown the remarkable procedural success & minimum adverse outcomes following multivessel stenting. This comparative observational study shows no death, procedural MI, tamponade, cerebrovascular accident, heart failure or cardiogenic shock, vascular access site complications like bleeding, A-V fistula in any group (single vessel stenting vs multivessel stenting). However, minor adverse events occurred at an overall rate of 6% in single vessel stenosis (SVS) group & 12% in multivessel stenosis (MVS) group. Procedural results were also similar in both groups. Angiographic success of 100% in the SVS group & 98% in the MVS group noted. The difference in the outcomes were between the two groups was not significant. Key Words: Adverse Outcomes; Multivessel Coronary Stenting; Procedural Results DOI: 10.3329/uhj.v5i2.4557 University Heart Journal Vol.5(2) July 2009 pp.66-70

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