scholarly journals Proximal Side Optimization: A Modification of the Double Kissing Crush Technique

2020 ◽  
Vol 14 ◽  
Author(s):  
Francesco Lavarra
Keyword(s):  
Clinical Outcomes ◽  
Vessel Diameter ◽  
Side Branch ◽  
Proximal Segment ◽  
Balloon Inflation ◽  
Proximal Side ◽  
Treatment Techniques ◽  
Stent Treatment ◽  
Procedural Time ◽  
Crush Technique

Coronary bifurcations with significant lesions >10 mm in the side branch (SB) are likely to require two-stent treatment techniques. To date, double kissing Crush (DK-Crush) stenting has demonstrated higher rates of final kissing balloon inflation and better clinical outcomes. The technical iterations that lead to optimal clinical outcomes have been attributed to the first kissing balloon that repairs the distorted proximal segment and fully expands the orifice of the side stent. One potential caution, which relates to all Crush techniques, is the possibility of the guidewire crossing in an inappropriate position toward the Crushed SB stent. When this occurs, the SB stent may be further Crushed, leaving the ostium uncovered, which potentially negates the benefit of the Crush technique. In our experience, proximal side optimization (PSO) during DK-Crush stenting ensures stent size ‘accommodation’ to the larger vessel diameter in the proximal segment and better strut apposition to the wall, which is particularly important in the ostial segment. The benefits of this additional modification of the established DK-Crush technique are reduction or elimination of the risk of SB stent distortion, increase of the space of optimal wiring, and avoidance of guidewire advancement under the stent struts, even in unfavorable anatomies with extreme angulation. The author describes a step-by-step approach of a proposed PSO technique, which is easy to perform without any additional procedural time or costs.

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.

scholarly journals Comparison of Different Stenting Techniques of Coronary Bifurcation Lesions: A Network Meta-Analysis of 7601 Patients

2021 ◽  
Author(s):  
Orit Barrett ◽  
Lital Hadad ◽  
Ala Abu Dogosh ◽  
Romain Didier ◽  
Hector Garcia-Garcia ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Observational Studies ◽  
Meta Analysis ◽  
Side Branch ◽  
Major Adverse Cardiovascular Events ◽  
Mixed Treatment Comparison ◽  
Treatment Comparison ◽  
Coronary Bifurcation Lesions ◽  
Improved Outcomes ◽  
Crush Technique

IntroductionIntervention on coronary bifurcations lesions (CBL) is challenging. While provisional side branch (PS) stenting is the recommended method in most cases, there is no consensus on the preferred 2-stent technique.Material and methodsWe performed a network meta-analysis including randomized controlled trials (RCT) and observational studies comparing stenting techniques in CBL with reported clinical outcomes. A mixed treatment comparison model generation was performed to compare culotte, T and protrusion (TAP), crush and provisional techniques.ResultsWe included 14 RCT and 14 observational studies comprising 7,601 patients among whom 2,516 were treated with PS, 792 with TAP, 1,493 with culotte and 2,808 with crush. A Bayesian network meta-analysis showed a significant rate reduction of major adverse cardiovascular events (OR=0.73; 95%CI 0.52-0.99) and a trend for reduction in lesion revascularization (OR=0.72; 95%CI 0.48-1.11) and myocardial infarction (OR=0.62; 95%CI 0.3-1.08) with the crush technique, mainly driven by the double kissing (DK) crush, compared with all other stenting techniques. Other clinical outcomes, including mortality and stent thrombosis (ST) did not differ significantly between methods.ConclusionsThe crush technique, and especially DKcrush, is associated with improved outcomes compared to culotte, T and protrusion (TAP) and provisional techniques for CBL treatment. Further research is required to determine the optimal stenting technique for CBL.

Percutaneous Coronary Intervention for Complex Bifurcation Lesions

2010 ◽  
Vol 5 (1) ◽  
pp. 58
Author(s):  
Yves Louvard ◽  
Morice Marie-Claude ◽  
Thomas Hovasse ◽  
Thierry Lefèvre ◽  
◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Side Branch ◽  
Drug Eluting Stents ◽  
Open Angle ◽  
Balloon Inflation ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Bifurcation Lesions ◽  
Stent Diameter

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.

Long-Term Follow-Up of Patients With Isolated Side Branch Coronary Artery Disease

Angiology ◽  
2021 ◽  
pp. 000331972110280
Author(s):  
Sukru Arslan ◽  
Ahmet Yildiz ◽  
Okay Abaci ◽  
Urfan Jafarov ◽  
Servet Batit ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vessel Diameter ◽  
Side Branch ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Artery Disease

The data with respect to stable coronary artery disease (SCAD) are mainly confined to main vessel disease. However, there is a lack of information and long-term outcomes regarding isolated side branch disease. This study aimed to evaluate long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients with isolated side branch coronary artery disease (CAD). A total of 437 patients with isolated side branch SCAD were included. After a median follow-up of 38 months, the overall MACCE and all-cause mortality rates were 14.6% and 5.9%, respectively. Among angiographic features, 68.2% of patients had diagonal artery and 82.2% had ostial lesions. In 28.8% of patients, the vessel diameter was ≥2.75 mm. According to the American College of Cardiology lesion classification, 84.2% of patients had either class B or C lesions. Age, ostial lesions, glycated hemoglobin A1c, and neutrophil levels were independent predictors of MACCE. On the other hand, side branch location, vessel diameter, and lesion complexity did not affect outcomes. Clinical risk factors seem to have a greater impact on MACCE rather than lesion morphology. Therefore, the treatment of clinical risk factors is of paramount importance in these patients.

Endograft Planning without Preoperative Arteriography: A Clinical Feasibility Study

2000 ◽  
Vol 7 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Hugh G. Beebe ◽  
Boonprasit Kritpracha ◽  
Sharon Serres ◽  
John P. Pigott ◽  
Charles I. Price ◽  
...  
Keyword(s):  
3D Model ◽  
Preoperative Evaluation ◽  
Spiral Ct ◽  
Side Branch ◽  
Aortic Aneurysms ◽  
Slice Thickness ◽  
Technical Success Rate ◽  
3 Dimensional ◽  
Procedural Time ◽  
Procedural Success

Purpose: To investigate an alternative method of preprocedural planning for aortic endografting based solely on spiral computed tomography (CT) with 3-dimensional (3D) reconstruction without preoperative arteriography. Methods: From August 1997 to April 1998, 25 consecutive patients with abdominal aortic aneurysms (AAA) were evaluated for endovascular repair by spiral CT scans (2-mm slice thickness) and computerized 3D model construction. No additional imaging for planning was performed. The aortoiliac dimensions, thrombus load, calcification, and vessel tortuosity were measured and evaluated from the 3D model of the aortoiliac segment. These data were used for selecting the patients; the configuration, diameter, and length of the endograft; and the attachment sites for deployment. Results: Primary procedural success was 92% (23/25). All endografts were deployed as planned, and there were no conversions to open repair. Six patients required adjunctive procedures for delivery system access or for iliac aneurysm exclusion, as predicted by the 3D model. Mean procedural time was 91 minutes (range 24 to 273). Two (8%) type II (side branch) endoleaks both sealed spontaneously within 1 month. No graft-related complications or death occurred, for a 30-day technical success rate of 100%. Conclusions: This computerized 3D model provided accurate data for preoperative evaluation of the aortoiliac segment for endovascular AAA repair. Satisfactory technical outcomes for aortic endografts can be achieved without the use of preprocedural invasive imaging.

Abstract TP13: Procedural Time (Groin Puncture to Recanalization) Significantly Predicts Outcomes in Endovascular Treatment: A Pooled Analysis of SWIFT, STAR and SWIFT PRIME Trials

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Jeffrey L Saver ◽  
Mayank Goyal ◽  
David S Liebeskind ◽  
Reza Jahan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Pooled Analysis ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Nihss Score ◽  
Post Procedure ◽  
Procedural Time

Background: Recent single center studies have suggested that “procedural time” independent of “time to procedure” can affect outcomes of acute ischemic stroke patients undergoing endovascular treatment (ET). We performed a pooled analysis from three ET trials to determine the effect of procedural time on angiographic and clinical outcomes. Objective: To determine the relationship between procedural time and clinical outcomes among acute ischemic stroke patients undergoing successful recanalization with ET. Methods: We analyzed data from SWIFT, STAR and SWIFT PRIME trials. Baseline demographic and clinical characteristics, NIHSS score on admission, intracranial hemorrhage rates and mRS at 3 months post procedure were analyzed. TICI scale was used to grade post procedure angiographic recanalization. Procedural time was defined by the time interval between groin puncture and recanalization. We estimated the procedural time after which favorable clinical outcome was unlikely even after recanalization (futile) after age and NIHSS score adjustment. Results: We analyzed 301 patients who underwent ET and had near complete or complete recanalization (TICI 2b or 3). The procedural time (±SD) was significantly shorter in patients who achieved a favorable outcome (mRS 0-2) compared with those who did not achieve favorable outcome (44±25 vs 51±33 minutes, p=0.04). Table 1. In the multivariate analysis (including all baseline characteristics with a p value <0.05 as independent variables), shorter procedural time was a significant predictor of lower odds of unfavorable outcome (OR 0.49, 95% CI 0.28, 0.85, p=0.012). The rates of favorable outcomes were significantly higher when the procedural time was <60 minutes compared with ≥60 minutes (62% vs 45%, p=0.020). Conclusion: Procedural time in patients undergoing mechanical thrombectomy for acute ischemic stroke is an important determinant of favorable outcomes in those with near complete or complete recanalization.

Abstract 1122‐000192: Transient Blood Flow Reversal in The Vertebral Artery As an Embolic Protection Method During Angioplasty/Stenting

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Kiana Moussavi ◽  
Mohammad Moussavi
Keyword(s):  
Blood Flow ◽  
Vertebral Artery ◽  
Carotid Stenosis ◽  
Clinical Outcomes ◽  
Transient Flow ◽  
Balloon Occlusion ◽  
Flow Reversal ◽  
Proximal Segment ◽  
Embolic Protection ◽  
Protection Devices

Introduction : Approximately 20% of all acute ischemic strokes occur in the vertebrobasilar (VB) circulation. Similar to carotid stenosis, symptomatic vertebral artery (VA) stenosis is associated with a high risk of stroke recurrence. The use of embolic protection devices for recanalization in the setting of carotid stenosis in order to improve clinical outcomes is well established. Recent randomised trials have failed to demonstrate improvement of clinical outcomes in VB stroke patients treated with stenting. To our knowledge, these studies did not require the use of embolic protection devices or techniques. This may be due to several factors. Firstly, since the caliber of the stenotic segment of VA is not large enough to safely allow the protection device delivery system to pass through, initial angioplasty without protection is needed. Secondly, the most common segment of VA to become stenotic is its origin, and usually after stenting of this segment, the edge of the stent is protruding into the SCA. When the angle of the VA relative to the SCA is acute, passing the filter capture catheter through this protruded stent is very difficult and dangerous. Methods : We are introducing a VA reversal blood flow technique for prevention of emboli through the VB system in the setting of symptomatic extracranial VA stenosis. In this technique, we used a balloon tip guide catheter in order to transiently occlude the proximal segment of the SCA, causing flow arrest. We then evaluated the presence of blood flow reversal in the VA. Theoretically, this induction of blood flow reversal in the VA can be considered protective because it washes the embolic particles into the distal SCA. Results : Of the 11 cases of VA origin symptomatic stenosis, 4 had desirable VA blood flow reversal after balloon occlusion trial. These patients had successful angioplasty‐stenting of the VA origin using balloon mounted stent without major complications such as ischemic stroke in the posterior circulation territory. Conclusions : This study demonstrates the feasibility of proximal SCA balloon occlusion to cause transient flow reversal in the VA during angioplasty +/‐ stenting of the proximal VA. Future studies are required to determine the effectiveness of this approach in the setting of extracranial VA stenosis due to atherosclerosis, especially at its proximal segment.

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