Provisional stenting or not provisional stenting: seven critical points for bifurcations treatment with a glimpse on left main bifurcation stenting

2021 ◽  
Vol 69 (3) ◽  
Author(s):  
Riccardo IORIO ◽  
Alberto CEREDA ◽  
Augustin VECCHIA ◽  
Enrico ROMAGNOLI ◽  
Paolo CIOFFI ◽  
...  
Keyword(s):  
Critical Points ◽  
Left Main ◽  
Bifurcation Stenting ◽  
Provisional Stenting

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

scholarly journals Long-Term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation Stenting

2018 ◽  
Vol 11 (13) ◽  
pp. 1247-1258 ◽  
Author(s):  
Sungsoo Cho ◽  
Tae Soo Kang ◽  
Jung-Sun Kim ◽  
Sung-Jin Hong ◽  
Dong-Ho Shin ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Left Main ◽  
Coronary Bifurcation ◽  
Bifurcation Stenting

scholarly journals Provisional Stenting for Left Main Bifurcation Disease under IVUS guidance: A Case Series

2021 ◽  
Vol 02 (01) ◽  
pp. 015-018
Author(s):  
Rohit Mody
Keyword(s):  
Imaging Techniques ◽  
Case Series ◽  
Side Branch ◽  
Heart Team ◽  
Left Main ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Procedural Complications ◽  
Bifurcation Lesions ◽  
Provisional Stenting

Around 15-20% of coronary lesions include bifurcation, and among which left main (LM) bifurcation lesions are critical and complex to manage. Though the two-stent strategy is the preferred option for complex LM bifurcation lesions, the provisional strategy should be considered if the side branch is disease-free to avoid peri- and post-procedural complications. Thus, precise anatomical and physiological assessment of LM lesion should be made using intravascular imaging techniques for appropriate decision making. Here, we report three cases of successfully managed LM bifurcation lesions using the provisional stenting technique with the guidance of intravascular ultrasound, fractional flow reserve, and heart team. All three patients were doing well and were ischemia-free on stress echocardiography at three months follow-up.

scholarly journals Intravascular ultrasound is essential for left main coronary artery bifurcation stenting. Authors' reply

2021 ◽  
Vol 79 (1) ◽  
pp. 97-98
Author(s):  
Ahmet Güner ◽  
Ezgi G. Güner ◽  
Macit Kalçık ◽  
Fatih Uzun ◽  
Mehmet Ertürk
Keyword(s):  
Coronary Artery ◽  
Intravascular Ultrasound ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Bifurcation Stenting

scholarly journals Comparative computed flow dynamic analysis of different optimization techniques in left main either provisional or culotte stenting

2017 ◽  
Vol 5 (4) ◽  
pp. 205-212 ◽  
Author(s):  
Gianluca Rigatelli ◽  
Fabio Dell’Avvocata ◽  
Marco Zuin ◽  
Sara Giatti ◽  
Khanh Duong ◽  
...  
Keyword(s):  
Dynamic Analysis ◽  
Surface Area ◽  
Fluid Dynamic ◽  
Optimization Techniques ◽  
The Other ◽  
Left Main ◽  
Flow Dynamic ◽  
Physiological Profile ◽  
Provisional Stenting ◽  
The Impact

Abstract Background and Objectives Provisional and culotte are the most commonly used techniques in left main (LM) stenting. The impact of different post-dilation techniques on fluid dynamic of LM bifurcation has not been yet investigated. The aim of this study is to evaluate, by means of computational fluid dynamic analysis (CFD), the impact of different post-dilation techniques including proximal optimization technique (POT), kissing balloon (KB), POT-Side-POT and POT–KB-POT, 2-steps Kissing (2SK) and Snuggle Kissing balloon (SKB) on flow dynamic profile after LM provisional or culotte stenting. Methods We considered an LM-LCA-LCX bifurcation reconstructed after reviewing 100 consecutive patients (mean age 71.4 ± 9.3 years, 49 males) with LM distal disease. The diameters of LAD and LCX were modelled according to the Finnet’s law as following: LM 4.5 mm, LAD 3.5 mm, LCX 2.75 mm, with bifurcation angle set up at 55°. Xience third-generation stent (Abbot Inc., USA) was reconstructed and virtually implanted in provisional/cross-over and culotte fashion. POT, KB, POT-side-POT, POT-KB-POT, 2SK and SKB were virtually applied and analyzed in terms of the wall shear stress (WSS). Results Analyzing the provisional stenting, the 2SK and KB techniques had a statistically significant lower impact on the WSS at the carina, while POT seemed to obtain a neutral effect. In the wall opposite to the carina, the more physiological profile has been obtained by KB and POT with higher WSS value and smaller surface area of the lower WSS. In culotte stenting, at the carina, POT-KB-POT and 2SK had a very physiological profile; while at the wall opposite to the carina, 2SK and POT–KB-POT decreased significantly the surface area of the lower WSS compared to the other techniques. Conclusion From the fluid dynamic point of view in LM provisional stenting, POT, 2SK and KB showed a similar beneficial impact on the bifurcation rheology, while in LM culotte stenting, POT-KB-POT and 2SK performed slightly better than the other techniques, probably reflecting a better strut apposition.

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