Physiologic Guidance of Provisional Stenting in Coronary Bifurcation Lesions

2010 ◽  
pp. 67-82
Author(s):  
Michael Lim ◽  
Bon-Kwon Koo
Keyword(s):  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Bifurcation Lesions ◽  
Provisional Stenting

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.

Side branch long lesion with main vessel vulnerable plaques by optical coherence tomography predict target-vessel myocardial infarction after provisional stenting in patients with coronary bifurcation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.L Chen
Keyword(s):  
Side Branch ◽  
Lesion Group ◽  
Lesion Length ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Vulnerable Plaques ◽  
Main Vessel ◽  
Bifurcation Lesions ◽  
Provisional Stenting ◽  
One Year

Abstract Background Provisional side branch (SB) stenting is correlated with target-vessel myocardial infarction (TVMI) in patients with coronary bifurcation lesions. However, the underlying mechanisms remain unknown. Objectives We aimed to determine the correlation of SB lesion length with vulnerable plaques using optical coherence tomography (OCT) and TVMI in patients with coronary bifurcation lesions treated by a provisional approach. Methods A total of 405 patients with 405 bifurcation lesions who underwent pre-PCI OCT imaging of both main vessel (MV) and SB was prospectively enrolled. Patients were defined as Long-SB lesion (SB lesion length ≥10 mm) and Short-SB lesion (SB lesion length <10 mm) groups according to quantitative coronary analysis and were also stratified by the presence of vulnerable plaques based on OCT findings. The primary endpoint was the occurrence of TVMI after provisional stenting at one-year follow-up. Results 178 (43.9%) patients had long SB lesions. Vulnerable plaques predominantly localized in the main vessel (MV) and more frequently in the Long-SB lesion group (42.7%) compared to 24.2% in the Short-SB lesion group (p<0.001). At one-year follow-up after provisional stenting, there were 31 (8.1%) TVMIs, with 11.8% in the Long-SB lesion group and 4.4% in the Short-SB lesion group (p=0.009), leading to significant difference in target lesion failure between two groups (15.2% vs. 6.6%, p=0.007). The rate of cardiac death, revascularization, and stent thrombosis was comparable between study groups. By multivariate regression analysis, long SB lesion length (p=0.011), presence of vulnerable plaques in the polygon of confluence (p=0.001), and true coronary bifurcation lesions (p=0.004) were three independent factors of TVMI. Conclusions Long-SB lesion length with MV vulnerable plaques predict increased TVMI after provisional stenting in patients with true coronary bifurcation lesions. Further study is warranted to identify the better stenting techniques for coronary bifurcation lesions with long lesion in the SB Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): NSFC

scholarly journals Randomized Comparison of FFR-Guided and Angiography-Guided Provisional Stenting of True Coronary Bifurcation Lesions

2015 ◽  
Vol 8 (4) ◽  
pp. 536-546 ◽  
Author(s):  
Shao-Liang Chen ◽  
Fei Ye ◽  
Jun-Jie Zhang ◽  
Tian Xu ◽  
Nai-Liang Tian ◽  
...  
Keyword(s):  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Bifurcation Lesions ◽  
Provisional Stenting

Abstract 430: A Novel Tram Stent Method in the Treatment of Coronary Bifurcation Lesions

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Mark Arokiaraj
Keyword(s):  
Side Branch ◽  
Coronary Bifurcation ◽  
Element Analysis ◽  
Coronary Bifurcation Lesions ◽  
Bifurcation Lesion ◽  
Bifurcation Lesions ◽  
Provisional Stenting ◽  
Coronary Bifurcation Lesion ◽  
Von Mises ◽  
Von Mises Stresses

Aims: A novel stent was designed for the treatment of coronary bifurcation lesion, and it was investigated for its performance by finite element analysis. This study was performed in search of a novel method of treatment of bifurcation lesion with provisional stenting. Methods: A coronary bifurcation model was created with the proximal vessel of 3.2 mm diameter, and the distal vessel after the side branch (2.3 mm) was 2.7 mm. A novel stent was designed with connections that had a profile of a tram. Laser cutting and shape setting of the stent was performed, and thereafter it was crimped and deployed over a balloon. The contact pressure, stresses on the arterial wall, stresses on the stent, the maximal principal log strain of the main artery and the side-branch were studied. Also multiple designs were tested in the tram area to suite the standard crimping. The study was performed in Abaqus. A firm lesion model with a stenosis of about 75% was then created with a discrete lesion in the sidebranch and the main vessel. The accompanying figure shows the model used for evaluation. Results: The stresses on the main branch and the distal branch were minimally increased after deployment of this stent. The side branch was preserved, and the stresses on the side branch were lesser; and at the confluence of bifurcation on either side of the side branch origin the Von Mises stresses were marginally increased as shown in figure. However, the stresses at the bifurcation and in the main branch were significantly lesser than the stresses by the existing techniques used in the treatment of bifurcation lesions. Conclusions: There is a potential for a novel Tram-stent method in the treatment of coronary bifurcation lesions.

scholarly journals Treatment effects of systematic two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: rationale and design of a prospective, randomised and multicentre DEFINITION II trial

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020019 ◽  
Author(s):  
Jun-Jie Zhang ◽  
Xiao-Fei Gao ◽  
Ya-Ling Han ◽  
Jing Kan ◽  
Ling Tao ◽  
...  
Keyword(s):  
Informed Consent ◽  
Target Lesion ◽  
Target Vessel ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Stent Restenosis ◽  
Institutional Review ◽  
Bifurcation Lesions ◽  
Provisional Stenting ◽  
Target Lesion Failure

IntroductionProvisional stenting (PS) for simple coronary bifurcation lesions is the mainstay of treatment. A systematic two-stent approach is widely used for complex bifurcation lesions (CBLs). However, a randomised comparison of PS and two-stent techniques for CBLs has never been studied. Accordingly, the present study is designed to elucidate the benefits of two-stent treatment over PS in patients with CBLs.Methods and analysisThis DEFINITION II study is a prospective, multinational, randomised, endpoint-driven trial to compare the benefits of the two-stent technique with PS for CBLs. A total of 660 patients with CBLs will be randomised in a 1:1 fashion to receive either PS or the two-stent technique. The primary endpoint is the rate of 12-month target lesion failure defined as the composite of cardiac death, target vessel myocardial infarction (MI) and clinically driven target lesion revascularisation. The major secondary endpoints include all causes of death, MI, target vessel revascularisation, in-stent restenosis, stroke and each individual component of the primary endpoints. The safety endpoint is the occurrence of definite or probable stent thrombosis.Ethics and disseminationThe study protocol and informed consent have been approved by the Institutional Review Board of Nanjing First Hospital, and accepted by each participating centre. Written informed consent was obtained from all enrolled patients. Findings of the study will be published in a peer-reviewed journal and disseminated at conferences.Trial registration numberNCT02284750; Pre-results.

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