Coronary Artery Bifurcation Lesions Research Articles

A Bayesian meta-analysis of double kissing (DK) crush or provisional stenting for coronary artery bifurcation lesions

ObjectiveDespite the development of dedicated, two-stent strategies, including the double kissing (DK) crush technique, the ideal technique for coronary artery bifurcation stenting has not been identified. We aimed to compare and determine the absolute risk difference (ARD) of the DK crush technique alone versus provisional stenting approaches for coronary bifurcation lesions, using the Bayesian technique. MethodWe queried PubMed/MEDLINE to identify randomized controlled trials (RCTs) that compared DK crush technique with provisional stenting for bifurcation lesions, published till January 2023. We used Bayesian methods to calculate the ARD and 95% credible interval (CrI). ResultsWe included three RCTs, with 916 patients, in the final analysis. The ARD of cardiac death was centered at −0.01 (95% CrI: −0.04 to 0.02; Tau: 0.02, 85% probability of ARD of DK crush vs. provisional stenting <0). ARD for myocardial infarction was centered at −0.03 (95%CrI: −0.9 to 0.03; Tau: 0.05, 87% probability of ARD of DK crush vs. provisional stenting <0). ARD for stent thrombosis was centered at 0.00 (95% CrI: −0.04 to 0.03, Tau: 0.03, 51% probability of ARD for DK crush vs. provisional stenting <0). Finally, ARD for target lesion revascularization was centered at −0.05 (95% CrI: −0.08 to −0.03, Tau: 0.02, 99.97% probability of ARD for DK crush vs. provisional stenting <0). ConclusionsBayesian analysis demonstrated a lower probability of cardiac death, myocardial infarction and target lesion revascularization, with DK crush compared with provisional stenting techniques, and a minimal probability of difference in stent thrombosis.

Effectiveness of using dual stent to intervene true left main coronary artery bifurcation lesions

Abstract: Lesions at the bifurcation of the left main coronary artery are dangerous lesions that account for approximately 4–8% of CAD (coronary artery disease) cases. In Vietnam, dual stent percutaneous coronary intervention has been used to treat true left main stem coronary artery bifurcation lesions, but there is no study that summarizes the recent results and evaluates them after a follow-up period. Consequently, we conducted this study.&#x0D; Research objectives: Effectiveness of using dual stent to intervene true left main coronary artery bifurcation lesions.[1]&#x0D; Objects and research methods: Crossectional study, review of all patients who received LMCA bifurcation lesions interventional stenting with dual stent at Hanoi Heart Hospital from 1/2018 to 6/2020.&#x0D; Research results: The rate of major cardiovascular events was determined as follow: 1 patient died during hospital stay; 18% of patients had at least one major cardiovascular event during the 12-month follow-up period; 3 patients had cerebrovascular accidents, which accounted for 6%; 3 patients had acute myocardial infarction, which accounted for 6%; and 2 patients had acute myocardial infarction, which accounted for 6%. Two patients require revascularization, representing 4% of the total population.

Single-stent strategy for left coronary artery bifurcation lesions in patients with chronic ischemic heart disease: protocol of a randomized trial

Aim. This study aims to compare the intraoperative, immediate postoperative and long-term postoperative results of stenting followed by final kissing balloon angioplasty (FKB) and without FKB for left coronary artery (LCA) bifurcation lesions in patients with chronic ischemic heart disease.Material and methods. We plan to perform an open-label, prospective, randomized, single-center, cohort trial that will include 40 patients with left main coronary artery bifurcation lesion, who will undergo stenting procedure followed by FKB or without FKB, using the second-generation drug-eluting stents. Randomization into two groups will be done after performing coronary angiography, confirming the inclusion criteria and the absence of non-inclusion criteria and signing a written consent in 2 copies. Group 1 — stenting followed by FKB. Group 2 — stenting without FKB. The total follow-up period is 24 weeks. It is planned to contact by phone on 30th and 180th day (±7 days) of postoperative period to obtain the information about patient condition, general survival rate, the events of combined controlled points and drug therapy. During 2d phone contact, on 180th day (±7 days), a patient will be invited to undergo multispiral computed tomography of the coronary arteries.The primary combined end-point: cardiac death, nonfatal myocardial infarction, acute cerebrovascular accident and the repeat target vessel revascularization. The secondary combined end-point: thrombosis and stent restenosis.Conclusion. Our study will optimize the approach to the choice of stenting strategy (with or without FRB) for left main coronary artery bifurcation lesions in patients with chronic ischemic heart disease.

TCTAP A-032 Factors Associated With Major Adverse Cardiovascular Events in Patients Treated by Provisional Stenting for Coronary Artery Bifurcation Lesions

TCTAP A-032 Factors Associated With Major Adverse Cardiovascular Events in Patients Treated by Provisional Stenting for Coronary Artery Bifurcation Lesions

OCT Guidance in Bifurcation Percutaneous Coronary Intervention

Coronary bifurcation is defined by the European Bifurcation Consensus as a coronary artery stenosis adjacent to the origin of a significant side branch. Its anatomy is composed of 3 different segments: proximal main vessel, distal main vessel and side branch. Coronary artery bifurcation lesions are encountered in approximately 15–20% of all percutaneous coronary interventions and constitute a complex subgroup of lesions characterized by lower procedural success rates and higher rates of adverse outcomes. In recent years, a growing focus in the European and Japanese bifurcation club meetings has been the emerging role of intravascular imaging, in guiding successful bifurcation percutaneous coronary interventions (PCI). In this review we will present the main ways optical coherence tomography (OCT) can be used to improve outcomes during bifurcation PCI.

Protection of side-branch ostium by the jailed balloon technique validated by three-dimensional optical coherence tomography

Objective: To evaluate the protective effect of jailed balloon technique on side branch (SB) ostium using three-dimensional optical coherence tomography(OCT). Methods: This is a retrospective study. Consecutive coronary disease patients with coronary artery bifurcation lesions who underwent percutaneous coronary intervention (PCI) and completed pre-and post-procedural OCT examinations at the Chinese People's Liberation Army General Hospital from September 2019 to March 2022 were enrolled. Patients were divided into the jailed balloon technique group and the unprotected group according to the options applied for the SB. The SB ostium area difference was calculated from OCT images (SB ostium area difference=post-PCI SB ostium area-pre-PCI SB ostium area). The SB ostium area differences were compared between the two groups and compared further in the subgroup of true bifurcation lesions and non-true bifurcation lesions. In the jailed balloon group, the SB ostium area difference was compared between the active jailed balloon technique and the conventional jailed balloon technique, between the jailed balloon>2.0 mm diameter and the jailed balloon≤2.0 mm diameter, and between the higher balloon pressure (>4 atm, 1 atm=101.325 kPa) and the lower balloon pressure (≤4 atm). Multivariate linear regression analysis was used to explore the correlation between the technical parameters of the jailed balloon technique and the SB protection effect. Results: A total of 176 patients with 236 bifurcation lesions were enrolled, aged (60.7±9.3) years, and there were 128 male patients (72.7%). There were 67 patients in the jailed balloon technique group with 71 bifurcation lesions and 123 patients in the unprotected group with 165 bifurcation lesions. Fourteen patients had 2 to 3 lesions, which were treated in different ways, so they appeared in the unprotected group and the jailed balloon technique group at the same time. The area difference in SB ostium was greater in the jailed balloon group than in the unprotected group (0.07 (-0.43, 1.05)mm2 vs.-0.33 (-0.83, 0.26)mm2, P<0.001), and the results were consistent in the true bifurcation lesion subgroup (0.29 (-0.35, 0.96)mm2 vs.-0.26 (-0.64, 0.29)mm2, P=0.004), while the difference between the two groups in the non-true bifurcation lesion subgroup was not statistically significant (P=0.136). In the jailed balloon technique group, the SB ostium area difference was greater in patients treated with the active jailed balloon technique than in those treated with the conventional jailed balloon technique ((0.43±1.36)mm2 vs. (-0.22±0.52)mm2, P=0.013). The difference in SB ostium area was greater in those using>2.0 mm diameter jailed balloons than in those using≤2.0 mm diameter jailed balloons (0.25 (-0.51, 1.31) mm2 vs.-0.01 (-0.45, 0.63) mm2, P=0.020), while SB ostium area difference was similar between those endowed with higher balloon pressure (>4 atm) compared to those with lower balloon pressure (≤4 atm) (P=0.731). Multivariate linear regression analysis showed that there was a positive correlation between jailed balloon diameter and SB ostium area difference (r=0.344, P=0.019). Conclusions: The jailed balloon technique significantly protects SB ostium, especially in patients with true bifurcation lesions. The active jailed balloon technique and larger diameter balloons may provide more protection to the SB.

Relationship between modifiable atherosclerotic cardiovascular risk factors and coronary artery bifurcation lesion

Abstract Background: Modifiable atherosclerotic cardiovascular disease risk factors are hypertension, diabetes mellitus, dyslipidemia, cigarette smoking, and obesity; the term coronary artery bifurcation is used when a coronary artery divides into two hemodynamically important branches or when the main branch has a hemodynamic significant side branch, bifurcation lesion represent 20% or more of coronary artery stenoses undergoing angiography. Objectives: To evaluate the relationship of hypertension, diabetes, dyslipidemia, cigarette smoking, and obesity to coronary bifurcation disease. Materials and Methods: In a cross-sectional study conducted in the Iraqi Center for Heart Diseases from May 2020 to May 2021, a total of 140 adult patients (70 cases with coronary bifurcation lesions and 70 control cases with non-bifurcation lesions) with angiography-documented stenotic coronary artery disease (CAD) were defined. Case demographics and modifiable CAD risk factors were addressed. Results: In the bifurcation group, the non-bifurcation lesion was mostly an associated angiographic finding (82%). The most significantly correlated atherosclerotic risk factor with bifurcation lesion compared to non-bifurcation lesion was diabetes, followed by systemic hypertension. Dyslipidemia was the most common prevalent risk factor, equally distributed in both groups. Smoking and obesity were distributed nearly equally in both groups. Conclusion: There is a significant relationship between diabetes and hypertension with coronary bifurcation lesions compared to non-bifurcation lesions.

Provisional Vs Dual Stenting of Left Main Coronary Artery Bifurcation Lesions

Background: The primary LMCA stenting methods used nowadays consist of single stent (provisional), and two stent (T and protrusion, and double kissing crush {DK crush}, culotte, or classic crush). The optimal technique for bifurcation lesion treatment for the patients present with distal ULMCA disease is still unclear and not much is known about the best course of action and the clinical outcomes following various PCI techniques for ULMCA bifurcations in Pakistan. Objective: To investigate the midterm (3-year) outcomes related to the provisional stenting compared to two-stenting technique for the bifurcations of ULMCA undergoing the percutaneous coronary intervention. Methodology: A single-center retrospective, non-randomized cohort study was conducted during the period from March 2021 to August 2022 including all the consecutive LM bifurcation lesions. The patients attending Punjab Institute of Cardiology, Lahore were divided into two groups, depending upon the treatment received. One group underwent PCI with provisional stenting technique while the other underwent 2-stent PCI. The groups were compared for procedural success and 3-year clinical outcomes. Data was analyzed using SPSS. Results: The success rate of left main bifurcation angiography was comparable between both the techniques (2-stent 93.6 % vs. Provisional 92.1 %, P = 0.62). MACE rates were comparable between groups at 1, 2, and 3 years (PS 3.0 % vs. Dual stent 2.4 %, p = 0.75 at 1-year, PS 4.8 % vs. Dual stent 8 %, p = 0.26 at 2-years, and PS 10.2 % vs. Dual stent 12 % at 3-years, p = 0.62). Conclusion: Two stenting strategy was linked to same rates of MACEs at the 3-year duration in comparison to the single stenting technique (PS 10.2 % vs. 2-Stent 12 %, p=0.62) and both the dual and single provisional stent techniques have comparable angiographic success rate for LM bifurcation lesions.

Left Main Coronary Artery Bifurcation Lesions: Two Stents vs One Stent Strategy-Comparison of Major Adverse Cardiac Events (MACE) at 2 years

Objective: To evaluate the long-term clinical results for a one-stent (1S) strategy compared to a two-stent (2S) strategy in distal unprotected left main coronary artery (ULMCA) bifurcation disease.&#x0D; Study Design: Comparative Cross-sectional study.&#x0D; Place and Duration of Study: Armed Forces Institute of Cardiology, Rawalpindi Pakistan, from Jan 2019 to Apr 2020.&#x0D; Methodology: 1-S approach was defined as stenting of the main vessel only and 2-S approach as stenting side branch and main vessel. Individual undergoing LMCA intervention were included via consecutive sampling in the study. Stent Crossover approach was used in 1-S technique; whereas, DK crush, culotte, and T-stenting approaches were employed in individuals who were treated with a 2-S approach. A composite of major adverse cardiovascular event (MACE) i.e., myocardial infarction, stroke or death and target lesion revascularization (TLR) were considered as primary end-point.&#x0D; Results: A sum of 110 individuals were inducted, 74 of them had stenting of left main bifurcation using a 1-S approach; and 36 patients underwent a 2-S PCI. Average age of the patients included in the study was 63.9±10.8 years. In 1 stent subset, the success rate of procedure was 99% whereas 100% success rate was seen in 2-S group. During the 2-year duration of follow up,frequency of MACE in single stent subset was (5.4%) whereas it was (13.8%, p=0.253) in the 2-S subset.&#x0D; Conclusion: When compared to 2-S approach of distal left main stenting, a 1-S strategy appears to demonstrate optimal clinical results and 2-year survival free of MACE. Choosing appropriate interventional strategy has proven prognostically significant; so, it demands mindful approach selection.

Provisional Versus Dual Stenting of Left Main Coronary Artery Bifurcation Lesions (from a Comprehensive Meta-Analysis)

The optimal technique for bifurcation of left main coronary artery (LMCA) stenting has been a subject of controversy since the inception of drug-eluting stents. We searched PubMed, Clinical Trials Registry, and the Cochrane Central Register of Controlled Trials from January 2002 through October 2021. A total of 13 studies comparing the use of provisional versus dual stenting in patients with LMCA bifurcation lesions were included. Any major adverse cardiac event (MACE) was considered the primary composite end point. The secondary end points included individual components of MACE, including death, myocardial infarction, and target lesion revascularization. The treatment effect was defined as the log odds ratio (OR) of provisional over dual stenting for cumulative event rate at 3 years. In 12 studies with 8,377 patients included for MACE, the use of a provisional-stenting strategy was associated with a significant reduction of 3-year MACE (OR 0.64, 95% confidence interval [CI] 0.46 to 0.88) compared with a dual-stenting strategy, primarily driven by target lesion revascularization (OR 0.51, 95% CI 0.36 to 0.73). No significant difference was found regarding death (OR 0.88; 95% CI 0.65 to 1.21) or myocardial infarction (OR 0.97, 95% Cl 0.61 to 1.54). In conclusion, our meta-analysis suggests that provisional stenting should be the preferred technique over dual stenting when treating LMCA bifurcation lesions with drug-eluting stents. Further randomized controlled studies compounded with intracoronary imaging comparing the 2 strategies are warranted.

A Review of Double Kissing Crush Stenting in Coronary Bifurcation Lesions

Double kissing (DK) crush stenting for coronary bifurcation lesions has gain popularity worldwide because of its superior randomized studies data and excellent clinical outcomes. This review evaluates all DK crush clinical trials and studies. It also reveals the contemporary technique steps by steps as well as the trouble shooting with illustrated clinical scenarios. Among all the available evidence, the DK crush technique is superior when compared to the provisional stenting technique for complex bifurcation lesion. DK crush stenting provides the best evidence-based approach to complex bifurcation lesions especially the left main coronary artery bifurcation lesions. Future direction of how to make this DK crush technique better is also proposed.

Safety Assessment of Microcatheter-Protected Rotational Atherectomy with the Double Guiding Catheter Technique for Severely Calcified Left Main Bifurcation.

Background Rotational atherectomy (RA) is a tool for calcium modification, but there is a risk of losing the side branch in left main coronary artery (LM) bifurcation lesions, resulting in disastrous consequences. Microcatheter-protected RA with the double guiding catheter (GC) technique for severely calcified LM bifurcations has been described previously, but its safety warrants further investigation. Methods Various sizes of coronary calcification vascular simulators were utilized to model calcified LM bifurcation lesions for RA in in vitro. The damage to the side branch protective microcatheters and guidewires was accessed after microcatheter-protected RA with the double GC technique. In clinical practice, microcatheter-protected RA with the double GC technique was carried out in two patients. Results In vitro, none of the protective microcatheters or guidewires were completely fractured, although the majority of them were damaged to varying degrees. In clinical practice, we successfully carried out two cases of percutaneous coronary intervention for severely calcified LM bifurcation with microcatheter-protected RA using the double GC technique. Conclusion RA of severely calcified LM bifurcation lesions may be successfully performed using microcatheter-protected RA with the double GC technique, potentially reducing the risk of side branch occlusion. Since majority of protective microcatheters or guidewires were damaged, there was still some risk, and it is recommended to use this technique only in highly selected patient population of severely calcified true (Medina 1, 1, 1) LM bifurcations.

Physiological Approach for CoronaryArtery Bifurcation Disease: Position Statement by Korean, Japanese, and EuropeanBifurcation Clubs.

Coronary artery bifurcation lesions are frequently encountered in cardiac catheterization laboratories and are associated with more complex procedures and worse clinical outcomes than nonbifurcation lesions. Therefore, anatomical and physiological assessment of bifurcation lesions before, during, and after percutaneous coronary intervention is of paramount clinical importance. Physiological assessment can help interventionalists appreciate the hemodynamic significance of coronary artery disease and guide ischemia-directed revascularization. However, it is important to understand that the physiological approach for bifurcation disease is more important than simply using physiological indexes for its assessment. This joint consensus document by the Korean, Japanese, and European bifurcation clubs presents the concept of a physiological approach for coronary bifurcation lesions, as well as current knowledge, practical tips, pitfalls, and future directions of applying physiological indexes in bifurcation percutaneous coronary intervention. This document aims to guide interventionalists in performing appropriate physiology-based assessments and treatment decisions for coronary bifurcation lesions.

Comparison of long-term clinical outcomes in diabetic and non-diabetic patients of the mini-crush two-stent technique for percutaneous treatment of complex coronary artery bifurcation lesions

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Diabetic patients present more aggressive coronary artery disease and worse outcomes after percutaneous coronary intervention (PCI), especially in complex coronary bifurcation lesions. Currently, the benefit of "double stenting" techniques in the treatment of complex bifurcations in diabetics with coronary artery disease, is controversial. Purpose The aim of this study was to compare the outcomes of PCI with "mini-crush" two-stent technique in diabetic and non-diabetic patients, in terms of MACE: cardiovascular mortality, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after long follow-up (median 32 months). Methods Observational study in which were included 152 consecutive patients (mean age 69.5 years, 38.3% diabetics) with 152 complex bifurcated coronary severe lesions that underwent PCI from April 2014 to April 2020. Results No significant differences were observed in the baseline characteristics, clinical presentation and antiplatelet pretreatment between both groups. Clopidogrel was the P2Y12-receptor inhibitor most commonly used. There were no differences in mean complexity according to the Syntax score (29.7 ± 11.3 in diabetics vs 30.4 ± 14.4 in non-diabetics, p=0.293). Left main bifurcation was the most frequently coronary artery affected in both groups and circumflex was the most common side vessel. The characteristics of the procedure was similar in both groups: no differences observed in pre-dilation rate either in final kissing balloon post-dilation rate. Similar length and diameter of the stents implanted in both groups. Angiographic follow-up clinically guided was 15.8% in diabetics and 16.9% in non-diabetics. We found no significant differences in the incidence of MACE or in any of its components separately. TLR rate was similar in diabetics and non-diabetics patients. Conclusions Comparable to non-diabetic patients, PCI in complex coronary bifurcation lesions with "mini-crush" two-stent technique in diabetic patients shows favorable results with low event rates and need for revascularization at long-term follow-up.

Crush techniques for percutaneous coronary intervention of bifurcation lesions.

Percutaneous coronary intervention (PCI) of coronary artery bifurcation lesions entails technical challenges and carries a higher risk of adverse events on follow-up, driven by repeat revascularisation and stent thrombosis. While most bifurcations can be tackled with a provisional (single-stent) approach, more complex lesions involving both branches (true bifurcation lesions) require a two-stent approach. In the latter context, several techniques have been proposed. Among them, the crush technique has dramatically evolved in recent years, and its more recent iterations have been shown to provide excellent and durable results, both for left main and non-left main bifurcations. The aim of the present work is to discuss the technical aspects and outcomes of the variants of the crush technique from the first description in the early 2000s to the present day.

Thrombosis and Major Bleeding Risk After Primary PCI Among Patients With Multivessel Coronary Artery Disease.

Background and AimThis study aimed to develop and validate separate risk prediction models for thrombosis events (TEs) and major bleeding (MB) in patients with multivessel coronary artery lesions who had undergone primary percutaneous coronary intervention (PCI).Methods and ResultsThrombosis events (TEs) were defined as the composite of myocardial infarction recurrence or ischemic cerebrovascular events, whereas MB was defined as the occurrence of bleeding academic research consortium (BARC) three or five bleeding. The derivation and validation cohorts comprised 2,976 patients who underwent primary PCI between January 2010 and June 2017. At a median follow-up of 3.07 years (1,122 days), TEs and MB occurred in 167 and 98 patients, respectively. Independent predictors of TEs were older age, prior PCI, non-ST elevated MI (NSTEMI), and stent thrombosis (ST). Independent predictors of MB were triple therapy at discharge, coronary artery bifurcation lesions, lesion restenosis, target lesion of the left main coronary artery, stent thrombosis, non-use of IABP during primary PCI, type A/B according to the American College of Cardiology classification of the coronary lesion, and PTCA. In the derivation and validation cohorts, the areas under the curve were 0.817 and 0.82 for thrombosis and 0.886 and 0.976 for bleeding, respectively. In the derivation cohort, high thrombotic risk (n = 755) was associated with higher 3-year incidence of TEs, major adverse cardiovascular events (MACEs), and all-cause death compared to low risk (n = 1,275) (p = 0.0022, 0.019, and 0.012, respectively). High bleeding risk (n = 1,675) was associated with higher incidence of bleeding, MACEs, and cardiac death compared to low risk (n = 355) (p < 0.0001).ConclusionSimple risk scores can be useful in predicting risks of ischemic and bleeding events after primary PCI, thereby stratifying thrombotic or MB risks and facilitating clinical decisions.

Improved Outcomes of Combined Main Branch Stenting and Side Branch Drug-Coated Balloon versus Two-Stent Strategy in Patients with Left Main Bifurcation Lesions.

Background Drug-eluting stent (DES) plus drug-coated balloon (DCB) is a safe and effective treatment strategy for coronary artery bifurcation lesions, but there is no report about this strategy being used for left main (LM) bifurcation lesions. We aim to explore the efficacy and safety of DES plus DCB in the treatment of LM bifurcation lesions. Methods A total of 100 patients diagnosed with LM bifurcation lesions by coronary angiography were retrospectively enrolled at our center from January 2018 to December 2019. They received either a two-stent strategy or a main branch (MB) stenting plus side branch (SB) DCB strategy and were accordingly divided into the 2-DES group and the DES + DCB group. Patients treated with DES + DCB were compared with a cohort of matched patients treated with a 2-DES strategy. Clinical data was collected and quantitative coronary analysis was performed. Results For immediate postoperative angiography, though the two groups had no differences in the minimal luminal diameter (MLD) and luminal stenosis of MB, the DES + DCB group had significantly lower SB ostial MLD and a higher degree of residual lumen stenosis than the 2-DES group (P < 0.05). At the time of follow-up, the SB ostial MLD of the DES + DCB group was higher than that of the 2-DES group, but lumen stenosis, late lumen loss (LLL), and LLL at the distal end of the left MB were all smaller than those of the 2-DES group (Ps < 0.05). Furthermore, the incidence of lumen restenosis and MACE between the two groups had no significance. Conclusion The combination of DES and DCB is relatively safe and effective for the treatment of LM bifurcation lesions, and this strategy seems to have advantages in reducing LLL at the SB ostium.

The Drug Coated Balloon-Only Strategy for Treatment of de Novo Left Main Coronary Artery Bifurcation Lesion: Stentless Strategy.

The study aimed to evaluate the efficacy and safety of drug coated balloon-only strategy (DCB-only) in the treatment of de novo left main coronary artery (LM) bifurcation lesions. 85 patients were enrolled in this study and classified them into two groups: DCB-only group (n = 36) and DES group (n = 49). The MLD of target vessels was measured before and immediately after percutaneous coronary intervention (PCI) and late luminal loss (LLL) were also calculated. And the occurrence of major adverse cardiovascular events (MACE) was also evaluated. Compared with that before PCI, the MLD of target lesions significantly increased immediately after PCI (P < .05) and no MACE was recorded during the perioperative period both in two groups. The MLD at follow-up was significantly higher than that before both DCB and DES treatment. Compared with the DES group, the MLD of the DCB group was smaller than immediately after PCI in the LM and LAD (P < .05). The LLL of LAD in DCB group was smaller than that in DES group (P < .05). There was no significant difference in the incidence of luminal restenosis at the target lesion between the two groups, and no significant difference in the incidence of MACE (P > .05). The use of DCB-only to treat de novo LM bifurcation lesions is effective and relatively safe, which provides new ideas for the treatment of LM coronary artery bifurcation lesions in the future.

Drug-eluting balloon catheters in the treatment of left main coronary artery bifurcation lesions

<h3></h3> В статье представлен обзор современных исследований по применению баллонных катетеров с лекарственным покрытием при чрескожных коронарных вмешательствах. Имеются многочисленные данные, подтверждающие эффективность и безопасность их использования у пациентов с рестенозами стентов, а также при поражениях артерий малого диаметра. Доказательная база их применения у пациентов с бифуркационными стенозами коронарных артерий остается ограниченной. Тем не менее, существующие исследования демонстрируют отсутствие преимуществ двухстентовых методик бифуркационного стентирования перед одностентовыми с применением баллонных катетеров с лекарственным покрытием. Однако остаются нерешенными вопросы отбора пациентов для подобных вмешательств при бифуркационных стенозах ствола левой коронарной артерии, технические аспекты процедуры стентирования, целесообразность применения внутрисосудистых методов исследования для оптимизации результатов лечения, недостаточно сведений об отдаленных результатах лечения таких пациентов.

A Case Summary of the Application of a Drug-Eluting Stent Combined with a Drug-Coated Balloon in Left Main Coronary Artery Disease

Objective: To evaluate the clinical efficacy of a drug-eluting stent (DES) combined with a drug-coated balloon (DCB) in the treatment of left main coronary artery bifurcation lesions. Methods: A retrospective analysis was conducted on the clinical data of eight patients with left main coronary artery bifurcation lesions treated with a DES combined with a DCB who were admitted to our hospital from July 2016 to July 2017. These eight patients all underwent DES treatment for their left main coronary artery and left anterior descending coronary artery lesions, and DCB treatment at the ostium of the left circumflex artery; six of the patients underwent surgical procedures under the guidance of intravascular ultrasonography. Immediate postoperative angiography was used to evaluate the patency of the diseased vessels, and the restenosis rate at the 6-month follow-up after the operation and the incidence of serious clinical events within 6 months were assessed as well. Results: The use of a DES combined with a DCB in the treatment of left main coronary artery bifurcation lesions had a low restenosis rate (left main coronary artery (8.4 ± 5.3)%, left anterior descending coronary artery (18.2 ± 5.0)%, left circumflex artery (30.5 ± 16.5)%). No serious clinical events occurred in any patients. Conclusion: A DES combined with a DCB is a safe and effective interventional treatment for left main artery coronary bifurcation lesions.