Stent Technique Research Articles

Abstract 4123480: Navigating Aspirin Allergy With Rapid Desensitization In A Patient Requiring Urgent Coronary Intervention

Introduction: Aspirin (ASA) hypersensitivity is a challenge in determining the appropriate, cost-effective therapy in patients after percutaneous coronary intervention (PCI). Various ASA desensitization protocols were studied and showed favorable outcomes. In this case, we highlight the use of rapid ASA desensitization protocols for patients requiring dual antiplatelet therapy (DAPT) post urgent PCI. Case: A 52-year-old male presented with severe left-sided chest pain associated with diaphoresis. He had a history of allergic reaction to ASA at the age of 18 years with swelling of the face and throat without shortness of breath or hypotension. Physical examination was unremarkable except for tachycardia. Workup showed no ECG abnormalities but significantly elevated, uptrending high sensitivity troponin. Medical management included clopidogrel load, heparin drip, and nitropaste for persistent pain. Urgent coronary angiography showed a severe bifurcating lesion in the LCx and OM1 arteries, successfully treated with the T stent technique using a drug-eluting stent. He received cilostazol and prasugrel, overlapped with a tirofiban drip post PCI. ASA desensitization was performed with oral ASA every 90 minutes for four doses (Figure). Vital signs were monitored every 30, 60, and 90 minutes after each dose. He was discharged home with no reported symptoms on follow up. Discussion: DAPT with ASA and oral P2Y12 inhibitors is recommended for patients with PCI. ASA desensitization could be considered for patients who are intolerant to ASA. Major clinical ASA desensitization protocols, like in ADAPTED and SCRIPPS studies, showed good outcomes in major adverse cardiovascular events. However, one limitation of these widely used protocols is the prolonged time required to achieve desensitization. The rapid protocol used in our patient who did not have ASA exacerbated respiratory disease showed effectiveness with shorter hospital stay. Conclusion: ASA desensitization is an appropriate option for patients with a history of ASA allergy requiring DAPT. Rapid desensitization protocols are associated with shorter hospitalization courses, and future efforts should evaluate their effectiveness in randomized controlled trials.

Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient

Background Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a form of peripheral arterial disease involving the infrarenal aorta and iliac arteries. The presentation of AIOD ranges from asymptomatic cases to limb-threatening emergencies. Advances and innovations in endovascular devices have replaced traditional surgical interventions for the management of AIOD. Here we report a case of a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique. Case presentation A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and a significant history of smoking, was admitted to our hospital with symptoms of long-standing bilateral claudication which recently progressed to rest pain. A history of AIOD was previously established. AIOD (TASC II Type D) diagnosis was made by lower extremity duplex ultrasound and CT angiography. The patient underwent urgent percutaneous transluminal angioplasty with kissing stent technique. The patient was discharged 4 days after the procedure without any significant complaints, received best medical therapy. Conclusion Endovascular interventions present excellent alternatives to surgical techniques in the treatment of complex AIOD. Herein we presented an endovascular treatment of AIOD utilizing the kissing stent technique which showed satisfactory outcomes.

Iatrogenic emboli during mechanical thrombectomy for acute ischemic stroke: comparison between stent retriever technique and contact aspiration-a retrospective case-control study.

Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke from large vessel occlusion (LVO). While embolization to a new territory (ENT) after MT is well-documented, data on embolization in the same distal territory (EDT) are limited. Achieving modified Treatment In Cerebral Infarction (mTICI) 3 reperfusion presents significant clinical benefits over mTICI 2b/2c, necessitating strategies to reduce both ENT and EDT. Previous studies suggest higher rates of EDTs with contact aspiration compared with stentrievers. However, comprehensive comparison studies in clinical practice are scarce. This study compares the rates of overall clot emboli (OCE) between these MT strategies. A retrospective, multicenter observational study was conducted at four university hospitals in France from January 2015 to November 2019. Adult patients (≥18 years) with acute ischemic stroke due to LVO, treated with either contact aspiration (ADAPT, A Direct Aspiration First Pass Technique) or stentrievers, specifically using the Embotrap device to maintain sample homogeneity, were included. Digital subtraction angiography was used for imaging, with two independent, blinded reviewers assessing OCE post-first MT pass. Propensity score full matching and independent sample testing were employed to evaluate OCE after the first MT pass. A significant difference in OCE rates was observed between contact aspiration and stentriever techniques, with the stentriever technique resulting in fewer embolic events compared with ADAPT, based on a propensity score analysis that accounts for key confounding factors. A statistically significant reduction in embolic events was observed with the stentriever technique compared with contact aspiration. These results suggest that the stentriever method may offer a safer profile in terms of embolic risk for LVO interventions, and should be considered over contact aspiration when embolic risk is a primary concern, while also considering individual patient factors.

Does initial use of large versus small burr size in left main stem bifurcation impact clinical and procedural outcomes?

Abstract Background Coronary calcifications, detected in up to 25% of treated coronary lesions nowadays, has a well-known association with complications during PCI, particularly for left main stem (LMS) interventions. Current guidelines recommend coronary artery bypass grafting for patients with LMS disease, particularly with high SYNTAX score ≥ 33. However, in those with increased surgical risk, PCI can be used particularly with use of rota-ablation (RA). RA is a well-established treatment for heavily calcified disease particularly in non LMS sites. However, data on the safety and efficacy of use of RA in LMS bifurcation management is limited. Current guidelines recommend using a small burr size at the start, with upsizing burrs if required. Whether upfront use of large burr size ≥ 1.75 versus smaller burr size in this context in is safe or effective is unknown. Methods This was a retrospective, single centre, study. Included patients undergoing RA to LMS bifurcation disease. Standard procedures for RA were applied to each case, following current national and international intraprocedural standards. The main study outcomes were overall mortality at 1 year, and a comparison of mortality at 1 and 4 years between groups and repeat target lesion revascularization at 4 years. Results To our knowledge, this is the largest series of LMS rota-ablation cases, with the longest available follow up. Between June 2009 and October 2021, we included 243 patients with a mean age of 74.7±9 years. Males formed 80% of the cases. 51.4% of patients were treated with a large bur size ≥ 1.75mm, with more males being treated with large burr size. Most treated lesions were true bifurcations (85.6%). Treated lesions were complex (Syntax score = 35.3 ± 10.6). Radial access was used in almost two thirds of patients, with size 7F sheath being the most used. Intravascular ultrasound was more commonly used with large burr size (p = 0.017). Upfront 2-stent techniques, predominantly culotte, was employed more often with large burr size. Provisional technique was used more often in the small burr size group. The burr size to vessel size was 0.4 in small burr group versus 0.48 in large burr size using stent size as a surrogate for vessel size. Post dilatation balloons were larger as well as stent size in the large burr group. The overall 1-year mortality for the group was 12.7% similar to international literature. Importantly, procedural complications were not different between groups, and similarly mortality at 1 and 4 years, p = 0.082 and p = 0.384 respectively. There was no difference between groups in terms of repeat vessel revascularization at 4 years p=0.487. Conclusions Upfront use of large burr size ≥ 1.75 is feasible and safe to treat LMS bifurcation disease with no increase in procedural complications or mortality and target lesion revascularization on long term follow up. It is notable that in-hospital mortality for this cohort was low at 1.6% in comparison to previous studies.1 and 4 year mortality KM curves

Necessity sequential intermediate kissing balloon dilation for crush stenting: Further insights from metal/polymer vessel scaffolds bench testing.

Sequential intermediate kissing balloon dilation (sIKBD) is crucial for crush stenting, but it require appropriate procedure remains unclear for crush stenting. This study aims to investigate whether sIKBD is necessary and how it can be properly performed during crush stenting. Mini-crush stenting (mini-CS) and sIKBD for mini-crush stenting (sIKBD-mini-CS) using metal drug-eluting stents/polymer bioresorbable vessel scaffolds (mDES/pBVS) were emulated in bifurcation models considering the branch diameter difference, and sIKBD was added to mini-CS for pretreating side-branch (SB) stent before main-branch (MB) stenting (second figure), respectively. Micro-computed tomography was used to assess the morphological parameters of bifurcated stents including length of overlapping stent segment, residual ostial stenosis of the SB, and neocarina length using quantitative methods. Further, optical coherence tomography was to analyze the incidence of stent malapposition. Quantitative analysis demonstrated that in mDES/pBVS phantom, the neocarina length (mDES: 0.45 ± 0.10 mm vs 0.30 ± 0.09 mm, P = .005; pBVS: 0.47 ± 0.11 mm vs 0.29 ± 0.09 mm, P = .001), residual ostial stenosis at the SB (mDES: 19.37 ± 8.21% vs 12.47 ± 2.05%, P = .001; pBVS: 21.89 ± 8.54% vs 9.98 ± 3.35%, P = .035), and stent malapposition in the overlapping segment (mDES: 10.29 ± 3.31% vs 3.83 ± 0.97%, P = .001; pBVS: 12.05 ± 3.87% vs 6.40 ± 1.59%, P = .003) were lower in the sIKBD-mini-CS group than those in the mini-CS group (P < .05 for all). The results of factorial analysis showed that mDES platform tended to have better morphological indicators than the pBVS platform. Adding the sIKBD to mini-CS showed better morphologic characteristics of mDES/pBVS phantoms when compared with mini-CS. Therefore, it should be considered as a critical and proper technique for crush stenting.

Clinical Outcomes of Double-Kissing Crush or Double-Kissing Culotte in Nonleft Main Bifurcation Lesions: The ROUTE Trial.

Double-kissing (DK) crush and DK culotte are the recommended 2-stent strategies in true coronary bifurcation lesions. However, it is a matter of curiosity about which of the DK crush and DK culotte stenting techniques will have superior results. We aimed to compare the clinical outcomes of DK crush and DK culotte stenting in nonleft main coronary artery bifurcation. Consecutive patients who received DK crush or DK culotte technique for de novo true nonleft main coronary artery bifurcation lesion were categorized according to which treatment they received. The primary end point of the study was target lesion failure as a composite end point of target lesion revascularization, target vessel myocardial infarction, and cardiac death. Secondary end points were all-cause death and definite stent thrombosis. A total of 202 patients were categorized as DK crush (101 patients) or DK culotte (101 patients) techniques. The target lesion failure had occurred frequently in the DK crush (10.9%) compared with the DK culotte (3.0%; P=0.028) that was mainly driven by increased target lesion revascularization (9.9% in the DK crush versus 3.0% in the DK culotte; P=0.045). The number of patients with target vessel myocardial infarction (3.0% in the DK crush versus 2.0% in the DK culotte; P=0.651) and cardiac death (1.0% in the DK crush versus 0.0% in the DK culotte; P=0.315) was higher in the DK crush. There were no differences in terms of definite stent thrombosis and all-cause death between groups. In the present analysis, DK culotte was associated with lower 1-year target lesion failure rates compared with DK crush in true nonleft main coronary artery bifurcations. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04789161.

Intelligent Ureteral Stent Placeable via Standard Procedure for Kidney Pressure Telemetry: An Ex-Vivo Study.

This paper reports the first telemetric ureteral stent compatible with common placement procedure, enabling wireless sensing and detection of ureteral obstruction and resultant kidney swelling known as hydronephrosis at an early stage. This sensor-integrated "intelligent" ureteral stent is prototyped via the design and fabrication approaches that raise the practicality of the device and tested in a harvested swine kidney-ureter model ex vivo. Leveraging a polymeric double-J stent and micro-electro-mechanical systems technology, the intelligent stent is built by embedding micro pressure sensors and a radiofrequency antenna, forming a resonant circuit that enables wireless kidney pressure monitoring in an operating frequency of 40-50MHz. The stent device is entirely packaged with Parylene-C for both biocompatibility and electrical insulation of the device in order to function in the real environment including urine, an electrically conductive liquid. A comparison between the results measured in in-vitro and ex-vivo settings show a good match in the sensitivity to applied pressure. In particular, the ex-vivo test in the kidney-ureter model pressurized with artificial urine in a cycled manner demonstrates wireless pressure tracking with a response of 1.3kHz/mmHg, over pressures up to 37mmHg that well covers a range of pressure increase known for chronic obstruction. This testing is enabled by the prototype placement into the ex-vivo model using the standard stenting technique and tools without noticeable functional degradation or failures, showing potential compatibility of the device with today's clinical need as a ureteral stent.

Impact of double stent retriever configuration on first-pass effect in stroke: a multicenter study

BackgroundEfficient recanalization of occluded cerebral arteries is crucial in the treatment of acute ischemic stroke. Double stent retrievers have shown the potential to enhance the rates of recanalization on the...

Modified Floating Wire: A Novel Aorto-Ostial Coronary Stenting Technique

: We present a modified floating wire technique for aorto-ostial coronary stenting. This novel approach ensures accurate ostial alignment without stent protrusion. The technique involves using a second wire as a marker at the true ostium to guide optimal stent placement. A balloon catheter is advanced on the floating wire to delineate the aorto-ostial plane. This method reduces the need for contrast media, prevents deep intubation of the guide catheter, and resembles the stent draw-back technique. The modified floating wire technique offers a safe and effective method for aorto-ostial coronary stenting and has potential for broader clinical application.

Evolution of Medical and Surgical Management of Carotid Disease from Carotid Endarterectomy to Transfemoral Carotid Stenting to TCAR

Patients with carotid stenosis can be broadly classified into two categories: symptomatic and asymptomatic. While there is little disagreement about surgical management of symptomatic carotid stenosis, the optimal management strategy for the patients with asymptomatic carotid disease has undergone significant evolution over past five decades. With increasing focus on role of plaque morphology on the etiology of symptoms, there has been an increased focus on optimizing the medical management targeted at plaque stabilization, especially for the patients with asymptomatic carotid disease, while reserving the most aggressive surgical treatment options for the patients with symptomatic carotid stenosis. This review summarizes the scientific evidence based on multiple large clinical studies showing how the modern-day management of carotid stenosis has evolved. Multiple, large randomized clinical trials have established carotid endarterectomy (CEA) as the treatment of choice for symptomatic patients with symptomatic, >50% stenosis of carotid artery or those who have asymptomatic high grade carotid stenosis. With the advancements in endovascular techniques, the technique of Trans Femoral Carotid Artery Stenting (TF-CAS) was popularized, but after multiple, large randomized controlled trials demonstrated superiority of CEA, the indications for TF-CAS as the initial operation of choice for carotid disease for all patients have been reduced. In the past five years, the introduction of the newer technique of Trans Carotid Artery Revascularization (TCAR) has shown promising results with significant reduction in the incidence of perioperative complications as compared to CEA and TF-CAS, however, there have been no randomized controlled trials comparing TCAR to either CEA or TF-CAS. Moreover, with the developments in the medical field with introduction of several new medications which have been demonstrated to successfully change the plaque morphology, there has been a renewed interest in exploring if the indications for surgical management for the asymptomatic carotid disease should be revisited.

422. MANAGEMENT OF ANASTOMOTIC LEAK AFTER TOTAL GASTRECTOMY WITH THE “RENDEZ-VOUS” HYBRID TECHNIQUE: PRESENTATION OF OUR APPROACH AND RESULTS

Abstract Background Anastomotic dehiscence following total gastrectomy and Roux-en-Y reconstruction remains a demanding clinical scenario, associated with high morbidity and mortality rates. Management options focus on controlling systemic and local sepsis while allowing for proper anastomotic healing. Optimal treatment algorithm remains to be determined and therapeutic strategy is being individualized. The primary goal of the present study is to present the modified rendezvous stenting technique, a technique implemented in our department during reoperation for washout, in critically ill anastomotic leak patients. Methods We performed a retrospective descriptive analysis of severely ill patients suffering an anastomotic leak from an esophagojejunal anastomosis, who had been operated in our department during the last five years (01/2018-12/2023). All patients were operated on by the same surgical team and endoscopy was performed by the same endoscopist. Data regarding patients who had been subjected to the modified rendezvous technique were collected. Results Since 2018, five anastomotic leak patients underwent stenting over the anastomosis using the modified rendezvous technique during relaparotomy. Stenting was effective in controlling local contamination in 4 out of 5 patients (80%). One patient required repeat stent placement due to stent migration. Overall the 30 day mortality rate was 20% and no deaths directly attributed to the leak were observed. Stents remained in position for an average of 4.25 weeks. Conclusion Anastomotic stenting using the rendezvous technique is a safe and feasible technique. It can prove useful in controlling local abdominal contamination in severe anastomotic leak patients, while minimizing the risk of stent migration. Further implementation of the technique will allow for more reliable conclusions to be drawn, regarding the technique’s actual effectiveness.

Immediate and Long Term Results of Percutaneous Coronary Intervention for Bifurcation Lesions in Diabetic Patients Using Two-Stents Technique Versus One Stent Technique

Immediate and Long Term Results of Percutaneous Coronary Intervention for Bifurcation Lesions in Diabetic Patients Using Two-Stents Technique Versus One Stent Technique

Endovascular Management of Basilar Artery Aneurysms: A Consecutive Series of 124 Patients

There is currently no established criterion for determining when interventional treatment is necessary and what strategy is appropriate for basilar artery (BA) aneurysms. Through this study, we aimed to propose an algorithm that can effectively determine the optimal endovascular treatment (EVT) option for BA aneurysms. We enrolled patients with BA aneurysms from June 2016 to December 2022 and performed procedures based on the algorithm. The analysis included demographic, clinical, and aneurysmal characteristics, procedural details, complications, angiographic outcomes, and clinical outcomes. This study included 124 patients (mean age 55.0 years) with a BA aneurysm who underwent EVT. Of these, 21 aneurysms were treated in the setting of subarachnoid hemorrhage (SAH). The majority of aneurysms were located at the basilar apex (74), followed by the basilar trunk (30) and vertebrobasilar junction (20). Coiling was used in 18.5% of cases, while stent-assisted coiling embolization was chosen for 58.9%. Overlapping stents were used in 12.9%, flow diverter (FD) implantation in 3.2%, Y/T stent techniques in 4.8%, and stent adjunctive coiling with unilateral vertebral artery (VA) occlusion in only 1.6%. Procedure-related complications occurred in 15 patients (12.1%). Patients had a modified Rankin Scale(mRS) score of 0.74±1.62; 98 (86.7%) had good prognosis with mRS scores ranging from 0 to 2 at the last follow-up. DSA was performed on 105 (84.7%) patients revealing that 101 (81.5%) achieved complete or near-complete occlusion. The endovascular treatment criteria for BA aneurysms depended on the multi-characteristics was safe and effective. However, further evidence is needed from large cohort studies.

Coronary bifurcation lesion treatment with the BioMime™ Branch sirolimus-eluting coronary side-branch stent system: A single-center experience

BackgroundCoronary bifurcation lesions (CBL) comprise 15 %–20 % of percutaneous coronary procedures and remain a challenge despite advances in stent and interventional techniques. The BioMime™ Branch sirolimus-eluting coronary side-branch stent (BBSES) is specifically designed for CBL treatment in conjunction with a standard drug-eluting stent (DES). We report the first single-center experience of treating complex CBL with the novel BBSES. MethodsThis is a retrospective, single-center study involving consecutive prospectively identified patients who underwent treatment of true CBL with the BBSES. The protocol included BBSES+DES implantation in the CBL and simultaneous final kissing balloon inflation. ResultsFifty-eight CBL were treated in 58 consecutive patients (89.6 % men, mean age 69.0 ± 9.5 years) presenting primarily with stable angina (84.4 %) and true (Medina 1,1,1,) CBL. Procedural success was 100 % without major adverse cardiac events (MACE). At a median follow-up of 18 months, one sudden death was reported that was accounted as possible late stent thrombosis. One patient had spontaneous myocardial infarction due to subacute thrombosis of a DES implanted in the main vessel proximally to the BBSES before the index procedure. Another patient was hospitalized for atrial fibrillation. ConclusionsThis is the first clinical experience to date of true CBL treatment with the BBSES demonstrating high procedural success, no in-hospital MACE and sustained clinical results at a median follow-up of 18 months.

Comparison between provisional Stenting and Two Stents Technique (DK-crush or Nano-crush) in Bifurcation Coronary Artery Lesions

Comparison between provisional Stenting and Two Stents Technique (DK-crush or Nano-crush) in Bifurcation Coronary Artery Lesions

Evaluation of microcirculatory protection in percutaneous revascularisation: A stent implantation technique and device comparison.

Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) is prognostically important and may also be a cause of persistent angina. The stent balloon inflation technique or material properties may influence the degree of CMD post-PCI. Thirty-six patients with stable angina attending for elective PCI were randomized to either slow drug eluting stent (DES) implantation technique (DES slow group): +2 atm. every 5 s., maintained for a further 30 s or a standard stent implantation technique (DES std group): rapid inflation and deflation. PressureWire X with thermodilution at rest and hyperemia and optical coherence tomography (OCT) were performed pre- and post-PCI. Combined primary endpoints were changes in index of microvascular resistance (delta IMR) and coronary flow reserve (delta CFR) following PCI. The secondary endpoints included differences in cardiac troponinI (delta cTnI) at 6 hpost-PCI, Seattle angina questionnaire (SAQ) at 1, 3, 6, and 12 months and OCT measures of stent results immediately post-PCI and at 3 months. Both groups were well matched, with similar baseline characteristics and OCT-defined plaque characteristics. Delta IMR was significantly better in the DES slow PCI arm with a median difference of -4.14 (95%CI -10.49, -0.39, p = 0.04). Delta CFR was also numerically higher with a median difference of 0.47 (95% CI -0.52, 1.31, p = 0.46). This did not translate to improved delta median cTnI(1.5 (34.8) vs. 0 (27.5) ng/L, p = 0.75) or median SAQ scoreat 3 months, (85 (20) vs. 95 (17.5), p = 0.47). Slow stent implantation is associated with less CMD after elective PCI in patients with stable angina.

The “buddy stent technique” to overcome poor support for cover stent implantation to treat coronary perforation

An 86-year-old woman was managed for a non-ST-segment elevation myocardial infarction. Coronary angiography revealed significant stenoses at the left anterior descending, left ostial circumflex (LCX), obtuse first marginal, and a Medina 1.0.1 bifurcation lesion at the middle LCX/ second obtuse marginal (OM2). During percutaneous coronary intervention, the rupture of the pre-dilatation balloon was complicated by a type III coronary perforation at the level of the LCX/OM2 bifurcation, leading to cardiac tamponade. Hemodynamics were stabilized by percutaneous pericardial drainage. The placement of a covered stent (BeGraft, Bentley InnoMed), to seal the coronary perforation, was not possible due to its great rigidity and the angulation towards the OM2, even with the use of a guiding catheter extension (Guidezilla, Boston Scientific). To further increase support, we decided to use the flexibility of a regular drug-eluting stent which we implanted from the LCX to the OM2, thereby creating a rail-like path in which the covered stent could then be positioned and deployed successfully, allowing the perforation to be sealed with a good final result. This is what we called the “buddy stent technique”.

Case Report: Endovascular approach with kissing stent technique in aortoiliac occlusive disease (Leriche syndrome) patient

Background: Aortoiliac occlusive disease (AIOD) or Leriche syndrome, is a peripheral artery disease, specifically affecting the infrarenal aorta and iliac arteries. Presentation of AIOD patients ranged from asymptomatic to having limb-threatening emergencies. Advances and innovations in endovascular devices have replaced surgical approach for AIOD treatment. Here we reported a 52-year-old man presenting with AIOD managed by endovascular approach using kissing stent technique. Case presentation: A 52-year-old man, with history of chronic coronary artery disease, diabetes mellitus type 2, long-standing hypertension, and who was a heavy smoker, was admitted to our hospital with symptoms of long time with bilateral claudication and became leg rest pain. He had history of aorto-infrarenal occlusion known from previous percutaneous coronary intervention from right and left femoral artery access. Aortoiliac occlusive disease (TASC II Type D Class) diagnosis was made by lower extremity duplex ultrasound and CT angiography. The patient underwent urgent percutaneous transluminal angioplasty with kissing stent technique. The patient was discharged 4 days after the procedure without any significant complaints, received optimal medical treatment, and was educated about smoking cessation. Conclusion: Treatment of AIOD should include both modification of risk factors and efforts to increase perfusion to the lower extremities. An endovascular approach is an excellent alternative and may replace surgical approach in complex aortoiliac obstructive disease. In this case report, an endovascular approach with kissing stent technique showed good results for the patient.

Early effect of different bifurcation techniques on left ventricular mechanics in elective percutaneous coronary intervention

BackgroundBifurcation lesions are prevalent amongst patients with symptomatic coronary artery disease subjected to percutaneous coronary intervention (PCI). Recent consensus commends a conservative (provisional) approach when managing the side branch. Here, the aim was to explore the immediate impact of different bifurcation techniques (one stent and two stent strategies) on left ventricular LV) myocardial functions using speckle tracking echocardiography in patients subjected to elective PCI. Sixty two consecutive patients diagnosed with coronary bifurcation lesion (CBL) were enrolled. Patients were categorized into: one-stent strategy (Provisional group, n = 44) and a two-stent strategy (TAP, DK crush, or Culotte technique, n = 18), based on the coronary bifurcation site, angle, side branch diameter and Medina classification. LVEF%, regional and global longitudinal strain (GLS), and E/E' were measured before and within 24 h post PCI.ResultsIn both provisional and 2- stent technique, the mitral inflow velocities and mitral annular velocities showed improvement with significant reduction in E/e' (P < 0.03 and P < 0.001) respectively while LVEF% did not change. There were no significant changes in any other echo parameters post PCI. In provisional group, there were significant improvements in LAD (P < 0.001), RCA (P < 0.01) territories and GLS (P < 0.01). Δ LAD was expressively higher (34.5%) compared with Δ LCX (9.6%) and ΔRCA (25.4%), P < 0.001, P < 0.01 respectively. In the 2-stent technique group, there were significant improvements in peak longitudinal strain of LAD territory (P < 0.01), RCA territory (P < 0.01) and GLS (P < 0.01) respectively. Δ LAD territory was significantly higher in provisional group in comparison with the 2- stent technique group. Δ GLS was correlated inversely to Gensini score in provisional group and to the number of vessel diseased in 2-stent technique group.ConclusionPCI of the bifurcation lesion positively impact myocardial function. Both bifurcation techniques improve LV mechanical properties using 2D strain imaging while LV EF% remains unchanged.

BOOM: A novel bifurcation stent technique using optical coherence tomography co-registration

Background/purposeBifurcation lesions comprise 20 % of percutaneous coronary interventions (PCI) and are associated with worse long-term outcomes. With an increasing percentage of patients presenting with complex anatomy, including bifurcation disease, there is a need for treatment strategies to optimize PCI outcomes. Methods/materialsWe retrospectively analyzed 48 patients undergoing OCT guided bifurcation PCI using the ‘Bifurcation and Ostial OCT Mapping’ (BOOM) technique. The primary efficacy variable studied was stent precision following deployment, defined as the distance of the most proximal stent strut from the true ostium of the target vessel. Additionally, targeted follow-up occurred by phone at 6- and 12-months post procedure, where the frequency of myocardial infarction, target lesion revascularization, target vessel and non-target vessel revascularization, and mortality were collected. ResultsA total of 40 (83.3 %) had an ostial lesion that required treatment while the remaining patients had true bifurcation disease. Most target lesions were in either the LAD or its branches (29 lesions (60.3 %)). With respect to stent positioning, the median absolute geographic miss, (i.e., stent protrusion into the main branch or lack of complete ostial stent coverage), was 0.75 mm. At 6 months, one patient required target lesion revascularization with no additional patients at 12 months. ConclusionsBOOM is a safe and simple strategy that can be a useful technique to optimize precise stent placement for ostial and bifurcation lesions.