Google Scholar. Porto, I. Plaque volume and occurrence and location of periprocedural myocardial necrosis after percutaneous coronary intervention: Insights from delayed-enhancement magnetic resonance imaging, thrombolysis in myocardial infarction myocardial perfusion grade analysis, and intravascular ultrasound. Chevalier, B. Left main bifurcation angioplasty: Are 2 stents one too many?.
Brilakis, E. DK-Crush should become preferred strategy for treating unprotected LM bifurcation lesions: No pain, no gain. Chieffo, A. EuroIntervention 12 , 47—52 Zhang, J. BMJ Open. Xu, B. Impact of operator experience and volume on outcomes after left main coronary artery percutaneous coronary intervention. Download references. You can also search for this author in PubMed Google Scholar. All the authors have participated in the study and manuscript preparation, and have approved the final version of the manuscript: J.
Correspondence to Shubin Qiao or Bo Xu. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions. Wang, J. Sci Rep 10, Download citation. Received : 17 February Accepted : 05 June Published : 26 June Anyone you share the following link with will be able to read this content:.
Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. By submitting a comment you agree to abide by our Terms and Community Guidelines.
If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Advanced search. Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily. Skip to main content Thank you for visiting nature. Download PDF. Subjects Cardiovascular diseases Coronary artery disease and stable angina Interventional cardiology Ischaemia.
Abstract There are controversies on optimal stenting strategy regarding true left main LM bifurcation lesions. Introduction Percutaneous coronary intervention PCI for bifurcation lesions, particularly those in the left main LM coronary artery, carries the risk of potential acute occlusion of side branches SB and higher rates of in-stent restenosis events 1 , 2 , 3.
Outcomes and definitions Cardiac death was defined as any death due to cardiac cause e. Statistical analysis Categorical variables are reported as percentage counts and were compared using chi-square or Fisher exact test.
Results Baseline characteristics Among the true LM bifurcation patients, Figure 1. Full size image. Table 1 Baseline patient characteristics between 1- or 2-stent strategy by LM bifurcation group. Full size table. Table 2 Baseline lesion characteristics between 1- or 2-stent strategy by LM bifurcation group. Table 3 Procedural characteristics and results. Table 4 Clinical Outcomes in simple and complex groups.
Figure 2. Figure 3. Complexity differentiation of true LM bifurcation lesions Differentiation of bifurcation lesion complexity is aimed at informing precise and personalized treatment ultimately reducing SB occlusion and short- and long-term adverse clinical events.
Limitations The study has the limitations inherent to its retrospective design, which might have introduced selection bias; however, we used an IPTW method to minimize such possibility. References 1. Article Google Scholar 2. Article Google Scholar 3. Article Google Scholar 4. Article Google Scholar 5. Article Google Scholar 6. Article Google Scholar 7. Article Google Scholar 8.
Article Google Scholar 9. Article Google Scholar Google Scholar Article Google Scholar Download references. View author publications. Ethics declarations Competing interests The authors declare no competing interests. Additional information Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information. Supplementary file. About this article. Cite this article Wang, J.
Coronary by-pass operation with grafting or PCI of index lesion. Target vessel revascularization. Coronary by-pass operation with grafting or PCI of index vessel.
Stent thrombosis. Vessel measurement. Proximal reference diameter: Vessel diameter proximal to lesion. Distal reference diameter: Vessel diameter distal to lesion.
Reference diameter: Mean of proximal and distal vessel diameter. Angiographic restenosis. Definition of index angiography The angiography obtained during the PCI procedure will be used as index angiography. Follow-up angiography. After 8 months, conventional diagnostic angiography will be performed and the projections used at the index angiography will be repeated.
Steering committee The steering committee members will be selected on basis of participation in the study, see below.
All steering committee members will have full access to the database and will participate in the interpretation of data. Progress of the study The progress of the study will be checked on a weekly basis by the steering committee.
They will receive and evaluate data on inclusion rate and the primary end point event rate. Further, the steering committee will receive and evaluate the weekly safety data on the rate of stent thrombosis in the three groups. Primary end point. The composite of the primary end points at six months follow-up will be analyzed by the Kaplan-Meier method. Differences between the event-free survival curves for the three groups will be compared with the use of the Wilcoxon and log-rank tests. Two-sided test is used, and the p-value considered to indicate significance will be 0.
Secondary end points and other parameters: For continuous variables, differences between the treatment groups will be evaluated by analysis of variance or Wilcoxon's rank-sum test. For discrete variables, differences will be expressed as counts, and percentages will be analyzed with Fisher's exact test.
Secondary end-points will be assessed after 8 months. Safety For safety reasons, stent thrombosis after one month will be monitored continuously. Analysis Population Results are analyzed according to the intention-to-treat principle i.
Protocol violations will be noted and the responsible centers notified. Sample size calculation patients will be included in each group, with a total of patients in the study. By including patients in each group, a possible dropout before follow-up is counted for. Randomization procedure The patient will be randomized before insertion of any stent. Both main vessels and side branch may be wired and predilated before randomization.
The patients will be computer randomized by a 24 hour telephone service. Monitoring of the study Data will be monitored according to GCP rules by independent professionals. During the trial, the monitor will have regular contacts with the trial site s , including visits to ensure that the trial is conducted and documented properly in compliance with the protocol, GCP and applicable regulatory requirements.
Publication Results will be published in an international cardiovascular journal. So many years, the protection and the treatment of SB is the key issue of coronary bifurcation stenting, but the clinical outcome is highly dependent on the MV stent expansion, particularly in the patients treated with 1-stent technique. Next question is what the indication of SB ballooning is. The clinical outcome, however, was proved not to be improved by the FFR-guided treatment of SB compared to conventional strategy.
POT is also beneficial to facilitate the cross of wire and balloon after MV stenting. It should cover the proximal edge of stent carina, which can be done by aligning the proximal edge of distal balloon marker with the tip of stent carina Figure 4. The clinical impact of this new technique should be tested in the clinical trial. B Correct positioning of a post-dilating balloon, aligning the proximal edge of distal balloon marker with the tip of stent carina.
C Post-dilation. D MV stent is expanded after post-dilation. Current consensus is that the provisional approach is the standard strategy for the most of coronary bifurcation stenting. The indication of SB treatment, however, is not clear in the provisional approach. Target vessel failure TVF , the primary endpoint was similar between 2 groups 9. Interestingly, TLR was numerically higher 7. As a conclusion, the indication of SB stenting is better to be conservative. Most of bifurcation lesion can be treated with the provisional approach, but still we have some cases we have to consider 2-stent technique.
There have several trials to find the best elective 2-stent techniques, but the results are quite variable. Maybe the optimal result especially in term of stent expansion is much more important than the selection of a specific 2-stent technique.
Currently most popular techniques are T-stent and small protrusion, mini-crush technique, mini-culotte technique, and DK-crush technique. I prefer T-stenting and small protrusion technique, because it is simple, provisional in nature, and above all the most familiar to me. Even after so many studies, still we have more questions than answers.
We do not know whether the elective 2-stenting is better with next generation DES. We do not know the future roles of dedicated bifurcation stent and fully bioresorbable scaffold in the bifurcation lesion. The best clinical come is the most important goal of coronary bifurcation stenting. Good question and persistent study will make it happen. Conflict of Interest: The author has no financial conflicts of interest.
National Center for Biotechnology Information , U. Journal List Korean Circ J v. Korean Circ J. Published online Apr Find articles by Hyeon-Cheol Gwon. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Mar 19; Accepted Apr 4. The Korean Society of Cardiology. This article has been cited by other articles in PMC. Abstract Coronary bifurcation stenting is still complex and associated with a high risk of stent thrombosis and restenosis even with contemporary techniques.
Keywords: Bifurcation lesion, Stents, Percutaneous coronary intervention. Open in a separate window. Figure 1. Various nomenclature systems of bifurcation lesion. Figure 2. Plaque shift and carina shift The occlusion of SB after MV stenting is one of the most common complications during bifurcation stenting. How to prevent SB occlusion The risk of SB occlusion during the procedure is the major cause of the complexity of coronary bifurcation stenting.
Figure 3. Figure 4. Indication of SB stenting in the provisional approach Current consensus is that the provisional approach is the standard strategy for the most of coronary bifurcation stenting. What is the best 2-stent technique? Footnotes Conflict of Interest: The author has no financial conflicts of interest. Data curation: Gwon HC. Formal analysis: Gwon HC. Investigation: Gwon HC. Methodology: Gwon HC. Supervision: Gwon HC. Validation: Gwon HC. Writing - original draft: Gwon HC.
References 1. J Am Coll Cardiol. Restenosis rates following bifurcation stenting with sirolimus-eluting stents for de novo narrowings. Am J Cardiol. Clinical and angiographic outcome after implantation of drug-eluting stents in bifurcation lesions with the crush stent technique: importance of final kissing balloon post-dilation. Long-term outcomes of provisional stenting compared with a two-stent strategy for bifurcation lesions: a meta-analysis of randomized trials.
Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled-analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study. Circ Cardiovasc Interv. Colombo A, Jabbour RJ. Bifurcation lesions: no need to implant two stents when one is sufficient!
0コメント