Impact of side-branch flow in coronary bifurcation intervention

Hamid Reza Poorhosseini, Seyed Ebrahim Kassaian, Seyed Kianoosh Hosseini, Mohmmad Fotoohi, Mojtaba Salarifar, Mohammad Alidoosti, Ahmad Sharafi, Younes Nozari, Ebrahim Nematipour, Hassan Aghajani, Ali Mohammad Haji Zeinali, Alireza Amirzadegan, Behzad Babapour, Mir Hosein Seyed Mohammad Zadeh, Hamid Reza Poorhosseini, Seyed Ebrahim Kassaian, Seyed Kianoosh Hosseini, Mohmmad Fotoohi, Mojtaba Salarifar, Mohammad Alidoosti, Ahmad Sharafi, Younes Nozari, Ebrahim Nematipour, Hassan Aghajani, Ali Mohammad Haji Zeinali, Alireza Amirzadegan, Behzad Babapour, Mir Hosein Seyed Mohammad Zadeh

Abstract

Background: The optimal strategy in percutaneous coronary intervention (PCI) for coronary artery bifurcation lesions has yet to be agreed upon. We compared a strategy for stenting the main vessel to provide a complete perfusion flow in the side branch, namely thrombolysis in myocardial infarction (TIMI) - III, with a strategy for intervention in both the main vessel and the side branch (MV + SB).

Methods: This retrospective study utilized data on 258 consecutive patients with bifurcation lesions scheduled for PCI at Tehran Heart Center between March 2003 and March 2008. The patients were followed up for 12 months, and the primary end point was a major adverse cardiac event (MACE), i.e. cardiac death, myocardial infarction, target-vessel revascularization, and target-lesion revascularization during the 12-month follow-up period.

Results: A total of 52.7% of the patients underwent PCI on the main vessel of the bifurcation lesions (MV group) and 47.3% with a similar lesion type received a percutaneous intervention on both the main vessel and the side branch (MV + SB group). The total rate of MACE during the follow-up was 4.3% (11 patients); the rate was not significantly different between the MV and MV + SB groups (3.7% vs. 4.9%, respectively; p value = 0.622).

Conclusion: There was no association between MACE in performing a simple or complex interventional strategy to treat coronary bifurcation lesions when drawing the TIMI- III flow as a goal in a simple technique.

Keywords: Angioplasty; Coronary bifurcation lesion; MACE.

References

    1. Ounpuu S, Negassa A, Yusuf S. Inter-heart: a global study of risk factors for acute myocardial infarction. Am Heart J. 2001;141:711–721.
    1. Ghadimi H, Bishehsari F, Allameh F, Bozorgi AH, Sodagari N, Karami N, Yaghoubi M, Emami S, Ghadimi F, Haerizadeh BF, Sanati A. Clinical characteristics, hospital morbidity and mortality, and up to 1-year follow-up events of acute myocardial infarction patients: the first report from Iran. Coron Artery Dis. 2006;17:585–591.
    1. Korn HV, Yu J, Ohlow MA, Huegl B, Schulte W, Wagner A, Wassmer G, Gruene S, Petek O, Lauer B. Interventional therapy of bifurcation lesions. A TIMI flow-guided concept to treat side branches in bifurcation lesions: a prospective randomized clinical study (Thueringer Bifurcation Study, THUEBIS Study as Pilot Trial) Circulation: Cardiovascular Interventions. 2009;2:535–542.
    1. Lefèvre T, Louvard Y, Morice MC, Dumas P, Loubeyre C, Benslimane A, Premchand RK, Guillard N, Piéchaud JF. Stenting of bifurcation lesions: classification, treatments, and results. Catheter Cardiovasc Interv. 2000;49:274–283.
    1. Kassaian SE, Alidoosti M, Salarifar M, Haji Zeinali A, Nematipour E, Sadeghian S, Poorhosseini H, Pirzadeh L, Goodarzynejad H, Sharafi A. Short-term outcomes and mid-term follow-up after coronary angioplasty in patients younger than 40 years of age. J Teh Univ Heart Ctr. 2007;2:81–86.
    1. George BS, Myler RK, Stertzer SH, Clark DA, Cote G, Shaw RE, Fishman-Rosen J, Murphy M. Balloon angioplasty of coronary bifurcation lesions: the kissing balloon technique. Catheter Cardiovasc Diagn. 1986;12:124–138.
    1. Louvard Y, Lefevre T, Morice MC. Percutaneous coronary intervention for bifurcation coronary disease. Heart. 2004;90:713–722.
    1. Assali AR, Teplitsky I, Hasdai D, Rechavia E, Solodky A, Sela O, Butto N, Shor N, Fuchs S, Battler A, Kornowski R. Coronary bifurcation lesions: to stent one branch or both? J Invasive Cardiol. 2004;16:447–450.
    1. Al Suwaidi J, Berger PB, Rihal CS, Garratt KN, Bell MR, Ting HH, Bresnahan JF, Grill DE, Holmes DR., Jr Immediate and long-term outcome of intracoronary stent implantation for true bifurcation lesions. J Am Coll Cardiol. 2000;35:929–936.
    1. Anzuini A, Briguori C, Rosanio S, Tocchi M, Pagnotta P, Bonnier H, Gimelli G, Airoldi F, Margonato A, Legrand V, Colombo A. Immediate and long-term clinical and angiographic results from Wiktor stent treatment for true bifurcation narrowings. Am J Cardiol. 2001;88:1246–1250.
    1. Pan M, Suárez de Lezo J, Medina A, Romero M, Hernández E, Segura J, Castroviejo JR, Pavlovic D, Melian F, Ramírez A, Castillo JC. Simple and complex stent strategies for bifurcated coronary arterial stenosis involving the side branch origin. Am J Cardiol. 1999;83:1320–1325.
    1. Yamashita T, Nishida T, Adamian MG, Briguori C, Vaghetti M, Corvaja N, Albiero R, Finci L, Di Mario C, Tobis JM, Colombo A. Bifurcation lesions: two stents versus one stent—immediate and follow-up results. J Am Coll Cardiol. 2000;35:1145–1151.
    1. Jorgensen E, Helqvist S. Stent treatment of coronary artery bifurcation lesions. Eur Heart J. 2007;28:383–385.
    1. Ong AT, Hoye A, Aoki J, van Mieghem CA, Rodriguez Granillo GA, Sonnenschein K, Regar E, McFadden EP, Sianos G, van der Giessen WJ, de Jaegere PP, de Feyter P, van Domburg RT, Serruys PW. Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation. J Am Coll Cardiol. 2005;45:947–953.
    1. Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, Airoldi F, Chieffo A, Montorfano M, Carlino M, Michev I, Corvaja N, Briguori C, Gerckens U, Grube E, Colombo A. Incidence, predictors and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293:2126–2130.
    1. Ge L, Airoldi F, Iakovou I, Cosgrave J, Michev I, Sangiorgi GM, Montorfano M, Chieffo A, Carlino M, Corvaja N, Colombo A. 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. J Am Coll Cardiol. 2005;46:613–620.
    1. Kaplan AV. Percutaneous coronary intervention treatment of bifurcation lesions: a work in progress. J Am Coll Cardiol Intv. 2009;2:195–196.
    1. Cho GY, Lee CW, Hong MK, Kim JJ, Park SW, Park SJ. Effects of stent design on side branch occlusion after coronary stent placement. Catheter Cardiovasc Interv. 2001;52:18–23.
    1. Pan M, Suárez de Lezo J, Medina A, Romero M, Delgado A, Segura J, Ojeda S, Mazuelos F, Hernandez E, Melian F, Pavlovic D, Esteban F, Herrador J. Drug-eluting stents for the treatment of bifurcation lesions: a randomized comparison between paclitaxel and Sirolimus stents. Am Heart J. 2007;153:15.e1–7.
    1. Ostovan MA, Mollazadeh R. Immediate small side branch occlusion after percutaneous coronary intervention. J Teh Univ Heart. 2007;2:217–222.
    1. Zhang F, Dong L, Ge J. Simple versus complex stenting strategy for coronary artery bifurcation lesions in the drug-eluting stent era: a meta-analysis of randomised trials. Heart. 2009;95:1676–1681.
    1. Colombo A, Moses JW, Morice MC, Ludwig J, Holmes DR, Jr, Spanos V, Louvard Y, Desmedt B, Di Mario C, Leon MB. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation. 2004;109:1244–1249.
    1. Pan M, de Lezo JS, Medina A, Romero M, Segura J, Pavlovic D, Delgado A, Ojeda S, Melián F, Herrador J, Ureña I, Burgos L. Rapamycin-eluting stents for the treatment of bifurcated coronary lesions: a randomized comparison of a simple versus complex strategy. Am Heart J. 2004;148:857–864.
    1. Steigen TK, Maeng M, Wiseth R, Erglis A, Kumsars I, Narbute I, Gunnes P, Mannsverk J, Meyerdierks O, Rotevatn S, Niemelä M, Kervinen K, Jensen JS, Galløe A, Nikus K, Vikman S, Ravkilde J, James S, Aarøe J, Ylitalo A, Helqvist S, Sjögren I, Thayssen P, Virtanen K, Puhakka M, Airaksinen J, Lassen JF, Thuesen L, Nordic PCI Study Group. Nordic PCI Study Group Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic Bifurcation Study. Circulation. 2006;114:1955–1961.
    1. Ferenc M, Gick M, Kienzle RP, Bestehorn HP, Werner KD, Comberg T, Kuebler P, Büttner HJ, Neumann FJ. Randomized trial on routine vs provisional T-stenting in the treatment of de novo coronary bifurcation lesions. Eur Heart J. 2008;29:2859–2867.
    1. Colombo A, Bramucci E, Saccà S, Violini R, Lettieri C, Zanini R, Sheiban I, Paloscia L, Grube E, Schofer J, Bolognese L, Orlandi M, Niccoli G, Latib A, Airoldi F. Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (Coronary Bifurcations: application of the Crushing Technique Using Sirolimus-Eluting Stents) Study. Circulation. 2009;119:71–78.
    1. SYNTAX Score Working Group. Gameren MV. SYNTAX Score. (25 March 2012)
    1. Sousa JE, Serruys PW, Costa MA. New frontiers in cardiology: drug eluting stents: Part I. Circulation. 2003;107:2274–2279.
    1. Niccoli G, Ferrante G, Porto I, Burzotta F, Leone AM, Mongiardo R, Mazzari MA, Trani C, Rebuzzi AG, Crea F. Coronary bifurcation lesions: to stent one branch or both? A meta-analysis of patients treated with drug eluting stents. Int J Cardiol. 2010;139:80–91.
    1. Iakovou I, Ge L, Colombo A. Contemporary stent treatment of coronary bifurcations. J Am Coll Cardiol. 2005;46:1446–1455.
    1. Gunalingam B, Chan RYJ. A novel buddy balloon technique to recross a T-stented bifurcation. Catheter Cardiovasc Interv. 2009;74:103–107.
    1. Koo BK, Kang HJ, Youn TJ, Chae IH, Choi DJ, Kim HS, Sohn DW, Oh BH, Lee MM, Park YB, Choi YS, Tahk SJ. Physiologic assessment of jailed side branch lesions using fractional flow reserve. J Am Coll Cardiol. 2005;46:633–637.
    1. Koo BK, Park KW, Kang HJ, Cho YS, Chung WY, Youn TJ, Chae IH, Choi DJ, Tahk SJ, Oh BH, Park YB, Kim HS. Physiological evaluation of the provisional side-branch intervention strategy for bifurcation lesions using fractional flow reserve. Eur Heart J. 2008;29:726–732.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する