Impact of the stent expansion index (EXPI) in percutaneous coronary intervention (PCI) for unprotected left main distal bifurcation lesions (ULMD) has been not completely understood especially in ...current-generation drug-eluting stent (cDES) era. We evaluated the impact of EXPI on clinical outcomes after PCI with cDES for ULMD. We identified 342 patients treated with cDES for ULMD and postintervention intravascular ultrasound between January 2010 and December 2019. In this study, the ratio of minimum stent area (MSA) to reference vessel area at the MSA site was adopted to assess the stent expansion. We defined the patients with the first and second tertile as low-intermediate EXPI group and those with the third tertile as high EXPI group and compared the clinical outcomes between both groups. The primary end point was target lesion failure (TLF). TLF was defined as a composite of cardiac death, target lesion revascularization (TLR) ,and myocardial infarction. The MSA was located in the ostium of left anterior descending coronary artery in most cases (318 of 342 patients; 93.0%). There were no significant differences between both groups in the baseline clinical, lesion, and procedural characteristics. The high EXPI group had lower TLF rate than the low-intermediate EXPI group (10.2% vs 19.9%, log-rank p = 0.033). In conclusion, this is the first report that the higher ratio of MSA to reference vessel area at the MSA site, which was defined as stent EXPI, was associated with more favorable clinical outcomes after PCI for ULMD.
Objectives
This study evaluated the 5‐years outcomes of intracoronary imaging‐guided proximal optimization technique (POT) for percutaneous coronary intervention (PCI) in patients with unprotected ...left main distal bifurcation lesions (ULMD).
Background
The long‐term effects of POT with intracoronary imaging guide in PCI for ULMD have been unclear.
Methods
Between January 2005 and December 2015, we identified 1832 consecutive patients who underwent DES implantation for ULM distal bifurcation lesions. Of them, 780 (56.1%) patients underwent POT with intravascular imaging guidance (optimal expansion group). Residual 611 (43.9%) patients did not undergo either POT or intravascular imaging or both (suboptimal expansion group). Analysis using propensity score adjustment was performed. The primary endpoint was target lesion failure (TLF) defined as a composite of cardiac death, target lesion revascularization (TLR), and myocardial infarction.
Results
TLF rate at 5 years was significantly lower in optimal expansion group than that in suboptimal expansion group adjusted HR 0.65, 95% CI (0.48–0.87), p = 0.004. Cardiac mortality was significantly lower in optimal expansion group than that in suboptimal expansion group adjusted HR 0.46, 95% CI (0.27–0.79), p = 0.004. The multivariable analysis identified POT with intravascular imaging guide adjusted HR 0.65, 95% CI (0.48–0.87), p = 0.004 as an independent predictor of TLF.
Conclusions
Intravascular imaging guided POT was strongly associated with the reduced risk of TLF at 5 years after PCI for ULMD, mainly driven by reducing cardiac mortality.
There are no available data about clinical outcomes of simple stenting for ostial left circumflex (LCX) lesions using current generation drug-eluting stents (cDES).
We assessed clinical outcomes ...after simple stenting using cDES for ostial LCX lesions.
We identified 81 consecutive patients who underwent PCI using cDES for ostial LCX lesions at New Tokyo Hospital, Matsudo, Japan between January 2010 and December 2016. An ostial LCX lesion was defined as a lesion with more than 75% stenosis by visual assessment and within 3 mm of the left main (LM) stem. The primary endpoint was target lesion failure (TLF). TLF was defined as a composite of cardiac death, target lesion revascularization (TLR) and myocardial infarction (MI). Additionally, we also assessed the revascularization for LM to left anterior descending artery (LAD) after ostial LCX stenting.
The TLF rate at 3 years after PCI was 24.5%. Furthermore, the rate of TLR and revascularization for LM-LAD after ostial LCX stenting were significantly higher in patients who were previously undergone stent implantation in ostial segment of LAD.
Clinical outcomes after cDES implantation for ostial LCX lesion could be acceptable. However, it could have better to be avoided in patients who previously received stent implantation in ostial segment of LAD.
Coronary sinus Reducer represents a novel therapeutic option for refractory angina. As emerging evidence of both reduction in angina symptoms and reduction of myocardial ischemia burden might lead to ...increased Reducer implantations, knowledge on how to manage potential complications is of clinical importance. We report a successful management of scaffold migration in right atrium.
The aim of this study was to determine the safety and efficacy of chimney stenting, a bailout technique to treat coronary artery occlusion (CAO).
CAO during transcatheter aortic valve replacement ...(TAVR) is a rare but often fatal complication.
In the international Chimney Registry, patient and procedural characteristics and data on outcomes are retrospectively collected from patients who underwent chimney stenting during TAVR.
To date, 16 centers have contributed 60 cases among 12,800 TAVR procedures (0.5%). Chimney stenting was performed for 2 reasons: 1) due to the development of an established CAO (n = 25 41.6%); or 2) due to an impending CAO (n = 35 58.3%). The majority of cases (92.9%) had 1 or more classical risk factors for CAO. Upfront coronary protection was performed in 44 patients (73.3%). Procedural and in-hospital mortality occurred in 1 and 2 patients, respectively. Myocardial infarction (52.0% vs. 0.0%; p < 0.01), cardiogenic shock (52.0% vs. 2.9%; p < 0.01), and resuscitation (44.0% vs. 2.9%; p < 0.01) all occurred more frequently in patients with established CAO compared with those with impending CAO. The absence of upfront coronary protection was the sole independent risk factor for the combined endpoint of death, cardiogenic shock, or myocardial infarction. During a median follow-up time of 612 days (interquartile range: 405 to 842 days), 2 cases of stent failure were reported (1 in-stent restenosis, 1 possible late stent thrombosis) after 157 and 374 days.
Chimney stenting appears to be an acceptable bailout technique for CAO, with higher event rates among those with established CAO and among those without upfront coronary protection.
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