A challenging technical scenario frequently encountered in a percutaneous coronary intervention of a coronary bifurcation lesion(CBL)is stent implantation of only the stenosed segment without compromising the other tw...A challenging technical scenario frequently encountered in a percutaneous coronary intervention of a coronary bifurcation lesion(CBL)is stent implantation of only the stenosed segment without compromising the other two normal segments in non-true bifurcation lesions.Another is precise stent implantation covering the side branch ostium without leaving excessive stent metal at the other two segments of a bifurcation lesion in complex true bifurcation lesions.The aim of this study was to describe a novel stenting technique for both non-true and true CBLs by using a guide extension catheter(GuideLiner).With the assistance of a guide extension catheter mounted on both the main and the side-branch guidewires and with its intubation down to the bifurcation carina,a stent can be implanted in the side branch segment or distal main segment of the bifurcation lesion appropriately without compromising the other two segments of the coronary bifurcation.Stent implantation is described in three bifurcation lesions in three cases and shown in detail with illustrative figures.The technique facilitates side-branch only stenting in side-branch mono-ostial(medina 0,0,1)CBL or only the distal main segment in distal mono-ostial(medina 0,1,0)CBL without compromising the other two remaining segments when using the onestent technique in non-true CBLs without leaving unnecessary excessive stent metal at the bifurcation site and when using a two-stent technique in complex true bifurcation lesions(tri-ostial or medina 1,1,1).Consequently,through optimizing stent deployment,the technique may have the potential to reduce the risk of subacute stent thrombosis and future in-stent restenosis.The most appropriate lesions suitable for the technique,and some other practical tips are also described.展开更多
Objective:The optimal percutaneous coronary intervention(PCI)technique for bifurcation lesions remains controversial,especially considering the variability of the side branch(SB).A provisional stenting technique is cu...Objective:The optimal percutaneous coronary intervention(PCI)technique for bifurcation lesions remains controversial,especially considering the variability of the side branch(SB).A provisional stenting technique is currently recommended in most cases.This meta-analysis aimed to compare outcomes of different bifurcation PCI strategies,clarifying their scope of application.Methods:Randomized controlled trials comparing PCI strategies for coronary bifurcation lesions were systematically retrieved from PubMed,Cochrane,Web of Science,and EBSCO literature databases without limitations on published date or language.Major adverse cardiovascular events(MACEs)were stipulated as main outcomes.Secondary outcomes of interest were all-cause mortality,cardiovascular mortality,target lesion revascularization(TLR),target vessel revascularization,myocardial infarction(MI),and stent thrombosis.Both pooled analysis and sub-group analysis were performed.Results:Twenty-three randomized controlled trials with 6380 participants were included.Eighteen studies compared the provisional strategy with 2-stent approaches.No significant difference in MACEs(relative risk(RR),1.16;95%confidence interval(CI),0.90-1.48;I2=62%)was found between 1-stent and 2-stent techniques.However,when SB lesion length was used as the separation condition,the 2-stent strategy was associated with fewer MACEs(RR,1.87;95%CI,1.46-2.41;I2=70%),TLRs(RR,2.13;95%CI,1.50-3.02;I2=59%),and MIs(RR,2.17;95%CI,1.19-3.95;I2=52%)than the provisional strategy in those where SB lesions measured>10 mm long.Conclusions:In the current work,there was no significant difference between 1-stent and 2-stent techniques in terms of MACEs or secondary outcomes.However,2-stent approaches have clinical advantages over the provisional strategy in bifurcation when the SB lesion length is>10 mm due to fewer cases of TLR and MI.展开更多
文摘A challenging technical scenario frequently encountered in a percutaneous coronary intervention of a coronary bifurcation lesion(CBL)is stent implantation of only the stenosed segment without compromising the other two normal segments in non-true bifurcation lesions.Another is precise stent implantation covering the side branch ostium without leaving excessive stent metal at the other two segments of a bifurcation lesion in complex true bifurcation lesions.The aim of this study was to describe a novel stenting technique for both non-true and true CBLs by using a guide extension catheter(GuideLiner).With the assistance of a guide extension catheter mounted on both the main and the side-branch guidewires and with its intubation down to the bifurcation carina,a stent can be implanted in the side branch segment or distal main segment of the bifurcation lesion appropriately without compromising the other two segments of the coronary bifurcation.Stent implantation is described in three bifurcation lesions in three cases and shown in detail with illustrative figures.The technique facilitates side-branch only stenting in side-branch mono-ostial(medina 0,0,1)CBL or only the distal main segment in distal mono-ostial(medina 0,1,0)CBL without compromising the other two remaining segments when using the onestent technique in non-true CBLs without leaving unnecessary excessive stent metal at the bifurcation site and when using a two-stent technique in complex true bifurcation lesions(tri-ostial or medina 1,1,1).Consequently,through optimizing stent deployment,the technique may have the potential to reduce the risk of subacute stent thrombosis and future in-stent restenosis.The most appropriate lesions suitable for the technique,and some other practical tips are also described.
基金funded by grants from the Nanjing Health Science and Technology Development Special Fund Project(ZKX20034)the Jiangsu Provincial Special Program of Medical Science(BE2019615).
文摘Objective:The optimal percutaneous coronary intervention(PCI)technique for bifurcation lesions remains controversial,especially considering the variability of the side branch(SB).A provisional stenting technique is currently recommended in most cases.This meta-analysis aimed to compare outcomes of different bifurcation PCI strategies,clarifying their scope of application.Methods:Randomized controlled trials comparing PCI strategies for coronary bifurcation lesions were systematically retrieved from PubMed,Cochrane,Web of Science,and EBSCO literature databases without limitations on published date or language.Major adverse cardiovascular events(MACEs)were stipulated as main outcomes.Secondary outcomes of interest were all-cause mortality,cardiovascular mortality,target lesion revascularization(TLR),target vessel revascularization,myocardial infarction(MI),and stent thrombosis.Both pooled analysis and sub-group analysis were performed.Results:Twenty-three randomized controlled trials with 6380 participants were included.Eighteen studies compared the provisional strategy with 2-stent approaches.No significant difference in MACEs(relative risk(RR),1.16;95%confidence interval(CI),0.90-1.48;I2=62%)was found between 1-stent and 2-stent techniques.However,when SB lesion length was used as the separation condition,the 2-stent strategy was associated with fewer MACEs(RR,1.87;95%CI,1.46-2.41;I2=70%),TLRs(RR,2.13;95%CI,1.50-3.02;I2=59%),and MIs(RR,2.17;95%CI,1.19-3.95;I2=52%)than the provisional strategy in those where SB lesions measured>10 mm long.Conclusions:In the current work,there was no significant difference between 1-stent and 2-stent techniques in terms of MACEs or secondary outcomes.However,2-stent approaches have clinical advantages over the provisional strategy in bifurcation when the SB lesion length is>10 mm due to fewer cases of TLR and MI.
