Impact of technique on bifurcation stent outcomes in the European Bifurcation Club Left Main Coronary Trial.

Autor: Arunothayaraj S; Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK., Lassen JF; Department of Cardiology, Odense University Hospital, Odense, Denmark., Clesham GJ; Department of Cardiology, Essex Cardiothoracic Centre, Basildon, Essex, UK.; Cardiovascular System Block, MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex, UK., Spence MS; Department of Cardiology, Belfast Health and Social Care Trust, Belfast, UK., Koning R; Department of Cardiology, Clinique Saint Hilaire, Rouen, France., Banning AP; Department of Cardiology, Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Lindsay M; Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK., Christiansen EH; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Egred M; Department of Cardiology, Freeman Hospital & Newcastle University, Newcastle upon Tyne, UK., Cockburn J; Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK., Mylotte D; Department of Cardiology, University Hospital and National University of Ireland, Galway, Ireland., Brunel P; Interventional Cardiology Unit, Clinique de Fontaine, Dijon, France., Ferenc M; Division of Cardiology and Angiology II, Universitäts-Herzzentrum Bad Krozingem, Bad Krozingen, Germany., Hovasse T; Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France., Wlodarczak A; Department of Cardiology, Poland Miedziowe Centrum Zdrowia Lubin, Lubin, Poland., Pan M; Department of Cardiology, Reina Sofia Hospital, University of Cordoba (IMIBIC), Cordoba, Spain., Silvestri M; Department of Cardiology, GCS Axium, Rambot, Aix en Provence, France., Erglis A; Department of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia., Kretov E; Interventional Cardiology Unit, Sibirskiy Fеdеrаl Biomedical Research Center Novosibirsk, Novosibirsk, Russia., Chieffo A; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy., Lefèvre T; Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France., Burzotta F; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy., Darremont O; Department of Cardiology, Clinique Saint-Augustin-Elsan, Bordeaux, France., Stankovic G; Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia., Morice MC; Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France., Louvard Y; Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France., Hildick-Smith D; Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2023 Feb; Vol. 101 (3), pp. 553-562. Date of Electronic Publication: 2023 Jan 29.
DOI: 10.1002/ccd.30575
Abstrakt: Background: Techniques for provisional and dual-stent left main bifurcation stenting require optimization.
Aim: To identify technical variables influencing procedural outcomes and periprocedural myocardial infarction following left main bifurcation intervention.
Methods: Procedural and outcome data were analyzed in 438 patients from the per-protocol cohort of the European Bifurcation Club Left Main Trial (EBC MAIN). These patients were randomized to the provisional strategy or a compatible dual-stent extension (T, T-and-protrude, or culotte).
Results: Mean age was 71 years and 37.4% presented with an acute coronary syndrome. Transient reduction of side vessel thrombolysis in myocardial infarction flow occurred after initial stent placement in 5% of procedures but was not associated with periprocedural myocardial infarction. Failure to rewire a jailed vessel during any strategy was more common when jailed wires were not used (9.5% vs. 2.5%, odds ratio [OR]: 6.4, p = 0.002). In the provisional cohort, the use of the proximal optimization technique was associated with less subsequent side vessel intervention (23.3% vs. 41.9%, OR: 0.4, p = 0.048). Side vessel stenting was predominantly required for dissection, which occurred more often following side vessel preparation (15.3% vs. 4.4%, OR: 3.1, p = 0.040). Exclusive use of noncompliant balloons for kissing balloon inflation was associated with reduced need for side vessel intervention in provisional cases (20.5% vs. 38.5%, OR: 0.4, p = 0.013), and a reduced risk of periprocedural myocardial infarction across all strategies (2.9% vs. 7.7%, OR: 0.2, p = 0.020).
Conclusion: When performing provisional or compatible dual-stent left main bifurcation intervention, jailed wire use is associated with successful jailed vessel rewiring. Side vessel preparation in provisional patients is linked to increased side vessel dissection requiring stenting. Use of the proximal optimization technique may reduce the need for additional side vessel intervention, and noncompliant balloon use for kissing balloon inflation is associated with a reduction in both side vessel stenting and periprocedural myocardial infarction.
Clinical Trial Registration: ClinicalTrials.gov Identifier NCT02497014.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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