Gérard Finet1, François Derimay2, Pascal Motreff3, Patrice Guerin4, Paul Pilet4, Jacques Ohayon5, Olivier Darremont6, Gilles Rioufol2. 1. Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unités Mixtes de Recherche 1060, Lyon, France. Electronic address: gerard.finet@univ-lyon1.fr. 2. Department of Interventional Cardiology, Cardiovascular Hospital and Claude Bernard University and INSERM Unités Mixtes de Recherche 1060, Lyon, France. 3. Cardiology Department, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France. 4. Cardiology, Unités Mixtes de Recherche 915, l'Institut du Thorax, Nantes, France. 5. Laboratory TIMC-IMAG, DynaCell, Centre National de la Recherche Scientifique, Unités Mixtes de Recherche 5525, Institut de l'Ingénierie et de l'Information de Santé (In3S), Grenoble, France. 6. Clinique Saint Augustin, Bordeaux, France.
Abstract
OBJECTIVES: This study used a fractal bifurcation bench model to compare 6 optimization sequences for coronary bifurcation provisional stenting, including 1 novel sequence without kissing balloon inflation (KBI), comprising initial proximal optimizing technique (POT) + side-branch inflation (SBI) + final POT, called "re-POT." BACKGROUND: In provisional bifurcation stenting, KBI fails to improve the rate of major adverse cardiac events. Proximal geometric deformation increases the rate of in-stent restenosis and target lesion revascularization. METHODS: A bifurcation bench model was used to compare KBI alone, KBI after POT, KBI with asymmetric inflation pressure after POT, and 2 sequences without KBI: initial POT plus SBI, and initial POT plus SBI with final POT (called "re-POT"). For each protocol, 5 stents were tested using 2 different drug-eluting stent designs: that is, a total of 60 tests. RESULTS: Compared with the classic KBI-only sequence and those associating POT with modified KBI, the re-POT sequence gave significantly (p < 0.05) better geometric results: it reduced SB ostium stent-strut obstruction from 23.2 ± 6.0% to 5.6 ± 8.3%, provided perfect proximal stent apposition with almost perfect circularity (ellipticity index reduced from 1.23 ± 0.02 to 1.04 ± 0.01), reduced proximal area overstretch from 24.2 ± 7.6% to 8.0 ± 0.4%, and reduced global strut malapposition from 40 ± 6.2% to 2.6 ± 1.4%. CONCLUSIONS: In comparison with 5 other techniques, the re-POT sequence significantly optimized the final result of provisional coronary bifurcation stenting, maintaining circular geometry while significantly reducing SB ostium strut obstruction and global strut malapposition. These experimental findings confirm that provisional stenting may be optimized more effectively without KBI using re-POT.
OBJECTIVES: This study used a fractal bifurcation bench model to compare 6 optimization sequences for coronary bifurcation provisional stenting, including 1 novel sequence without kissing balloon inflation (KBI), comprising initial proximal optimizing technique (POT) + side-branch inflation (SBI) + final POT, called "re-POT." BACKGROUND: In provisional bifurcation stenting, KBI fails to improve the rate of major adverse cardiac events. Proximal geometric deformation increases the rate of in-stent restenosis and target lesion revascularization. METHODS: A bifurcation bench model was used to compare KBI alone, KBI after POT, KBI with asymmetric inflation pressure after POT, and 2 sequences without KBI: initial POT plus SBI, and initial POT plus SBI with final POT (called "re-POT"). For each protocol, 5 stents were tested using 2 different drug-eluting stent designs: that is, a total of 60 tests. RESULTS: Compared with the classic KBI-only sequence and those associating POT with modified KBI, the re-POT sequence gave significantly (p < 0.05) better geometric results: it reduced SB ostium stent-strut obstruction from 23.2 ± 6.0% to 5.6 ± 8.3%, provided perfect proximal stent apposition with almost perfect circularity (ellipticity index reduced from 1.23 ± 0.02 to 1.04 ± 0.01), reduced proximal area overstretch from 24.2 ± 7.6% to 8.0 ± 0.4%, and reduced global strut malapposition from 40 ± 6.2% to 2.6 ± 1.4%. CONCLUSIONS: In comparison with 5 other techniques, the re-POT sequence significantly optimized the final result of provisional coronary bifurcation stenting, maintaining circular geometry while significantly reducing SB ostium strut obstruction and global strut malapposition. These experimental findings confirm that provisional stenting may be optimized more effectively without KBI using re-POT.
Authors: Ilias Nikolakopoulos; Evangelia Vemmou; Judit Karacsonyi; Lorenzo Azzalini; Brian A Bergmark; Yiannis S Chatzizisis; Allison B Hall; Jason Wollmuth; Kevin Croce; Hani Jneid; Bavana V Rangan; M Nicholas Burke; Emmanouil S Brilakis Journal: J Invasive Cardiol Date: 2022-01 Impact factor: 2.022
Authors: Gianluca Rigatelli; Fabio Dell'Avvocata; Marco Zuin; Sara Giatti; Khanh Duong; Trung Pham; Nguyen Si Tuan; Dobrin Vassiliev; Ramesh Daggubati; Thach Nguyen Journal: J Transl Int Med Date: 2017-12-29
Authors: Robert J Gil; Jacek Bil; Ricardo A Costa; Katarzyna E Gil; Dobrin Vassiliev Journal: Int J Cardiovasc Imaging Date: 2016-06-17 Impact factor: 2.357