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Drug eluting stents: focus on Cypher sirolimus-eluting coronary stents in the treatment of patients with bifurcation lesions.

Chieffo A, Aranzulla TC, Colombo A - Vasc Health Risk Manag (2007)

Bottom Line: The introduction of drug-eluting stent (DES) has remarkably improved the outcome in bifurcation lesions compared to BMS, resulting in lower adverse events and main branch (MB) restenosis rates.Furthermore, although the "provisional" stenting technique (second stent on the SB placed, after the MB stenting, only in case of suboptimal or inadequate result) remained the prevailing approach, several two-stent techniques emerged (crush) or were re-introduced (V, T, culottes) to allow stenting in both branches when needed.Moreover, no study has so far addressed which is the best strategy to use among the several techniques reported in the literature when both branches are intentionally stented from the outset.

View Article: PubMed Central - PubMed

Affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.

ABSTRACT
Coronary bifurcations represent a challenging lesions subset and account for up to 15% of all current PCI. Regardless of the stenting technique used, however, restenosis rate after bare metal stent (BMS) is high, especially at the ostium of the side branch (SB). The introduction of drug-eluting stent (DES) has remarkably improved the outcome in bifurcation lesions compared to BMS, resulting in lower adverse events and main branch (MB) restenosis rates. Furthermore, although the "provisional" stenting technique (second stent on the SB placed, after the MB stenting, only in case of suboptimal or inadequate result) remained the prevailing approach, several two-stent techniques emerged (crush) or were re-introduced (V, T, culottes) to allow stenting in both branches when needed. At the present time, only few randomized studies and some observational reports specifically addressed the issue of bifurcation lesion treatment with sirolimus-eluting stents (SES). It is still not clear yet which is the better strategy between the provisional approach and stenting both branches when dealing with a bifurcation lesion which has a stenosis in the SB suitable for stenting. Moreover, no study has so far addressed which is the best strategy to use among the several techniques reported in the literature when both branches are intentionally stented from the outset. Finally, the introduction of dedicated stents for different types of bifurcations, with specific stent designs to provide good deliverability, secured access to the side branch, complete coverage of the lesion site without double/triple layers of stent struts, thus incorporating the benefits of drug elution and ensuring drug availability to all diseased surfaces, may further facilitate the conquest of one of the most challenging areas in interventional cardiology.

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Related in: MedlinePlus

Current practise in the treatment of bifurcation lesions in our Center.
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fig1: Current practise in the treatment of bifurcation lesions in our Center.

Mentions: The introduction of DES has markedly improved the outcome in bifurcation lesions as compared to BMS, resulting in lower adverse events and restenosis rates (Colombo et al 2004; Pan et al 2004; Ge et al 2005b; Tanabe et al 2004). Furthermore, although the “provisional” stenting technique (second stent on the SB placed after the MB stenting, only in case of suboptimal result or complication in side branch) remained the prevailing approach, several two-stent techniques emerged (crush) or were re-introduced (V, T, culottes) (Iakovou et al 2005a). In our experience (Figure 1) the provisional stent approach is in general the preferred one when the SB diameter is less than 2.25 mm and it is not diffusely diseased (Iakovou et al 2005a). Conversely, stenting of both branches as intention-to-treat, is preferred in true bifurcations with a diffusely diseased SB ≥2.25 mm in diameter.


Drug eluting stents: focus on Cypher sirolimus-eluting coronary stents in the treatment of patients with bifurcation lesions.

Chieffo A, Aranzulla TC, Colombo A - Vasc Health Risk Manag (2007)

Current practise in the treatment of bifurcation lesions in our Center.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2291332&req=5

fig1: Current practise in the treatment of bifurcation lesions in our Center.
Mentions: The introduction of DES has markedly improved the outcome in bifurcation lesions as compared to BMS, resulting in lower adverse events and restenosis rates (Colombo et al 2004; Pan et al 2004; Ge et al 2005b; Tanabe et al 2004). Furthermore, although the “provisional” stenting technique (second stent on the SB placed after the MB stenting, only in case of suboptimal result or complication in side branch) remained the prevailing approach, several two-stent techniques emerged (crush) or were re-introduced (V, T, culottes) (Iakovou et al 2005a). In our experience (Figure 1) the provisional stent approach is in general the preferred one when the SB diameter is less than 2.25 mm and it is not diffusely diseased (Iakovou et al 2005a). Conversely, stenting of both branches as intention-to-treat, is preferred in true bifurcations with a diffusely diseased SB ≥2.25 mm in diameter.

Bottom Line: The introduction of drug-eluting stent (DES) has remarkably improved the outcome in bifurcation lesions compared to BMS, resulting in lower adverse events and main branch (MB) restenosis rates.Furthermore, although the "provisional" stenting technique (second stent on the SB placed, after the MB stenting, only in case of suboptimal or inadequate result) remained the prevailing approach, several two-stent techniques emerged (crush) or were re-introduced (V, T, culottes) to allow stenting in both branches when needed.Moreover, no study has so far addressed which is the best strategy to use among the several techniques reported in the literature when both branches are intentionally stented from the outset.

View Article: PubMed Central - PubMed

Affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.

ABSTRACT
Coronary bifurcations represent a challenging lesions subset and account for up to 15% of all current PCI. Regardless of the stenting technique used, however, restenosis rate after bare metal stent (BMS) is high, especially at the ostium of the side branch (SB). The introduction of drug-eluting stent (DES) has remarkably improved the outcome in bifurcation lesions compared to BMS, resulting in lower adverse events and main branch (MB) restenosis rates. Furthermore, although the "provisional" stenting technique (second stent on the SB placed, after the MB stenting, only in case of suboptimal or inadequate result) remained the prevailing approach, several two-stent techniques emerged (crush) or were re-introduced (V, T, culottes) to allow stenting in both branches when needed. At the present time, only few randomized studies and some observational reports specifically addressed the issue of bifurcation lesion treatment with sirolimus-eluting stents (SES). It is still not clear yet which is the better strategy between the provisional approach and stenting both branches when dealing with a bifurcation lesion which has a stenosis in the SB suitable for stenting. Moreover, no study has so far addressed which is the best strategy to use among the several techniques reported in the literature when both branches are intentionally stented from the outset. Finally, the introduction of dedicated stents for different types of bifurcations, with specific stent designs to provide good deliverability, secured access to the side branch, complete coverage of the lesion site without double/triple layers of stent struts, thus incorporating the benefits of drug elution and ensuring drug availability to all diseased surfaces, may further facilitate the conquest of one of the most challenging areas in interventional cardiology.

Show MeSH
Related in: MedlinePlus