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Practical based approach to left main bifurcation stenting.

Ahn JM, Lee PH, Park SJ - BMC Cardiovasc Disord (2016)

Bottom Line: However, elective two-stent techniques, none of which has been proven superior to the others, are still used in patients with severely diseased large side branches to avoid acute hemodynamic compromise.In addition, unnecessary complex intervention can be avoided by measuring fractional flow reserve in angiographically isolated side branches.Most importantly, good long-term clinical outcomes are more related to the successful procedure itself than to the type of stenting technique, emphasizing the greater importance of optimizing the chosen technique than the choice of method.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea. drjmahn@gmail.com.

ABSTRACT
Despite the recent developments that have been made in the field of percutaneous left main (LM) intervention, the treatment of distal LM bifurcation remains challenging. The provisional one-stent approach for LM bifurcation has shown more favorable outcomes than the two-stent technique, making the former the preferred strategy in most types of LM bifurcation stenosis. However, elective two-stent techniques, none of which has been proven superior to the others, are still used in patients with severely diseased large side branches to avoid acute hemodynamic compromise. Selecting the proper bifurcation treatment strategy using meticulous intravascular ultrasound evaluation for side branch ostium is crucial for reducing the risk of side branch occlusion and for improving patient outcomes. In addition, unnecessary complex intervention can be avoided by measuring fractional flow reserve in angiographically isolated side branches. Most importantly, good long-term clinical outcomes are more related to the successful procedure itself than to the type of stenting technique, emphasizing the greater importance of optimizing the chosen technique than the choice of method.

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Related in: MedlinePlus

Fractional flow measurement after main vessel stenting. A patient with a distal LM bifurcation disease (a) underwent provisional one-stent implantation (b). After main vessel stenting, significant stenosis was observed at the ostium of the left circumflex artery (c). However, fractional flow reserve value was 0.92, indicating functionally insignificant stenosis (d), and suggesting that additional procedures were unnecessary
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Fig2: Fractional flow measurement after main vessel stenting. A patient with a distal LM bifurcation disease (a) underwent provisional one-stent implantation (b). After main vessel stenting, significant stenosis was observed at the ostium of the left circumflex artery (c). However, fractional flow reserve value was 0.92, indicating functionally insignificant stenosis (d), and suggesting that additional procedures were unnecessary

Mentions: Because of the large myocardial volume supplied by the left circumflex artery (LCX) in many patients, the possibility of circulatory collapse after main vessel (MV) stenting should always be considered. Therefore, the presence or absence of significant disease in the ostium of the LCX is regarded as an important factor in choosing a stenting strategy. The provisional one-stent approach is preferred for LM bifurcations with insignificant stenosis at the ostial LCX or a non-dominant left coronary system (Fig. 2). By contrast, the elective two-stent technique is preferred in patients with significant ostial stenosis of the LCX with a dominant left coronary arterial system [9, 10]. Fractional flow reserve (FFR) evaluation for the side branch (SB) has provided valuable information on the relation between physiological and angiographic severity and can be useful to make correct choice of the treatment strategy [11]. Table 2 summarizes the selection criteria for stenting strategies based on the anatomic features involving the LM bifurcation.Fig. 2


Practical based approach to left main bifurcation stenting.

Ahn JM, Lee PH, Park SJ - BMC Cardiovasc Disord (2016)

Fractional flow measurement after main vessel stenting. A patient with a distal LM bifurcation disease (a) underwent provisional one-stent implantation (b). After main vessel stenting, significant stenosis was observed at the ostium of the left circumflex artery (c). However, fractional flow reserve value was 0.92, indicating functionally insignificant stenosis (d), and suggesting that additional procedures were unnecessary
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4759961&req=5

Fig2: Fractional flow measurement after main vessel stenting. A patient with a distal LM bifurcation disease (a) underwent provisional one-stent implantation (b). After main vessel stenting, significant stenosis was observed at the ostium of the left circumflex artery (c). However, fractional flow reserve value was 0.92, indicating functionally insignificant stenosis (d), and suggesting that additional procedures were unnecessary
Mentions: Because of the large myocardial volume supplied by the left circumflex artery (LCX) in many patients, the possibility of circulatory collapse after main vessel (MV) stenting should always be considered. Therefore, the presence or absence of significant disease in the ostium of the LCX is regarded as an important factor in choosing a stenting strategy. The provisional one-stent approach is preferred for LM bifurcations with insignificant stenosis at the ostial LCX or a non-dominant left coronary system (Fig. 2). By contrast, the elective two-stent technique is preferred in patients with significant ostial stenosis of the LCX with a dominant left coronary arterial system [9, 10]. Fractional flow reserve (FFR) evaluation for the side branch (SB) has provided valuable information on the relation between physiological and angiographic severity and can be useful to make correct choice of the treatment strategy [11]. Table 2 summarizes the selection criteria for stenting strategies based on the anatomic features involving the LM bifurcation.Fig. 2

Bottom Line: However, elective two-stent techniques, none of which has been proven superior to the others, are still used in patients with severely diseased large side branches to avoid acute hemodynamic compromise.In addition, unnecessary complex intervention can be avoided by measuring fractional flow reserve in angiographically isolated side branches.Most importantly, good long-term clinical outcomes are more related to the successful procedure itself than to the type of stenting technique, emphasizing the greater importance of optimizing the chosen technique than the choice of method.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea. drjmahn@gmail.com.

ABSTRACT
Despite the recent developments that have been made in the field of percutaneous left main (LM) intervention, the treatment of distal LM bifurcation remains challenging. The provisional one-stent approach for LM bifurcation has shown more favorable outcomes than the two-stent technique, making the former the preferred strategy in most types of LM bifurcation stenosis. However, elective two-stent techniques, none of which has been proven superior to the others, are still used in patients with severely diseased large side branches to avoid acute hemodynamic compromise. Selecting the proper bifurcation treatment strategy using meticulous intravascular ultrasound evaluation for side branch ostium is crucial for reducing the risk of side branch occlusion and for improving patient outcomes. In addition, unnecessary complex intervention can be avoided by measuring fractional flow reserve in angiographically isolated side branches. Most importantly, good long-term clinical outcomes are more related to the successful procedure itself than to the type of stenting technique, emphasizing the greater importance of optimizing the chosen technique than the choice of method.

Show MeSH
Related in: MedlinePlus