Treatment of Coronary Bifurcation Lesions, Part I: Implanting the First Stent in the Provisional Pathway. The 16th Expert Consensus Document of the European Bifurcation Club

Overview

Journal EuroIntervention

Specialties Cardiology & Vascular Diseases
Pharmacology

Date 2022 May 16

PMID 35570748

Authors

Remo Albiero

Francesco Burzotta

Jens Flensted Lassen

Thierry Lefevre

Adrian P Banning

Yiannis S Chatzizisis

Thomas W Johnson

Miroslaw Ferenc

Manuel Pan

Olivier Daremont

David Hildick-Smith

Alaide Chieffo

Yves Louvard

Goran Stankovic

Affiliations

Soon will be listed here.

Abstract

Stepwise layered provisional stenting (PS) is the most commonly used strategy to treat coronary bifurcation lesions (CBL). The term 'stepwise layered' emphasises the versatility of this approach that allows the adjustment of the procedure plan according to the CBL complexity, starting with stent implantation in one branch and implantation of a second stent in the other branch only when required. A series of refinements have been implemented over the years to facilitate the achievement of predictable procedural results using this approach. However, despite its simplicity and versatility, operators using this technique require full knowledge of the pitfalls of each procedural step. Part I of this 16 European Bifurcation Club consensus paper provides a detailed step-by-step overview of the pitfalls and technical troubleshooting during the implantation of the first stent using the PS strategy for the treatment of CBL.

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References

Burzotta F, Lassen J, Louvard Y, Lefevre T, Banning A, Daremont O . European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions. Catheter Cardiovasc Interv. 2020; 96(5):1067-1079. PMC: 8915133. DOI: 10.1002/ccd.29071. View

Toth G, Sasi V, Franco D, Prassl A, Di Serafino L, Ng J . Double-kissing culotte technique for coronary bifurcation stenting. EuroIntervention. 2020; 16(9):e724-e733. DOI: 10.4244/EIJ-D-20-00130. View

Zhong M, Tang B, Zhao Q, Cheng J, Jin Q, Fu S . Should kissing balloon inflation after main vessel stenting be routine in the one-stent approach? A systematic review and meta-analysis of randomized trials. PLoS One. 2018; 13(6):e0197580. PMC: 6021082. DOI: 10.1371/journal.pone.0197580. View

Burzotta F, Trani C . Jailed balloon protection and rescue balloon jailing techniques set the field for safer bifurcation provisional stenting. Int J Cardiol. 2015; 201:376-7. DOI: 10.1016/j.ijcard.2015.06.185. View

Hall A, Chavez I, Garcia S, Gossl M, Poulose A, Sorajja P . Double kissing crush bifurcation stenting: step-by-step troubleshooting. EuroIntervention. 2020; 17(4):e317-e325. PMC: 8919516. DOI: 10.4244/EIJ-D-19-00721. View

Wang X, Matsumura M, Mintz G, Lee T, Zhang W, Cao Y . In Vivo Calcium Detection by Comparing Optical Coherence Tomography, Intravascular Ultrasound, and Angiography. JACC Cardiovasc Imaging. 2017; 10(8):869-879. DOI: 10.1016/j.jcmg.2017.05.014. View

Onuma Y, Katagiri Y, Burzotta F, Holm N, Amabile N, Okamura T . Joint consensus on the use of OCT in coronary bifurcation lesions by the European and Japanese bifurcation clubs. EuroIntervention. 2018; 14(15):e1568-e1577. DOI: 10.4244/EIJ-D-18-00391. View

Ng J, Foin N, Ang H, Fam J, Sen S, Nijjer S . Over-expansion capacity and stent design model: An update with contemporary DES platforms. Int J Cardiol. 2016; 221:171-9. DOI: 10.1016/j.ijcard.2016.06.097. View

Burzotta F, Lassen J, Lefevre T, Banning A, Chatzizisis Y, Johnson T . Percutaneous coronary intervention for bifurcation coronary lesions: the 15 consensus document from the European Bifurcation Club. EuroIntervention. 2020; 16(16):1307-1317. PMC: 8919527. DOI: 10.4244/EIJ-D-20-00169. View

10.

Kocka V, Theriault-Lauzier P, Xiong T, Ben-Shoshan J, Petr R, Labos M . Optimal Fluoroscopic Projections of Coronary Ostia and Bifurcations Defined by Computed Tomographic Coronary Angiography. JACC Cardiovasc Interv. 2020; 13(21):2560-2570. DOI: 10.1016/j.jcin.2020.06.042. View

11.

Lassen J, Albiero R, Johnson T, Burzotta F, Lefevre T, Iles T . Treatment of coronary bifurcation lesions, part II: implanting two stents. The 16th expert consensus document of the European Bifurcation Club. EuroIntervention. 2022; 18(6):457-470. PMC: 11064682. DOI: 10.4244/EIJ-D-22-00166. View

12.

Di Gioia G, Sonck J, Ferenc M, Chen S, Colaiori I, Gallinoro E . Clinical Outcomes Following Coronary Bifurcation PCI Techniques: A Systematic Review and Network Meta-Analysis Comprising 5,711 Patients. JACC Cardiovasc Interv. 2020; 13(12):1432-1444. DOI: 10.1016/j.jcin.2020.03.054. View

13.

Brunel P, Lefevre T, Darremont O, Louvard Y . Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: results of the French multicenter "TULIPE" study. Catheter Cardiovasc Interv. 2006; 68(1):67-73. DOI: 10.1002/ccd.20800. View

14.

Jin Z, Yang S, Jing L, Liu H . Impact of StentBoost subtract imaging on patient radiation exposure during percutaneous coronary intervention. Int J Cardiovasc Imaging. 2013; 29(6):1207-13. DOI: 10.1007/s10554-013-0200-3. View

15.

Lefevre T, Darremont O, Albiero R . Provisional side branch stenting for the treatment of bifurcation lesions. EuroIntervention. 2011; 6 Suppl J:J65-71. DOI: 10.4244/EIJV6SUPJA11. View

16.

Banning A, Lassen J, Burzotta F, Lefevre T, Darremont O, Hildick-Smith D . Percutaneous coronary intervention for obstructive bifurcation lesions: the 14th consensus document from the European Bifurcation Club. EuroIntervention. 2019; 15(1):90-98. DOI: 10.4244/EIJ-D-19-00144. View

17.

Williams P, Mamas M, Morgan K, El-Omar M, Clarke B, Bainbridge A . Longitudinal stent deformation: a retrospective analysis of frequency and mechanisms. EuroIntervention. 2011; 8(2):267-74. DOI: 10.4244/EIJV8I2A41. View

18.

Sandoval Y, Lobo A, Brilakis E . Covered stent implantation through a single 8-french guide catheter for the management of a distal coronary perforation. Catheter Cardiovasc Interv. 2017; 90(4):584-588. DOI: 10.1002/ccd.27020. View

19.

Choi Y, Lee S, Kim B, Hong S, Ahn C, Kim J . Effect of Wire Jailing at Side Branch in 1-Stent Strategy for Coronary Bifurcation Lesions. JACC Cardiovasc Interv. 2022; 15(4):443-455. DOI: 10.1016/j.jcin.2021.11.012. View

20.

Hildick-Smith D, Egred M, Banning A, Brunel P, Ferenc M, Hovasse T . The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN). Eur Heart J. 2021; 42(37):3829-3839. DOI: 10.1093/eurheartj/ehab283. View