0371: Bifurcation techniques with ABSORB® bioresorbable vascular scaffold: optical frequency-domain imaging and micro-computed tomography assessment

AimsWe aimed to determine the correlation between optical frequency-domain imaging (OFDI) and micro-computed tomography (mCT) in the quantitative and qualitative assessment of ABSORB® bioresorbable vascular scaffold (BVS) in a bench test of multiple bifurcation technique.MethodBVS were deployed in bifurcation silicon phantoms divided into two benches. Bench A is a LAD-diagonal bifurcation with a 40° angle and bench B, a left main bifurcation with a 70° angle. Finet’s law was respected. Different bifurcation techniques (provisional T stenting, kissing balloon, mini crush and culotte) were performed with a total of 16 procedures, 8 for each bench. All procedures were imaged by OFDI and mCT. BVS area, lumen area, number of struts, maximal stent thickness, disruption, lumen protrusion and deformation were the parameters collected. The analysis was performed in each segment, proximal, bifurcation and distal.ResultsIn bench A, we found no differences between OFDI and mCT for each proximal, bifurcation and distal segments concerning BVS area, lumen area, number of struts, maximal stent thickness, fractures, lumen protrusion, BVS deformation or BVS fragments. In the proximal segment, length was higher in mCT (13.2mm vs 10.4mm; p<0.0001) and there was more malapposition detected in mCT (75% vs 0%, p=0.007). In bench B, for the proximal segment, lumen area was higher (13.7mm2 vs 13.mm2, p=0.01) and we found more BVS malapposition in mCT (100% vs 0%, p=0.0002). All the other parameters were similar. In each bench, the apposition defect measured by mCT remained minimal.ConclusionWe demonstrated an excellent correlation between OFDI and mCT which is considered as the gold standard to evaluate stent in bench tests. In vitro techniques can now be validated in vivo using OFDI

Suivi sur 1 an de 44 patients traités par alcoolosation ou embolisation septale pour cardiomyopathie hypertrophique obstructive en Aquitaine

Objectifs : Evaluer sur 1 an l'efficacité et les complications des procédures d'ablation septale par alcoolisation (AS) ou embolisation (ES) septales réalisées pour cardiomyopathie hypertrophique. Comparer les résultats entre AS et ES. Etudier la valeur pronostique du taux d'enzyme cardiaque post-procédure sur les résultats. Méthode : Etude observationnelle rétrospective concernant toutes les procédures d'ablation septale au CHU de Bordeaux et à la Clinique Saint-Augustin jusqu'à mi-2012. L'efficacité des procédures était jugée par les critères : évolution du gradient maximal d'obstruction de repos, de la dyspnée par grade NYHA, du nombre de symptômes fonctionnels (malaise/syncope, palpitations, douleur thoracique/angor). Les critères principaux de tolérance recueillis étaient : mortalité, incidence de bloc auriculo-ventriculaire complet (BAV 3), de pose de Pacemaker, de troubles du rythme ventriculaire. Le recueil a été effectué par analyse rétrospective des dossiers médicaux et compte-rendus de consultation et d'échocardiographie de suivi. Résultat : Sur 46 patients, 44 ont été inclus dans l'étude pour 49 interventions. Les 2 sous-groupes étaient comparables. Le gain de gradient moyen à 1 an était de 62 % (p<0,0001 ; N=45) avec une différence significative AS/ES (72mmHg (83 % ; N=27) / 35mmHg (35 % ; N=18) ; p=0,004). Le gain moyen de grade de dyspnée était de 1,17 (N=44) (1,61 / 0,41 ; p=0,007) et le gain moyen de symptômes fonctionnels était de 0,43 (N=44) (0,68 / 0,14 ; p=0,033). Les ES n'ont donné aucune complication. Pour les AS, la mortalité et l'incidence de troubles du rythme ventriculaires était nulle, l'incidence de BAV 3 était de 43 % (N=13 ; p<0,001), de pose de pacemaker de 33 % (N=10 ; p=0,035). Conclusion : L'AS a une efficacité supérieure à L'ES et comparable à la chirurgie, mais une incidence de BAV 3 importante. Ces procédures sont sûres. Le taux de troponine semble prédictif de BAV 3 et de gain de gradient, mais nécessite d'autres études.BORDEAUX2-BU Santé (330632101) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocSudocFranceF

Percutaneous coronary intervention for bifurcation disease.A consensus view from the first meeting of the European Bifurcation Club.

peer reviewe

Percutaneous coronary intervention of bifurcation lesions: state-of-the-art. Insights from the second meeting of the European Bifurcation Club.

peer reviewe

Percutaneous coronary intervention for obstructive bifurcation lesions: the 14th consensus document from the European Bifurcation Club

The European Bifurcation Club recommends an approach to a bifurcation stenosis which involves careful assessment, planning and a sequential provisional approach. In the minority of lesions where two stents are required, careful deployment and optimal expansion are essential to achieve a long-term result

Unprotected left main stenting in the real world: two-year outcomes of the French left main taxus registry

BACKGROUND: Cardiac surgery is the reference treatment for patients with left main (LM) disease, although percutaneous coronary intervention with drug-eluting stents is emerging as a possible alternative. The objective of this registry was to evaluate the 2-year outcome of elective percutaneous coronary intervention for unprotected LM disease with paclitaxel-eluting stents. METHODS AND RESULTS: A total of 291 patients were prospectively included from 4 centers. Acute myocardial infarction and cardiogenic shock were the only exclusion criteria. Patients were 69+/-11 years old, 29% were diabetic, and 25% had 3-vessel disease. For distal LM lesions (78%), the provisional side-branch T-stenting approach was used in 92% of cases and final kissing balloon inflation in 97%. Angiographic success was obtained in 99.7% of cases. At 2-year follow-up, the total cardiac death rate was 5.4% (1 EuroSCORE point was associated with a 15% [95% confidence interval 2.9% to 28.2%, P=0.013] higher risk of cardiac death), target-lesion revascularization was 8.7%, and incidence of Q-wave or non-Q-wave myocardial infarction was 0.9% and 3.1%, respectively. The combined end point occurred in 15.8% of cases and stroke in 0.7%. The incidence of definite and probable LM stent thrombosis was 0.7%, whereas the incidence of any stent thrombosis was 3.8%, with a higher risk in patients with side-branch stenting in the presence of LM bifurcation lesions (hazard ratio 9.6, 95% confidence interval 1.2 to 77.7, P=0.035). CONCLUSIONS: Unprotected LM stenting with paclitaxel-eluting stents, with a strategy of provisional side-branch T-stenting for distal lesions, provides excellent acute angiographic results and good mid-term clinical outcomes, with a 15.8% rate of major adverse cardiac events at 2-year follow-up

Classification of coronary artery bifurcation lesions and treatments: time for a consensus!

BACKGROUND: Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains a subject of debate. Many studies have been published in this setting. They are often small scale and display methodological flaws and other shortcomings such as inaccurate designation of lesions, heterogeneity, and inadequate description of techniques implemented. METHODS: The aim is to propose a consensus established by the European Bifurcation Club (EBC), on the definition and classification of bifurcation lesions and treatments implemented with the purpose of allowing comparisons between techniques in various anatomical and clinical settings. RESULTS: A bifurcation lesion is a coronary artery narrowing occurring adjacent to, and/or involving, the origin of a significant side branch. The simple lesion classification proposed by Medina has been adopted. To analyze the outcomes of different techniques by intention to treat, it is necessary to clearly define which vessel is the distal main branch and which is (are) the side branche(s) and give each branch a distinct name. Each segment of the bifurcation has been named following the same pattern as the Medina classification. The classification of the techniques (MADS: Main, Across, Distal, Side) is based on the manner in which the first stent has been implanted. A visual presentation of PCI techniques and devices used should allow the development of a software describing quickly and accurately the procedure performed. CONCLUSION: The EBC proposes a new classification of bifurcation lesions and their treatments to permit accurate comparisons of well described techniques in homogeneous lesion groups

Early and long-term results of unprotected left main coronary artery stenosis with paclitaxel-eluting stents: the FRIEND (French multicentre RegIstry for stenting of uNprotecteD LMCA stenosis) registry.

International audienceAIMS: To evaluate the angiographic and clinical outcome of patients undergoing paclitaxel-eluting stent (PES) implantation for unprotected left main coronary artery (ULMCA) stenosis in a "real-world" multicentre, prospective registry. Percutaneous coronary intervention (PCI) is an increasingly utilised method of revascularisation in patients with ULMCA. METHODS AND RESULTS: A prospective registry including all patients with a significant (>50%) ULMCA stenosis. Of 151 such patients, the target lesion involved the distal bifurcation in 100 patients (66%), which was treated predominantly by a "provisional T-stenting" strategy. In the distal ULMCA disease group, 72% had only one stent implantation while 28% had multiple (either two or three) stents implanted. At a median follow-up of 1,123±80 days, cardiac death occurred in five patients (3.3%) and major adverse cardiac and cerebrovascular events (MACCE) in 32 patients (21.2%). The three-year survival rate was 93.3%. CONCLUSIONS: In the drug-eluting stent era, paclitaxel-eluting stent implantation of ULMCA stenosis provided excellent immediate and long-term results in this selected population, suggesting that this approach may be considered as a safe and effective alternative to CABG for selected patients with ULMCA who are treated in experienced institutions performing large numbers of PCI procedures