Skip to main content
SpringerLink
Log in
Book cover

Textbook of Catheter-Based Cardiovascular Interventions pp 745–776Cite as

Treatment of Coronary Bifurcation Lesions

  • Chapter
  • First Online:

Abstract

The optimal treatment for coronary bifurcation lesions is still the subject of debate. Balloon angioplasty for this type of lesion used to be associated with significant risk of acute complications compounded by a high risk of recurrent stenosis. With the advent of bare-metal stents, the first controversies arose as to whether one or several stents should be used to treat these lesions. The outcome of various nonrandomized studies demonstrated the benefit of implementing a single-stent strategy, whereby a stent is implanted in the main branch across the side branch. Drug-eluting stents allowed considerable reduction in the risk of restenosis and repeat interventions while encouraging the development of numerous complex techniques permitting complete bifurcation coverage. However, the results of large randomized studies, for which 5-year data is now available, confirmed the absence of benefits for complex strategies compared with provisional side-branch stenting, when both approaches are possible. Today, the provisional side branch stenting approach is considered the gold standard. This chapter explains when and how to perform this technique and how to resolve common difficulties. It also describes when and how to use a two-stent approach.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Latib A, Colombo A. Bifurcation disease: what do we know, what should we do? JACC Cardiovasc Interv. 2008;1:218–26.

    Article  PubMed  Google Scholar 

  2. Gao XF, Zhang YJ, Tian NL, et al. Stenting strategy for coronary artery bifurcation with drug-eluting stents: a meta-analysis of nine randomised trials and systematic review. EuroIntervention. 2014;10:561–9.

    Article  PubMed  Google Scholar 

  3. Kassab GS. Functional hierarchy of coronary circulation: direct evidence of a structure-function relation. Am J Phys Heart Circ Phys. 2005;289:H2559–65.

    CAS  Google Scholar 

  4. Kassab GS, Bhatt DL, Lefevre T, Louvard Y. Relation of angiographic side branch calibre to myocardial mass: a proof of concept myocardial infarct index. EuroIntervention. 2013;8:1461–3.

    Article  PubMed  Google Scholar 

  5. Kassab GS, Finet G. Anatomy and function relation in the coronary tree: from bifurcations to myocardial flow and mass. EuroIntervention. 2015;11(Suppl V):V13–7.

    Article  PubMed  Google Scholar 

  6. Kamiya A, Takahashi T. Quantitative assessments of morphological and functional properties of biological trees based on their fractal nature. J Appl Physiol. 2007;102:2315–23.

    Article  PubMed  Google Scholar 

  7. Murray CD. The physiological principle of minimum work: I. The vascular system and the cost of blood volume. Proc Natl Acad Sci U S A. 1926;12:207–14.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Murray CD. The physiological principle of minimum work applied to the angle of branching of arteries. J Gen Physiol. 1926;9:835–41.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Huo Y, Kassab GS. A scaling law of vascular volume. Biophys J. 2009;96:347–53.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Finet G, Gilard M, Perrenot B, et al. Fractal geometry of arterial coronary bifurcations: a quantitative coronary angiography and intravascular ultrasound analysis. EuroIntervention. 2008;3:490–8.

    Article  PubMed  Google Scholar 

  11. Choy JS, Kassab GS. Scaling of myocardial mass to flow and morphometry of coronary arteries. J Appl Physiol. 2008;104:1281–s6.

    Article  PubMed  Google Scholar 

  12. Asakura T, Karino T. Flow patterns and spatial distribution of atherosclerotic lesions in human coronary arteries. Circ Res. 1990;66:1045–66.

    Article  PubMed  CAS  Google Scholar 

  13. Chatzizisis YS, Jonas M, Coskun AU, et al. Prediction of the localization of high-risk coronary atherosclerotic plaques on the basis of low endothelial shear stress: an intravascular ultrasound and histopathology natural history study. Circulation. 2008;117:993–1002.

    Article  PubMed  Google Scholar 

  14. Joner M, Finn AV, Farb A, et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol. 2006;48:193–202.

    Article  PubMed  Google Scholar 

  15. Shimada Y, Courtney BK, Nakamura M, et al. Intravascular ultrasonic analysis of atherosclerotic vessel remodeling and plaque distribution of stenotic left anterior descending coronary arterial bifurcation lesions upstream and downstream of the side branch. Am J Cardiol. 2006;98:193–6.

    Article  PubMed  Google Scholar 

  16. van der Giessen AG, Wentzel JJ, Meijboom WB, et al. Plaque and shear stress distribution in human coronary bifurcations: a multislice computed tomography study. EuroIntervention. 2009;4:654–61.

    Article  PubMed  Google Scholar 

  17. Medina A, Martin P. Suarez de Lezo J et al. ultrasound study of the prevalence of plaque at the carina in lesions that affect the coronary bifurcation. Implications for treatment with provisional stent. Rev Esp Cardiol. 2011;64:43–50.

    Article  PubMed  Google Scholar 

  18. Nakazawa G, Yazdani SK, Finn AV, Vorpahl M, Kolodgie FD, Virmani R. Pathological findings at bifurcation lesions: the impact of flow distribution on atherosclerosis and arterial healing after stent implantation. J Am Coll Cardiol. 2010;55:1679–87.

    Article  PubMed  Google Scholar 

  19. Spaziano M, Theriault-Lauzier P, Meti N, et al. Optimal fluoroscopic viewing angles of left-sided heart structures in patients with aortic stenosis and mitral regurgitation based on multislice computed tomography. J Cardiovasc Comput Tomogr. 2016;10:162–72.

    Article  PubMed  Google Scholar 

  20. Ahmed JM, Mintz GS, Weissman NJ, et al. Mechanism of lumen enlargement during intracoronary stent implantation: an intravascular ultrasound study. Circulation. 2000;102:7–10.

    Article  PubMed  CAS  Google Scholar 

  21. Koo BK, Waseda K, Kang HJ, et al. Anatomic and functional evaluation of bifurcation lesions undergoing percutaneous coronary intervention. Circ Cardiovasc Interv. 2010;3:113–9.

    Article  PubMed  Google Scholar 

  22. Saucedo JF, Mehran R, Dangas G, et al. Long-term clinical events following creatine kinase--myocardial band isoenzyme elevation after successful coronary stenting. J Am Coll Cardiol. 2000;35:1134–41.

    Article  PubMed  CAS  Google Scholar 

  23. Bhargava B, Waksman R, Lansky AJ, Kornowski R, Mehran R, Leon MB. Clinical outcomes of compromised side branch (stent jail) after coronary stenting with the NIR stent. Catheter Cardiovasc Interv. 2001;54:295–300.

    Article  PubMed  CAS  Google Scholar 

  24. Louvard Y, Thomas M, Dzavik V, et al. Classification of coronary artery bifurcation lesions and treatments: time for a consensus! Catheter Cardiovasc Interv. 2008;71:175–83.

    Article  PubMed  Google Scholar 

  25. Koller P, Safian R. Bifurcation stenosis in manual of interventional cardiology. Birmingham: Physician’s Press; 1996. p. 229–41.

    Google Scholar 

  26. Spokojny A, Sanborn T. The bifurcation lesion. In: Wilkins WA, editor. Strategic approaches in coronary intervention, vol. 288. Baltimore: Lippincott, Williams and Wilkins; 1996.

    Google Scholar 

  27. Lefevre T, Louvard Y, Morice MC, et al. Stenting of bifurcation lesions: classification, treatments, and results. Catheter Cardiovasc Interv. 2000;49:274–83.

    Article  PubMed  CAS  Google Scholar 

  28. Hoye A, van Mieghem CA, Ong AT, et al. Treatment of de novo bifurcation lesions: comparison of Sirolimus- and paclitaxel-eluting stents. EuroIntervention. 2005;1:24–30.

    PubMed  Google Scholar 

  29. Medina A, Suarez de Lezo J, Pan M. A new classification of coronary bifurcation lesions. Rev Esp Cardiol. 2006;59:183.

    Article  PubMed  Google Scholar 

  30. Movahed MR, Stinis CT. A new proposed simplified classification of coronary artery bifurcation lesions and bifurcation interventional techniques. J Invasive Cardiol. 2006;18:199–204.

    PubMed  Google Scholar 

  31. Topol E, Teirstein P. Textbook of interventional cardiology. 7th ed. Philadelphia: Elsevier; 2016.

    Google Scholar 

  32. Lansky A, Tuinenburg J, Costa M, et al. Quantitative angiographic methods for bifurcation lesions: a consensus statement from the European bifurcation group. Catheter Cardiovasc Interv. 2009;73:258–66.

    Article  PubMed  Google Scholar 

  33. Grundeken MJ, Ishibashi Y, Ramcharitar S, et al. The need for dedicated bifurcation quantitative coronary angiography (QCA) software algorithms to evaluate bifurcation lesions. EuroIntervention. 2015;11(Suppl V):V44–9.

    Article  PubMed  Google Scholar 

  34. Andriotis A, Zifan A, Gavaises M, et al. A new method of three-dimensional coronary artery reconstruction from X-ray angiography: validation against a virtual phantom and multislice computed tomography. Catheter Cardiovasc Interv. 2008;71:28–43.

    Article  PubMed  Google Scholar 

  35. Pflederer T, Ludwig J, Ropers D, Daniel WG, Achenbach S. Measurement of coronary artery bifurcation angles by multidetector computed tomography. Investig Radiol. 2006;41:793–8.

    Article  Google Scholar 

  36. Girasis C, Farooq V, Diletti R, et al. Impact of 3-dimensional bifurcation angle on 5-year outcome of patients after percutaneous coronary intervention for left main coronary artery disease: a substudy of the SYNTAX trial (synergy between percutaneous coronary intervention with taxus and cardiac surgery). JACC Cardiovasc Interv. 2013;6:1250–60.

    Article  PubMed  Google Scholar 

  37. Muramatsu T, Grundeken MJ, Ishibashi Y, et al. Comparison between two- and three-dimensional quantitative coronary angiography bifurcation analyses for the assessment of bifurcation lesions: a subanalysis of the TRYTON pivotal IDE coronary bifurcation trial. Catheter Cardiovasc Interv. 2015;86:E140–9.

    Article  PubMed  Google Scholar 

  38. Sarno G, Garg S, Onuma Y, et al. Bifurcation lesions: functional assessment by fractional flow reserve vs. anatomical assessment using conventional and dedicated bifurcation quantitative coronary angiogram. Catheter Cardiovasc Interv. 2010;76:817–23.

    Article  PubMed  Google Scholar 

  39. Zhang YJ, Zhu H, Shi SY, et al. Comparison between two-dimensional and three-dimensional quantitative coronary angiography for the prediction of functional severity in true bifurcation lesions: insights from the randomized DK-CRUSH II, III, and IV trials. Catheter Cardiovasc Interv. 2016;87(Suppl 1):589–98.

    Article  PubMed  Google Scholar 

  40. Koo BK, Kang HJ, Youn TJ, et al. Physiologic assessment of jailed side branch lesions using fractional flow reserve. J Am Coll Cardiol. 2005;46:633–7.

    Article  PubMed  Google Scholar 

  41. Goktekin O, Kaplan S, Dimopoulos K, et al. A new quantitative analysis system for the evaluation of coronary bifurcation lesions: comparison with current conventional methods. Catheter Cardiovasc Interv. 2007;69:172–80.

    Article  PubMed  Google Scholar 

  42. Ramcharitar S, Onuma Y, Aben JP, et al. A novel dedicated quantitative coronary analysis methodology for bifurcation lesions. EuroIntervention. 2008;3:553–7.

    Article  PubMed  Google Scholar 

  43. Ather S, Bavishi CP, Bhatia V, Bajaj NS, Leesar MA. Comparison of failure rates of crossing side branch with pressure vs. coronary guidewire: a meta-analysis. Eur J Clin Investig. 2016;46:448–59.

    Article  Google Scholar 

  44. Omori H, Kawase Y, Tanigaki T, Matsuo H. The utility of a jailed pressure wire technique for the treatment of coronary bifurcation lesion in a patient with chronic kidney disease. Cardiovasc Interv Ther. 2017;32(3):269–73.

    Article  PubMed  Google Scholar 

  45. Lee JM, Koo BK, Kumsars I, et al. Coronary fractional flow reserve in bifurcation stenoses: what have we learned? EuroIntervention. 2015;11(Suppl V):V59–63.

    Article  PubMed  Google Scholar 

  46. Furukawa E, Hibi K, Kosuge M, et al. Intravascular ultrasound predictors of side branch occlusion in bifurcation lesions after percutaneous coronary intervention. Circ J. 2005;69:325–30.

    Article  PubMed  Google Scholar 

  47. Okamura T, Onuma Y, Yamada J, et al. 3D optical coherence tomography: new insights into the process of optimal rewiring of side branches during bifurcational stenting. EuroIntervention. 2014;10:907–15.

    Article  PubMed  Google Scholar 

  48. Gonzalo N, Garcia-Garcia HM, Regar E, et al. In vivo assessment of high-risk coronary plaques at bifurcations with combined intravascular ultrasound and optical coherence tomography. JACC Cardiovasc Imaging. 2009;2:473–82.

    Article  PubMed  Google Scholar 

  49. Tyczynski P, Ferrante G, Moreno-Ambroj C, et al. Simple versus complex approaches to treating coronary bifurcation lesions: direct assessment of stent strut apposition by optical coherence tomography. Rev Esp Cardiol. 2010;63:904–14.

    Article  PubMed  Google Scholar 

  50. Park SJ, Kim YH, Park DW, et al. Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interv. 2009;2:167–77.

    Article  PubMed  Google Scholar 

  51. Costa MA, Angiolillo DJ, Tannenbaum M, et al. Impact of stent deployment procedural factors on long-term effectiveness and safety of sirolimus-eluting stents (final results of the multicenter prospective STLLR trial). Am J Cardiol. 2008;101:1704–11.

    Article  CAS  PubMed  Google Scholar 

  52. Nakazawa G, Granada JF, Alviar CL, et al. Anti-CD34 antibodies immobilized on the surface of sirolimus-eluting stents enhance stent endothelialization. JACC Cardiovasc Interv. 2010;3:68–75.

    Article  PubMed  Google Scholar 

  53. Louvard Y, Medina A. Definitions and classifications of bifurcation lesions and treatment. EuroIntervention. 2015;11(Suppl V):V23–6.

    Article  PubMed  Google Scholar 

  54. Zamani P, Kinlay S. Long-term risk of clinical events from stenting side branches of coronary bifurcation lesions with drug-eluting and bare-metal stents: an observational meta-analysis. Catheter Cardiovasc Interv. 2011;77:202–12.

    Article  PubMed  Google Scholar 

  55. Yamashita T, Nishida T, Adamian MG, et al. Bifurcation lesions: two stents versus one stent--immediate and follow-up results. J Am Coll Cardiol. 2000;35:1145–51.

    Article  PubMed  CAS  Google Scholar 

  56. Colombo A, Moses JW, Morice MC, et al. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation. 2004;109:1244–9.

    Article  PubMed  Google Scholar 

  57. Pan M, de Lezo JS, Medina A, et al. Rapamycin-eluting stents for the treatment of bifurcated coronary lesions: a randomized comparison of a simple versus complex strategy. Am Heart J. 2004;148:857–64.

    Article  PubMed  CAS  Google Scholar 

  58. Steigen TK, Maeng M, Wiseth R, et al. Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study. Circulation. 2006;114:1955–61.

    Article  PubMed  Google Scholar 

  59. Ferenc M, Gick M, Kienzle RP, et al. Randomized trial on routine vs. provisional T-stenting in the treatment of de novo coronary bifurcation lesions. Eur Heart J. 2008;29:2859–67.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Colombo A, Bramucci E, Sacca S, et al. Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (coronary bifurcations: application of the crushing technique using Sirolimus-eluting stents) study. Circulation. 2009;119:71–8.

    Article  PubMed  Google Scholar 

  61. Hildick-Smith D, de Belder AJ, Cooter N, et al. Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British bifurcation coronary study: old, new, and evolving strategies. Circulation. 2010;121:1235–43.

    Article  PubMed  CAS  Google Scholar 

  62. Chen SL, Santoso T, Zhang JJ, et al. A randomized clinical study comparing double kissing crush with provisional stenting for treatment of coronary bifurcation lesions: results from the DK-CRUSH-II (double kissing crush versus provisional stenting technique for treatment of coronary bifurcation lesions) trial. J Am Coll Cardiol. 2011;57:914–20.

    Article  PubMed  Google Scholar 

  63. Maeng M, Holm NR, Erglis A, et al. Long-term results after simple versus complex stenting of coronary artery bifurcation lesions: Nordic bifurcation study 5-year follow-up results. J Am Coll Cardiol. 2013;62:30–4.

    Article  PubMed  Google Scholar 

  64. Ferenc M, Ayoub M, Buttner HJ, et al. Long-term outcomes of routine versus provisional T-stenting for de novo coronary bifurcation lesions: five-year results of the bifurcations Bad Krozingen I study. EuroIntervention. 2015;11:856–9.

    Article  PubMed  Google Scholar 

  65. Kim YH, Lee JH, Roh JH, et al. Randomized comparisons between different stenting approaches for bifurcation coronary lesions with or without side branch stenosis. JACC Cardiovasc Interv. 2015;8:550–60.

    Article  PubMed  Google Scholar 

  66. Genereux P, Kumsars I, Lesiak M, et al. A randomized trial of a dedicated bifurcation stent versus provisional stenting in the treatment of coronary bifurcation lesions. J Am Coll Cardiol. 2015;65:533–43.

    Article  PubMed  Google Scholar 

  67. Behan MW, Holm NR, de Belder AJ, et al. Coronary bifurcation lesions treated with simple or complex stenting: 5-year survival from patient-level pooled analysis of the Nordic bifurcation study and the British bifurcation coronary study. Eur Heart J. 2016;37:1923–8.

    Article  PubMed  Google Scholar 

  68. Katritsis DG, Siontis GC, Ioannidis JP. Double versus single stenting for coronary bifurcation lesions: a meta-analysis. Circ Cardiovasc Interv. 2009;2:409–15.

    Article  PubMed  Google Scholar 

  69. Brar SS, Gray WA, Dangas G, et al. Bifurcation stenting with drug-eluting stents: a systematic review and meta-analysis of randomised trials. EuroIntervention. 2009;5:475–84.

    Article  PubMed  Google Scholar 

  70. Hakeem A, Khan FM, Bhatti S, et al. Provisional vs. Complex stenting strategy for coronary bifurcation lesions: meta-analysis of randomized trials. J Invasive Cardiol. 2009;21:589–95.

    PubMed  Google Scholar 

  71. Zhang F, Dong L, Ge J. Simple versus complex stenting strategy for coronary artery bifurcation lesions in the drug-eluting stent era: a meta-analysis of randomised trials. Heart. 2009;95:1676–81.

    Article  PubMed  CAS  Google Scholar 

  72. Athappan G, Ponniah T, Jeyaseelan L. True coronary bifurcation lesions: meta-analysis and review of literature. J Cardiovasc Med. 2010;11:103–10.

    Article  Google Scholar 

  73. Biondi-Zoccai G. Duplicate meta-analyses on coronary bifurcation strategies: when more is less? EuroIntervention. 2010;6:181–3.

    Article  PubMed  Google Scholar 

  74. Niccoli G, Ferrante G, Porto I, et al. Coronary bifurcation lesions: to stent one branch or both? A meta-analysis of patients treated with drug eluting stents. Int J Cardiol. 2010;139:80–91.

    Article  PubMed  Google Scholar 

  75. Behan MW, Holm NR, Curzen NP, et al. Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled-analysis of the Nordic bifurcation study and the British bifurcation coronary study. Circ Cardiovasc Interv. 2011;4:57–64.

    Article  PubMed  Google Scholar 

  76. Erglis A, Kumsars I, Niemela M, et al. Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study. Circ Cardiovasc Interv. 2009;2:27–34.

    Article  PubMed  Google Scholar 

  77. Sawaya FJ, Lefevre T, Chevalier B, et al. Contemporary approach to coronary bifurcation lesion treatment. JACC Cardiovasc Interv. 2016;9:1861–78.

    Article  PubMed  Google Scholar 

  78. Louvard Y, Lefevre T, Morice MC. Percutaneous coronary intervention for bifurcation coronary disease. Heart. 2004;90:713–22.

    Article  PubMed  PubMed Central  Google Scholar 

  79. 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;68:67–73.

    Article  PubMed  Google Scholar 

  80. Burzotta F, De Vita M, Sgueglia G, Todaro D, Trani C. How to solve difficult side branch access? EuroIntervention. 2010;6(Suppl J):J72–80.

    Article  PubMed  Google Scholar 

  81. Chatterjee A, Brott B, Foley F, Leesar MA. Electron microscopic examination of polymer coated hydrophilic guidewires used for side-branch protection during bifurcation coronary intervention. J Am Coll Cardiol. 2014;63:A1916. (Abstr).

    Article  Google Scholar 

  82. Chatterjee A, Brott BC, Foley R, et al. Safety of hydrophilic guidewires used for side-branch protection during stenting and proximal optimization technique in coronary bifurcation lesions. Cardiovascular revascularization medicine : including molecular interventions. 2016;17:456–62.

    Article  Google Scholar 

  83. Vassilev D, Gil R. Clinical verification of a theory for predicting side branch stenosis after main vessel stenting in coronary bifurcation lesions. J Interv Cardiol. 2008;21:493–503.

    Article  PubMed  Google Scholar 

  84. Lefevre T, Darremont O, Albiero R. Provisional side branch stenting for the treatment of bifurcation lesions. EuroIntervention. 2010;6(Suppl J):J65–71.

    Article  PubMed  Google Scholar 

  85. Darremont O, Leymarie JL, Lefevre T, Albiero R, Mortier P, Louvard Y. Technical aspects of the provisional side branch stenting strategy. EuroIntervention. 2015;11(Suppl V):V86–90.

    Article  PubMed  Google Scholar 

  86. Burzotta F, Trani C, Sianos G. Jailed balloon protection: a new technique to avoid acute side-branch occlusion during provisional stenting of bifurcated lesions. Bench test report and first clinical experience. EuroIntervention. 2010;5:809–13.

    Article  PubMed  Google Scholar 

  87. Furuichi S, Airoldi F, Colombo A. Rescue inverse crush: a way of get out of trouble. Catheter Cardiovasc Interv. 2007;70:708–12.

    Article  PubMed  Google Scholar 

  88. Ormiston JA, Webster MW, El Jack S, et al. Drug-eluting stents for coronary bifurcations: bench testing of provisional side-branch strategies. Catheter Cardiovasc Interv. 2006;67:49–55.

    Article  PubMed  Google Scholar 

  89. Murasato Y, Finet G, Foin N. Final kissing balloon inflation: the whole story. EuroIntervention. 2015;11(Suppl V):V81–5.

    Article  PubMed  Google Scholar 

  90. Niemela M, Kervinen K, Erglis A, et al. Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic-Baltic bifurcation study III. Circulation. 2011;123:79–86.

    Article  PubMed  Google Scholar 

  91. Gwon HC, Hahn JY, Koo BK, et al. Final kissing ballooning and long-term clinical outcomes in coronary bifurcation lesions treated with 1-stent technique: results from the COBIS registry. Heart. 2012;98:225–31.

    Article  PubMed  Google Scholar 

  92. Yu CW, Yang JH, Song YB, et al. Long-term clinical outcomes of final kissing ballooning in coronary bifurcation lesions treated with the 1-stent technique: results from the COBIS II registry (Korean coronary bifurcation stenting registry). JACC Cardiovasc Interv. 2015;8:1297–307.

    Article  PubMed  Google Scholar 

  93. Song YB, Park TK, Hahn JY, et al. Optimal strategy for provisional side branch intervention in coronary bifurcation lesions: 3-year outcomes of the SMART-STRATEGY randomized trial. JACC Cardiovasc Interv. 2016;9:517–26.

    Article  PubMed  Google Scholar 

  94. Pan M, Medina A, Suarez de Lezo J, et al. Coronary bifurcation lesions treated with simple approach (from the Cordoba & las Palmas [CORPAL] kiss trial). Am J Cardiol. 2011;107:1460–5.

    Article  PubMed  Google Scholar 

  95. Rahman S, Leesar T, Cilingiroglu M, et al. Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions: a serial volumetric intravascular ultrasound study. JACC Cardiovasc Interv. 2013;6:923–31.

    Article  PubMed  Google Scholar 

  96. Foin N, Torii R, Alegria E, et al. Location of side branch access critically affects results in bifurcation stenting: insights from bench modeling and computational flow simulation. Int J Cardiol. 2013;168:3623–8.

    Article  PubMed  CAS  Google Scholar 

  97. Park TK, Lee JH, Song YB, et al. Impact of non-compliant balloons on long-term clinical outcomes in coronary bifurcation lesions: results from the COBIS (COronary BIfurcation stent) II registry. EuroIntervention. 2016;12:456–64.

    Article  PubMed  Google Scholar 

  98. Foin N, Torii R, Mortier P, et al. Kissing balloon or sequential dilation of the side branch and main vessel for provisional stenting of bifurcations: lessons from micro-computed tomography and computational simulations. JACC Cardiovasc Interv. 2012;5:47–56.

    Article  PubMed  Google Scholar 

  99. Finet G, Derimay F, Motreff P, et al. Comparative analysis of sequential proximal optimizing technique versus kissing balloon inflation technique in provisional bifurcation stenting: fractal coronary bifurcation bench test. JACC Cardiovasc Interv. 2015;8:1308–17.

    Article  PubMed  Google Scholar 

  100. Secco GG, Rittger H, Hoffmann S, et al. The Glider registry: a prospective multicentre registry of a new ultrashort dedicated balloon for side-branch ostial dilatation. Catheter Cardiovasc Interv. 2013. https://doi.org/10.1002/ccd.25040.

  101. Chevalier B, Glatt B, Royer T, Guyon P. Placement of coronary stents in bifurcation lesions by the "culotte" technique. Am J Cardiol. 1998;82:943–9.

    Article  PubMed  CAS  Google Scholar 

  102. Zhang JJ, Chen SL. Classic crush and DK crush stenting techniques. EuroIntervention. 2015;11(Suppl V):V102–5.

    Article  PubMed  Google Scholar 

  103. Ormiston JA, Webster MW, Webber B, Stewart JT, Ruygrok PN, Hatrick RI. The "crush" technique for coronary artery bifurcation stenting: insights from micro-computed tomographic imaging of bench deployments. JACC Cardiovasc Interv. 2008;1:351–7.

    Article  PubMed  Google Scholar 

  104. Erglis A, Lassen JF, Di Mario C. Technical aspects of the culotte technique. EuroIntervention. 2015;11(Suppl V):V99–101.

    Article  PubMed  Google Scholar 

  105. Ng J, Foin N, Ang HY, et al. Over-expansion capacity and stent design model: an update with contemporary DES platforms. Int J Cardiol. 2016;221:171–9.

    Article  PubMed  Google Scholar 

  106. Motreff P, Rioufol G, Gilard M, et al. Diffuse atherosclerotic left main coronary artery disease unmasked by fractal geometric law applied to quantitative coronary angiography: an angiographic and intravascular ultrasound study. EuroIntervention. 2010;5:709–15.

    Article  PubMed  Google Scholar 

  107. Kubo S, Kadota K, Sabbah M, et al. Clinical and angiographic outcomes after drug-eluting stent implantation with triple-kissing-balloon technique for left main trifurcation lesion: comparison of single-stent and multi-stent procedures. J Invasive Cardiol. 2014;26:571–8.

    PubMed  Google Scholar 

  108. Stone GW, Sabik JF, Serruys PW, et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med. 2016;375(23):2223–35.

    Article  PubMed  CAS  Google Scholar 

  109. Makikallio T, Holm NR, Lindsay M, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet (London, England). 2016;388(10061):2743–52.

    Article  Google Scholar 

  110. Palmerini T, Marzocchi A, Tamburino C, et al. Impact of bifurcation technique on 2-year clinical outcomes in 773 patients with distal unprotected left main coronary artery stenosis treated with drug-eluting stents. Circ Cardiovasc Interv. 2008;1:185–92.

    Article  PubMed  Google Scholar 

  111. Kim YH, Park SW, Hong MK, et al. Comparison of simple and complex stenting techniques in the treatment of unprotected left main coronary artery bifurcation stenosis. Am J Cardiol. 2006;97:1597–601.

    Article  PubMed  Google Scholar 

  112. Toyofuku M, Kimura T, Morimoto T, et al. Comparison of 5-year outcomes in patients with and without unprotected left main coronary artery disease after treatment with sirolimus-eluting stents: insights from the j-cypher registry. JACC Cardiovasc Interv. 2013;6:654–63.

    Article  PubMed  Google Scholar 

  113. D’Ascenzo F, Iannaccone M, Giordana F, et al. Provisional vs. two-stent technique for unprotected left main coronary artery disease after ten years follow up: a propensity matched analysis. Int J Cardiol. 2016;211:37–42.

    Article  PubMed  Google Scholar 

  114. Chieffo A, Hildick-Smith D. The European bifurcation Club left main study (EBC MAIN): rationale and design of an international, multicentre, randomised comparison of two stent strategies for the treatment of left main coronary bifurcation disease. EuroIntervention. 2016;12:47–52.

    Article  PubMed  Google Scholar 

  115. Gil RJ, Bil J, Dzavik V, et al. Regular drug-eluting stent vs dedicated coronary bifurcation BiOSS expert stent: Multicenter open-label randomized controlled POLBOS I trial. Can J Cardiol. 2015;31:671–8.

    Article  PubMed  Google Scholar 

  116. Gil RJ, Bil J, Vassiliev D, Inigo Garcia LA. First-in-man study of dedicated bifurcation sirolimus-eluting stent: 12-month results of BiOSS LIM(R) registry. J Interv Cardiol. 2015;28:51–60.

    Article  PubMed  Google Scholar 

  117. Dubois C, Bennett J, Dens J, et al. COmplex coronary bifurcation lesions: RAndomized comparison of a strategy using a dedicated self-expanding biolimus-eluting stent versus a culotte strategy using everolimus-eluting stents: primary results of the COBRA trial. EuroIntervention. 2016;11:1457–67.

    Article  PubMed  Google Scholar 

  118. Briguori C, Donahue M, Visconti G, et al. Coronary artery bifurcation narrowing treated by Axxess stent implantation: the CARINAX registry. Catheter Cardiovasc Interv. 2017;89(4):E112–23.

    Article  PubMed  Google Scholar 

  119. Ohlow MA, Farah A, Richter S, El-Garhy M, von Korn H, Lauer B. Comparative case-control analysis of a dedicated self-expanding Biolimus A9-eluting bifurcation stent versus provisional or mandatory side branch intervention strategies in the treatment of coronary bifurcation lesions. Catheter Cardiovasc Interv. 2017;90(1):39–47.

    Article  PubMed  Google Scholar 

  120. Genereux P, Kini A, Lesiak M, et al. Outcomes of a dedicated stent in coronary bifurcations with large side branches: a subanalysis of the randomized TRYTON bifurcation study. Catheter Cardiovasc Interv. 2016;87:1231–41.

    Article  PubMed  Google Scholar 

  121. Genereux P, Kumsars I, Schneider JE, et al. Dedicated bifurcation stent for the treatment of bifurcation lesions involving large side branches: outcomes from the Tryton confirmatory study. JACC Cardiovasc Interv. 2016;9:1338–46.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France

    Marco Spaziano MD, Yves Louvard MD, FSCAI & Thierry Lefèvre MD, FESC, FSCAI

  2. McGill University Health Center, Montreal, Canada

    Marco Spaziano MD

Authors
  1. Marco Spaziano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yves Louvard MD, FSCAI
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thierry Lefèvre MD, FESC, FSCAI
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thierry Lefèvre MD, FESC, FSCAI .

Editor information

Editors and Affiliations

  1. Middle German Heart Center and Health Care Center Bitterfeld-Wolfen, gGmbH, Bitterfeld-Wolfen, Germany

    Peter Lanzer

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Spaziano, M., Louvard, Y., Lefèvre, T. (2018). Treatment of Coronary Bifurcation Lesions. In: Lanzer, P. (eds) Textbook of Catheter-Based Cardiovascular Interventions. Springer, Cham. https://doi.org/10.1007/978-3-319-55994-0_46

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-55994-0_46

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55993-3

  • Online ISBN: 978-3-319-55994-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation