Background Stenting strategies and clinical outcomes of bifurcation lesions in a chronic total occlusion （CTO） vessel after successful recanalization remain to be unknown. Methods Between January 2001 and December 2...Background Stenting strategies and clinical outcomes of bifurcation lesions in a chronic total occlusion （CTO） vessel after successful recanalization remain to be unknown. Methods Between January 2001 and December 2009, 195 （41.1%） patients with 254 （47.0%） bifurcation lesions in CTO vessels from a pool of 564 patients with 659 CTO lesions were included and divided into proximal （n=134） and distal （n=-120） groups, according to the location of the bifurcation lesions. The primary endpoint was the occurrence of major adverse cardiac events （MACE） at the end of clinical follow-up, including cardiac death, myocardial infarction, or target vessel revascularization （TVR）. Results Collaterals with Rentrop class 3 were seen more in distal group （100% and 68.3%）, compared to proximal group （76.9% and 45.6%）. Two-stent technique for proximal bifurcation lesions was used in 24.6%, significantly different from the distal group （6.7%, P 〈0.001）, without significant difference in composite MACE between proximal and distal groups, or between one- and two-stent subgroups in proximal group. The composite MACE after 1-year in complete revascularization subgroup was 17.9% relative to 29.6% in the incomplete revascularization group （P=0.044）. Stents in long false lumen in main vessel were mainly attributive to decreased TIMI grade flow, with resultant increased in-stent restenosis, total occlusion, TVR and coronary aneurysms. Imcomplete revasculzarization （HR 2.028, P=0.049, 95% CI 1.002-4.105） and post-stenting TIMI flow （HR 6.122, P=0.020, 95% Cl 1.334-28.092） were two independent predictors of composite MACE at the 1-year follow-up. Conclusions Two-stent was more used for proximal bifurcation lesions. No significant difference was observed in MACE between proximal and distal, or between one- and two-stent subgroups in the proximal group. Placement of a safety wire was critical for proximal bifurcation lesions. Complete revascularization was mandatory to improve clinical outcomes.展开更多
Background Sirolimus-eluting stents （SES） are reported to be associated with reduced late lumen loss （LLL）, resulting in less frequent restenosis when compared to bare-metal stent. The current study aimed to asses...Background Sirolimus-eluting stents （SES） are reported to be associated with reduced late lumen loss （LLL）, resulting in less frequent restenosis when compared to bare-metal stent. The current study aimed to assess the difference in LLL between SES with biodegradable and with permanent polymer. Methods From March 2010 to June 2011, 300 consecutive patients having only biodegradable polymers or permanent polymer SES for all diseased vessels were included. Serial quantitative coronary analysis was performed on both the ＂in-stent＂ and ＂segment＂ area, including the stented segment, as well as both five mm margins proximal and distal to the stent. The primary endpoint was the LLL defined as the minimal lumen diameter （MLD） post-stenting minus the MLD at nine-month after the indexed procedure. Results LLL was comparable between the two stents. Importantly, LLL for the distal segment （median 0.05 mm, interquartile 0 to 0.09 mm） was less severe compared with in-stent （median 0.13 mm, interquartile 0.08 to 0.18 mm） and proximal segment LLL （median 0.12 mm, interquartile 0.06 to 0.14 mm, all P 〈0.001 ）. In general, the LLL was associated with the post-procedure MLD （b=0.28, P=0.002）, hyperlipidemia （b=0.14, P=0.021）, and calcified lesions （b=0.58, P=-0.001）. The R2 and Radj of the multiple regression model were 0.651 and 0.625, respectively. Conclusions SES with either biodegradable or permanent polymer had lower value of LLL. The small amount of LLL at the distal segment possibly contributed to the less distal edge stenosis.展开更多
文摘Background Stenting strategies and clinical outcomes of bifurcation lesions in a chronic total occlusion （CTO） vessel after successful recanalization remain to be unknown. Methods Between January 2001 and December 2009, 195 （41.1%） patients with 254 （47.0%） bifurcation lesions in CTO vessels from a pool of 564 patients with 659 CTO lesions were included and divided into proximal （n=134） and distal （n=-120） groups, according to the location of the bifurcation lesions. The primary endpoint was the occurrence of major adverse cardiac events （MACE） at the end of clinical follow-up, including cardiac death, myocardial infarction, or target vessel revascularization （TVR）. Results Collaterals with Rentrop class 3 were seen more in distal group （100% and 68.3%）, compared to proximal group （76.9% and 45.6%）. Two-stent technique for proximal bifurcation lesions was used in 24.6%, significantly different from the distal group （6.7%, P 〈0.001）, without significant difference in composite MACE between proximal and distal groups, or between one- and two-stent subgroups in proximal group. The composite MACE after 1-year in complete revascularization subgroup was 17.9% relative to 29.6% in the incomplete revascularization group （P=0.044）. Stents in long false lumen in main vessel were mainly attributive to decreased TIMI grade flow, with resultant increased in-stent restenosis, total occlusion, TVR and coronary aneurysms. Imcomplete revasculzarization （HR 2.028, P=0.049, 95% CI 1.002-4.105） and post-stenting TIMI flow （HR 6.122, P=0.020, 95% Cl 1.334-28.092） were two independent predictors of composite MACE at the 1-year follow-up. Conclusions Two-stent was more used for proximal bifurcation lesions. No significant difference was observed in MACE between proximal and distal, or between one- and two-stent subgroups in the proximal group. Placement of a safety wire was critical for proximal bifurcation lesions. Complete revascularization was mandatory to improve clinical outcomes.
文摘Background Sirolimus-eluting stents （SES） are reported to be associated with reduced late lumen loss （LLL）, resulting in less frequent restenosis when compared to bare-metal stent. The current study aimed to assess the difference in LLL between SES with biodegradable and with permanent polymer. Methods From March 2010 to June 2011, 300 consecutive patients having only biodegradable polymers or permanent polymer SES for all diseased vessels were included. Serial quantitative coronary analysis was performed on both the ＂in-stent＂ and ＂segment＂ area, including the stented segment, as well as both five mm margins proximal and distal to the stent. The primary endpoint was the LLL defined as the minimal lumen diameter （MLD） post-stenting minus the MLD at nine-month after the indexed procedure. Results LLL was comparable between the two stents. Importantly, LLL for the distal segment （median 0.05 mm, interquartile 0 to 0.09 mm） was less severe compared with in-stent （median 0.13 mm, interquartile 0.08 to 0.18 mm） and proximal segment LLL （median 0.12 mm, interquartile 0.06 to 0.14 mm, all P 〈0.001 ）. In general, the LLL was associated with the post-procedure MLD （b=0.28, P=0.002）, hyperlipidemia （b=0.14, P=0.021）, and calcified lesions （b=0.58, P=-0.001）. The R2 and Radj of the multiple regression model were 0.651 and 0.625, respectively. Conclusions SES with either biodegradable or permanent polymer had lower value of LLL. The small amount of LLL at the distal segment possibly contributed to the less distal edge stenosis.
