Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in main vessel and side branch limits the long-term prognosis although several kinds of techni...Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in main vessel and side branch limits the long-term prognosis although several kinds of techniques have been identified to be successful for coronary bifurcations. Reports have demonstrated the main reason for higher incidence of ostial side branch even though drugeluting stent used in side vessel lies in that there were gaps in metal coverage and drug application. Therefore,展开更多
Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including...Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including ＂T＂, ＂V＂, ＂Y＂, ＂culotte＂ and ＂simultaneous kissing stents （SKS）＂. Understanding the drawbacks in classical crush techniques, we proposed a novel double kissing （DK） crush technique being testified in our previous serial studies]＇2 The results from these randomized and pilot studies are describing a fantastic story---DK crush technique, by final kissing balloon inflation （FKBI） in 100% of lesions and high quality of kissing as assessed by both angiography and intravascular ultrasound, significantly improved the clinical outcome at a relative short-term follow-up. However, whether the advantage of the DK crush technique was sustained or not at a long-term remains unclear. The present study aimed to extend clinical follow-up and verify the differences between DK and classic crush techniques.展开更多
Background Fluid dynamic mechanisms attributed to coronary bifurcation lesions remain a subject of study. The present study aimed at investigating the hemodynamic change of wall shear stress （WSS） in patients with c...Background Fluid dynamic mechanisms attributed to coronary bifurcation lesions remain a subject of study. The present study aimed at investigating the hemodynamic change of wall shear stress （WSS） in patients with coronary bifurcation lesions treated by double kissing （DK） crush or one-stent with final kissing balloon inflation （FKBI）. Methods Eighty-one patients with bifurcation lesions treated by stenting who had 3-D model reconstruction were studied. The bifurcation vessels were divided into main vessel （MV）, main branch （MB）, side branch （SB）, and polygon of confluence （POC）. MB and SB were classified by internal- and lateral-subsegments, respectively. Results The baseline magnitude of WSS in proximal MV, POC-MV, POC-MB, POC-SB and MB-internal segments increased significantly, compared to MB-lateral, SB-internal and SB-lateral. DK crush had the potential of uniformly reducing WSS, turbulent index and the WSS gradient. The WSS value at the POC-SB and SB in the one-stent group remained higher. The turbulent index and WSS gradient between the POC-SB minus the SB-lateral had equal predictive values for in-stent restenosis （ISR）. Conclusion Fluid dynamic results favor the use of DK crush over the one-stent technique.展开更多
文摘Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in main vessel and side branch limits the long-term prognosis although several kinds of techniques have been identified to be successful for coronary bifurcations. Reports have demonstrated the main reason for higher incidence of ostial side branch even though drugeluting stent used in side vessel lies in that there were gaps in metal coverage and drug application. Therefore,
文摘Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including ＂T＂, ＂V＂, ＂Y＂, ＂culotte＂ and ＂simultaneous kissing stents （SKS）＂. Understanding the drawbacks in classical crush techniques, we proposed a novel double kissing （DK） crush technique being testified in our previous serial studies]＇2 The results from these randomized and pilot studies are describing a fantastic story---DK crush technique, by final kissing balloon inflation （FKBI） in 100% of lesions and high quality of kissing as assessed by both angiography and intravascular ultrasound, significantly improved the clinical outcome at a relative short-term follow-up. However, whether the advantage of the DK crush technique was sustained or not at a long-term remains unclear. The present study aimed to extend clinical follow-up and verify the differences between DK and classic crush techniques.
文摘Background Fluid dynamic mechanisms attributed to coronary bifurcation lesions remain a subject of study. The present study aimed at investigating the hemodynamic change of wall shear stress （WSS） in patients with coronary bifurcation lesions treated by double kissing （DK） crush or one-stent with final kissing balloon inflation （FKBI）. Methods Eighty-one patients with bifurcation lesions treated by stenting who had 3-D model reconstruction were studied. The bifurcation vessels were divided into main vessel （MV）, main branch （MB）, side branch （SB）, and polygon of confluence （POC）. MB and SB were classified by internal- and lateral-subsegments, respectively. Results The baseline magnitude of WSS in proximal MV, POC-MV, POC-MB, POC-SB and MB-internal segments increased significantly, compared to MB-lateral, SB-internal and SB-lateral. DK crush had the potential of uniformly reducing WSS, turbulent index and the WSS gradient. The WSS value at the POC-SB and SB in the one-stent group remained higher. The turbulent index and WSS gradient between the POC-SB minus the SB-lateral had equal predictive values for in-stent restenosis （ISR）. Conclusion Fluid dynamic results favor the use of DK crush over the one-stent technique.
