Authors
Bazunov A.K., Biryukov A.V., Pelipas’ A.Yu., Shevchenko K.E., Khubulava G.G.
Pavlov University, Saint Petersburg
Abstract
Objective. To analyze the current state of application of the provisional stenting technique for bifurcation lesions of the coronary arteries by different specialists in various medical organizations in Russia.
Materials and methods. The data required for analysis and statistical processing were obtained by developing a formalized questionnaire (20 questions, some of which with the ability to select several answers at the same time - multiple choice), which was published in three Russian Internet communities dedicated to endovascular surgery (“Angiopicture”, “Rentgenhirurg Club” and “Endovascular School”). Participation was anonymous. The survey lasted 14 days (from June 23, 2024 to August 6, 2024). The results of the study were collected using the Google Forms online service and processed using the Google Sheets service. Multiple-choice answers were processed as absolute numbers and presented as a percentage of the total number of answers to a specific question.
Results and discussion. The total number of respondents who took part in the survey was 86, whose average age was 35 years. Practical activity is represented by work in medical organizations of various levels, but most of the responses were received from 3rd level MO (48.8%). The professional experience of most respondents in the specialty does not exceed 15 years (80.2%). The following results were revealed based on the study: Slightly less than half of the respondents (43%) equally assess the possibility of using provisional stenting on a planned and emergency basis. When choosing this technique, 58.1% of respondents rely on their professional experience in treating bifurcation lesions of the coronary arteries. The vast majority of endovascular surgeons perform sequential insertion of coronary guidewires into the main branch and then into the side branch using two coronary guidewires. (73.3%). When performing provisional stenting, the preferred technique is the classical one, with sequential “POT-kissing-POT” dilations (34.9%). The most common criterion for performing SB dilation after MV stenting is significant impairment of blood flow through the SB (TIMI <3) – 81.4%. When switching to a two-stent technique, surgeons give great preference to the following techniques: “CULLOTE” (75.6%) and “T/TAP” (64%). The reasons for using the provisional stenting technique are: good results in the early and late postoperative periods (82.6%), ease of implementation (83.7%), and the possibility of switching to a two-stent technique (66.3%).
Conclusion. To date, there is no unified approach to provisional stenting for bifurcation coronary artery disease. The results of this survey revealed disagreements among specialists regarding the indications and sequence for selecting and performing provisional stenting. Finding the optimal method for performing provisional stenting is a critically important clinical task aimed at reducing perioperative complications and improving long-term treatment outcomes.
Keywords: bifurcation lesions, coronary arteries, stenting, proximal optimization, kissing dilation, provisional stenting, stent cell postdilation.
References
1. Alekyan BG, Grigor’yan AM, Staferov AV, Karapetyan NG. Endovascular diagnostics and treatment in the russian federation – 2022. Russian Journal of Endovascular Surgery. 2023; 10 (Special issue): 5-256. (In Russ.) doi: 10.24183/2409-4080-2023-10S-S5-S256.
2. Lassen JF, Burzotta F, Banning AP, et al. Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. EuroIntervention. 2018; 13(13): 1540-1553. doi: 10.4244/EIJ-D-17-00622.
3. Plechev VV, Risberg RYu, Buzaev IV, Oleinik BA, Kharasova AF. Сomplications of percutaneous coronary interventions. Bashkortostan Medical Journal. 2016; 11(6): 102-108. (In Russ.)
4. Aedma SK, Naik A, Kanmanthareddy A. Coronary Bifurcation Stenting: Review of Current Techniques and Evidence. Current cardiology reviews. 2023; 19(1). doi: 10.2174/1573403X18666220406113517.
5. Lassen JF, Albiero R, Johnson T, et al. 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. doi: 10.4244/EIJ-D-22-00166.
6. Smolin NS, Khrapov KN, Miroshkina VM. Epidural analgesia as a part of combined anesthesia during abdominal oncological surgeries (results of the survey among the Russian anesthesiologists and resuscitators). Messenger of Anesthesiology and Resuscitation. 2022; 19(4): 61-68. (In Russ.) doi: 10.21292/2078-5658-2022-19-4-61-68.
7. Holm NR, Andreasen LN, Walsh S, et al. Rational and design of the European randomized Optical Coherence Tomography Optimized Bifurcation Event Reduction Trial (OCTOBER). Americal Heart Jornal. 2018; 205: 97-109. doi: 10.1016/j.ahj.2018.08.003.
8. Ford TJ, McCartney P, Corcoran D, et al. Single- Versus 2-Stent Strategies for Coronary Bifurcation Lesions: A Systematic Review and Meta-Analysis of Randomized Trials With Long-Term Follow-up. J Am Heart Assoc. 2018; 7(11): e008730. doi: 10.1161/JAHA.118.008730.
9. Dérimay F, Finet G, Souteyrand G, et al. Benefit of a new provisional stenting strategy, the re-proximal optimisation technique: the rePOT clinical study. EuroIntervention. 2018; 14(3): e325-e332. doi: 10.4244/ EIJ-D-17-00941.
10. Khelimskii D, Bessonov I, Kashtanov M, et al. Long-term clinical outcomes after kissing balloon inflation in patients with coronary bifurcation lesions treated with provisional stenting technique. Results from the real-world multicenter registry. Indian Heart J. 2023; 75(5): 313-320. doi: 10.1016/j.ihj.2023.05.003.
11. Yoshinobu M, Masaaki N, Takahiro M, Kyohei M, et al. Feasibility and efficacy of an ultra-short side branch-dedicated balloon in coronary bifurcation stenting: Glider balloon in coronary bifurcation stenting. EuroIntervention. 2021; 17(5): e425-e432. doi: 10.4244/EIJ-D-20-00334.
12. Holm NR, Andreasen LN, Neghabat O, et al. OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions. N Engl J Med. 2023; 389(16): 1477-1487. doi: 10.1056/NEJMoa2307770.
13. Pan M, Lassen JF, Burzotta F, et al. The 17th expert consensus document of the European Bifurcation Club – techniques to preserve access to the side branch during stepwise provisional stenting. EuroIntervention. 2023; 19(1): 26-36. doi: 10.4244/EIJ-D-23-00124.
14. Suryawan IGR, Saputra PBT, Rurus MESE, et al. Comparison between provisional and dual systematic stenting approach for left main bifurcation disease: A systematic review and meta-analysis. Curr Probl Cardiol. 2024; 49(8): 102633. doi: 10.1016/j.cpcardiol.2024.102633.
15. Burzotta F, De Vita M, Sgueglia G, et al. How to solve difficult side branch access? EuroIntervention. 2010; 6: 72-80. doi: 10.4244/EIJV6SUPJA12
16. Burzotta F., Lassen JF, Louvard Y, et al. European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions. Catheter Cardiovasc Interv. 2020; 96(5): 1067-1079. doi: 10.1002/ccd.29071.
17. Banning AP, Lassen JF, Burzotta F, et al. 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.
18. Eshtehardi P, McDaniel MC, Suo J, et al. Association of coronary wall shear stress with atherosclerotic plaque burden, composition, and distribution in patients with coronary artery disease. J Am Heart Assoc. 2012; 1(4): e002543. doi: 10.1161/JAHA.112.002543.
19. Shishikura D, Sidharta SL, Honda S, et al. The relationship between segmental wall shear stress and lipid core plaque derived from near-infrared spectroscopy. Atherosclerosis. 2018; 275: 68-73. doi: 10.1016/j.atherosclerosis.2018.04.022.
20. Albiero R, Burzotta F, Lassen JF, et al. 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. EuroIntervention. 2022; 18(5): 362-376. doi: 10.4244/EIJ-D-22-00165.
21. Burzotta F, Lassen JF, Lefèvre T, et al. Percutaneous coronary intervention for bifurcation coronary lesions: the 15th consensus document from the European Bifurcation Club. EuroIntervention. 2021; 16(16): 1307-1317. doi: 10.4244/EIJ-D-20-00169.
22. Dérimay F, Rioufol G, Nishi T, et al. Optimal balloon positioning for the proximal optimization technique? An experimental bench study. Int J Cardiol. 2019; 292: 95-97. doi: 10.1016/j.ijcard.2019.05.041.
23. Gwon HC, Choi SH, Song YB, et al. Long-term clinical results and predictors of adverse outcomes after drug-eluting stent implantation for bifurcation lesions in a real-world practice: The COBIS (Coronary Bifurcation Stenting) registry. Circ J. 2010; 74(11): 2322-2328. doi: 10.1253/circj.cj-10-0352.
24. Suárez de Lezo J, Medina A, Martín P, et al. Predictors of ostial side branch damage during provisional stenting of coronary bifurcation lesions not involving the side branch origin: an ultrasonographic study. EuroIntervention. 2012; 7(10): 1147-1154. doi: 10.4244/EIJV7I10A185.
25. Kini AS, Vengrenyuk Y, Pena J, et al. Plaque morphology predictors of side branch occlusion after provisional stenting in coronary bifurcation lesion: Results of optical coherence tomography bifurcation study (ORBID). Catheter Cardiovasc Interv. 2017; 89(2): 259-268. doi: 10.1002/ccd.26524.
26. Watanabe M, Uemura S, Sugawara Y, et al. Side branch complication after a single-stent crossover technique: prediction with frequency domain optical coherence tomography. Coron Artery Dis. 2014; 25(4): 321-329. doi: 10.1097/MCA.0000000000000091.
27. Fujino Y, Attizzani GF, Tahara S, et al. Impact of main-branch calcified plaque on side-branch stenosis in bifurcation stenting: an optical coherence tomography study. Int J Cardiol. 2014; 176(3): 1056-1060. doi: 10.1016/j.ijcard.2014.07.143.
28. Mintz GS, Nissen SE, Anderson WD, et al. American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2001; 37(5): 1478-1492. doi: 10.1016/s0735-1097(01)01175-5.
29. Tearney GJ, Regar E, Akasaka T, et al. International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT). Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol. 2012; 59(12): 1058-1072. doi: 10.1016/j.jacc.2011.09.079.
30. Prati F, Guagliumi G, Mintz GS, et al. Expert’s OCT Review Document. Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures. Eur Heart J. 2012; 33(20): 2513-2520. doi: 10.1093/eurheartj/ehs095.
31. Tu S, Barbato E, Köszegi Z, et al. Fractional flow reserve calculation from 3-dimensional quantitative coronary angiography and TIMI frame count: a fast computer model to quantify the functional significance of moderately obstructed coronary arteries. JACC Cardiovasc Interv. 2014; 7(7): 768-777. doi: 10.1016/j.jcin.2014.03.004.
32. Papafaklis MI, Muramatsu T, Ishibashi Y, et al. Fast virtual functional assessment of intermediate coronary lesions using routine angiographic data and blood flow simulation in humans: comparison with pressure wire – fractional flow reserve. EuroIntervention. 2014; 10(5): 574-583. doi: 10.4244/EIJY14M07_01.
33. Chen SL, Zhang JJ, Han Y, et al. Double Kissing Crush Versus Provisional Stenting for Left Main Distal Bifurcation Lesions: DKCRUSH-V Randomized Trial. J Am Coll Cardiol. 2017; 70(21): 2605-2617. doi: 10.1016/j.jacc. 2017.09.1066.
34. Crimi G, Mandurino-Mirizzi A, Gritti V, et al. Percutaneous Coronary Intervention Techniques for Bifurcation Disease: Network Meta-analysis Reveals Superiority of Double-Kissing Crush. Can J Cardiol. 2020; 36: 906-914. doi: 10.1016/j.cjca.2019.09.002.
35. Hall AB, Chavez I, Garcia S, et al. Double kissing crush bifurcation stenting: step-by-step troubleshooting. EuroIntervention. 2021; 17: 317-325. doi: 10.4244/EIJ-D-19-00721.
36. Andreasen LN, Holm NR, Webber B, Ormiston JA. Critical aspects of balloon position during final proximal optimization technique (POT) in coronary bifurcation stenting. Catheter Cardiovasc Interv. 2020; 96(1): 31-39. doi: 10.1002/ccd.28801.
37. 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: 376-377. doi: 10.1016/j.ijcard.2015.06.185.
38. Saito S, Shishido K, Moriyama N, et al. Modified jailed balloon technique for bifurcation lesions. Catheter Cardiovasc Interv. 2018; 92(3): 218-226. doi: 10.1002/ccd.27334.
