| 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. | |
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MedLine Citation:
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PMID: 22230150 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This study sought to evaluate post-dilation strategies in bifurcation stenting. BACKGROUND: In bifurcation stenting practice, it is still controversial how post-dilation should be performed and whether the kissing balloon (KB) technique is mandatory when only the main vessel (MV) receives a stent. METHODS: A series of drug-eluting stents (DES) (n = 26) were deployed in a coronary bifurcation model following a provisional approach. After the deployment of the stent in the MV, post-dilation with the KB technique was compared with a 2-step, sequential post-dilation of the side branch (SB) and MV without kissing. RESULTS: The percentage of the SB lumen area free of stent struts was similar after KB (79.1 ± 8.7%) and after the 2-step sequence (74.4 ± 11.6%, p = 0.25), a considerable improvement compared with MV stenting only without dilation of the stent at the SB ostium (30.8 ± 7.8%, p < 0.0001). The rate of strut malapposition in the ostium was 21.3 ± 9.2% after KB and 24.9 ± 10.4% after the 2-step sequence, respectively, a significant reduction compared with a simple SB dilation (55.3 ± 16.8%, p < 0.0001) or MV stenting only (47.0 ± 8.5%, p < 0.0005). KB created a significant elliptical overexpansion of the MV lumen, inducing higher stress concentration proximal to the SB. KB also led to a higher risk of incomplete stent apposition at the proximal stent edge (30.7 ± 26.4% vs. 2.8 ± 9.6% for 2-step, p = 0.0016). CONCLUSIONS: Sequential 2-step post-dilation of the SB and MV may offer a simpler and more efficient alternative to final KB technique for provisional stenting of bifurcations. |
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Authors:
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Nicolas Foin; Ryo Torii; Peter Mortier; Mathieu De Beule; Nicola Viceconte; Pak Hei Chan; Justin E Davies; Xiao Yun Xu; Rob Krams; Carlo Di Mario |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: JACC. Cardiovascular interventions Volume: 5 ISSN: 1876-7605 ISO Abbreviation: JACC Cardiovasc Interv Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-01-10 Completed Date: 2012-05-16 Revised Date: 2012-08-29 |
Medline Journal Info:
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Nlm Unique ID: 101467004 Medline TA: JACC Cardiovasc Interv Country: United States |
Other Details:
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Languages: eng Pagination: 47-56 Citation Subset: IM |
Copyright Information:
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Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Bioengineering, Imperial College London, London, United Kingdom. nicolas.foin@ic.ac.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Computer Simulation Coronary Angiography / instrumentation*, methods Coronary Artery Disease / pathology, radiography, therapy* Coronary Vessels / pathology* Drug-Eluting Stents* Finite Element Analysis Humans Hydrodynamics Risk Assessment Time Factors Tomography, X-Ray Computed / instrumentation |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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