Calcified coronary plaque (CCP) is a challenge for interventional cardiology. Stent underexpansion (SU) commonly associated with CCP could predispose to stent thrombosis or restenosis. Currently, SU in severe CCP can be treated by rotational atherectomy, orbital atherectomy, balloon cutting/scoring, non-compliant high-pressure balloons, or intravascular lithotripsy (IVL). The aim of this meta-analysis was to determine the…
EuroPCR 2023 | Provisional Stenting is Still the First Choice
The EBC TWO in Non-LM study randomized 200 patients with bifurcation lesions not affecting the left main coronary artery (LCA) to receive provisional stenting vs. culotte (Norobi stent). The secondary branch had to have a diameter ≥2.5 mm and a lesion length >5 mm. The crossover of those who received provisional stenting to the two-stent strategy was 16%.…
EuroPCR 2023 | Left Main Coronary Artery Angioplasty: One or Two Stents?
The EBC MAIN LM study randomized 467 patients with severe left main coronary artery (LCA) lesions to receive provisional stenting or a two-sent strategy (Resolute or Onix stent). The two-stent strategy was decided by the operator (culotte, DK-minicrush, T/TAP). The crossover rate from those randomized to provisional stenting was 22%. After a 3-year follow-up, the composite…
EuroPCR 2023 | iFR vs FFR Guided Revascularization in Left Main De Novo Lesions
Acute coronary syndrome guidelines recommend the use of iFR and FFR guided invasive management for patients with high risk ischemia regardless medical treatment. However, iFR and FFR they are often considered exchangeable. Prior literature has shown there can be a discrepancy of around 20% between these techniques when it comes to revascularization outcomes. Choosing the…
EuroPCR 2023 | KISS: Provisional Stenting in Bifurcations
Provisional stenting is the most frequent strategy and the most recommended in the treatment of bifurcations, even though in some situations the two-step kiss technique is prioritized, seeing as it offers the benefit of better rheology, less side branch occlusion, less periprocedural injury, better angina control and less restenosis. It included patients with de novo bifurcation…
EuroPCR 2023 | EBC Two – Provisional Stenting vs Culotte in Bifurcations
MD Sandeep Arunothayaraj presented the 5-year followup of EBC Two (which had not previously shown significant differences in clinical outcomes at 12 months) in patients randomized to provisional stenting vs. systematic culotte in bifurcations that were not left main. The study followed up 200 patients with true bifurcations, side branch ≥2.5mm and lesion length ≥5mm,…