Approximately 20% of all percutaneous coronary interventions (PCI) are performed on bifurcation lesions, which continue to pose a challenge in terms of strategy: how many stents to use, what is the most suitable strategy, and when to transition from a single stent to two during the procedure. Additionally, the use of two stents in these...
Coronary bifurcation lesions have been a subject to debate, with different approaches by various medical teams. These lesions often carry a higher risk of ischemic events compared with lesions at non-bifurcated sites. The main strategy, supported by medical society recommendations and clinical guidelines, involves using provisional stenting with one stent to minimize the number of...
The use of fractional flow reserve (FFR) and non-hyperemic pressure indices (NHPRs) have become essential for intermediate lesion revascularization. A linear inverse correlation has been recently shown between the use of post PCI physiology and cardiovascular events at followup. However, its adoption has been limited so far, seeing the wide variety of algorithms used in...
Predictors of intrastent restenosis in the right coronary artery ostium. The ostium of the right coronary artery (RCA) presents certain histological aspects. Atherosclerotic and fibrotic plaques in this area contain an abundance of smooth muscle, collagen, and a certain degree of calcification, along with thicker adventitia. Additionally, it has certain anatomical aspects such as poor...
Intravascular Ultrasound (IVUS) has shown, in several studies, its great benefits for both restenosis and mortality reduction. Even though several variables have been studied, so far minimal stent area (MSA) has been disregarded as important. The OPTIVUS-Complex PCI looked at 961 patients with 1,957 lesions, and found 1.6% TLR incidence (30 lesions). There were no...
The optimal treatment of true bifurcation lesions not affecting the left main coronary artery is widely debated. Results from randomized studies have shown neutral or worse outcomes with the two-stent technique. Regarding these studies, researchers used first-generation stents and the secondary branches were small. The EBC TWO study compared the provisional stenting strategy against the...
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...
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%....
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...
Coronary obstruction is a complication from TAVR that can cause death (up to 50% mortality), even though its incidence is lower than 1%. One of the most frequent strategies used in the prevention of this complication is chimney stenting in patients at high anatomical risk (valve in valve, narrow sinotubular junction, short coronary ostium height)....