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Circulation Journal : Official Journal... 2011For several decades, based on clinical trials comparing coronary-artery bypass grafting (CABG) with medical therapy, bypass surgery has been regarded as the treatment of... (Review)
Review
For several decades, based on clinical trials comparing coronary-artery bypass grafting (CABG) with medical therapy, bypass surgery has been regarded as the treatment of choice for patients with unprotected left main coronary artery (LMCA) disease. However, because of marked advancements in the techniques of percutaneous coronary intervention (PCI) with stenting and CABG and adjunctive pharmacologic therapy, reevaluation and review of current indications for optimal revascularization therapy for LMCA disease are required to determine the standard of care for these patients. The available current evidence suggests that the composite outcome of death, myocardial infarction and stroke is similar in patients with LMCA disease who are treated with either PCI with stenting or CABG, the only difference being the rate of repeat revascularization. Cumulative and emerging data from several extensive registries and a large clinical trial may have prompted many interventional cardiologists to select PCI with stenting as an alternative revascularization strategy for such patients. In addition, these data not only may change future guidelines, but support the need for prospective, large randomized trials comparing the 2 revascularization treatments. Finally, this evidence will change the current clinical practice of revascularization strategy for unprotected LMCA disease.
Topics: Angioplasty, Balloon, Coronary; Animals; Clinical Trials as Topic; Coronary Artery Bypass; Coronary Artery Disease; Humans; Stents
PubMed: 21415546
DOI: 10.1253/circj.cj-11-0217 -
JACC. Cardiovascular Interventions Apr 2015
Topics: Angioplasty, Balloon, Coronary; Cardiology; Health Services Needs and Demand; Humans; India; Radiology, Interventional
PubMed: 25907096
DOI: 10.1016/j.jcin.2015.03.004 -
JACC. Cardiovascular Interventions Mar 2017
Topics: Angioplasty, Balloon, Coronary; Cardiac Catheters; Coronary Artery Bypass; Coronary Artery Disease; History, 20th Century; Humans; Risk Factors; Smoking; Time Factors; Treatment Outcome
PubMed: 28279324
DOI: 10.1016/j.jcin.2017.02.001 -
JACC. Cardiovascular Interventions Apr 2023
Topics: Humans; Treatment Outcome; Angioplasty, Balloon, Coronary; Myocardial Infarction; Angioplasty, Balloon
PubMed: 37045499
DOI: 10.1016/j.jcin.2023.02.026 -
The Korean Journal of Internal Medicine Mar 2012Intravascular ultrasound (IVUS) is a useful diagnostic method that provides valuable information in addition to angiography regarding the coronary vessel lumen,... (Review)
Review
Intravascular ultrasound (IVUS) is a useful diagnostic method that provides valuable information in addition to angiography regarding the coronary vessel lumen, dimensions, plaque burden, and characteristics. The major use of IVUS in coronary intervention is to guide interventional strategies and assess optimal stent deployment. Since the introduction of the drug-eluting stent (DES), concerns about restenosis have decreased. However, high-risk lesion subsets are being routinely treated with DESs, and the incidence of suboptimal results after stent deployment, such as stent underexpansion, incomplete stent apposition, edge dissection, geographic miss, and the risk of stent thrombosis, have correspondingly increased. Thus, optimization of stent deployment under IVUS guidance may be clinically important. In this review, we focus on the potential role of IVUS in stent optimization during percutaneous coronary intervention and its clinical benefits.
Topics: Angioplasty, Balloon, Coronary; Coronary Artery Disease; Coronary Restenosis; Drug-Eluting Stents; Evidence-Based Medicine; Humans; Myocardial Infarction; Prosthesis Design; Stents; Thrombosis; Treatment Outcome; Ultrasonography, Interventional
PubMed: 22403496
DOI: 10.3904/kjim.2012.27.1.30 -
JACC. Cardiovascular Interventions Dec 2015
Topics: Angioplasty, Balloon; Angioplasty, Balloon, Coronary; Constriction, Pathologic; Humans; Stents; Treatment Outcome
PubMed: 26627991
DOI: 10.1016/j.jcin.2015.10.013 -
Cardiovascular and Interventional... Feb 2021
Topics: Angioplasty, Balloon; Angioplasty, Balloon, Coronary; Arteries; Humans; Paclitaxel; Registries
PubMed: 33289049
DOI: 10.1007/s00270-020-02731-y -
Advances in Therapy May 2020Scoring balloon angioplasty (SBA) for lumen gain prior to stent implantations or drug-coated balloon angioplasty (DCB) is considered an essential interventional tool for... (Observational Study)
Observational Study
INTRODUCTION
Scoring balloon angioplasty (SBA) for lumen gain prior to stent implantations or drug-coated balloon angioplasty (DCB) is considered an essential interventional tool for lesion preparation. Recent evidence indicates that SBA may play a pivotal role in enhancing the angiographic and clinical outcomes of DCB angioplasty.
METHODS
We studied the systematic use of SBA with a low profile, non-slip element device prior to DCB angioplasty in an unselected, non-randomized patient population. This prospective, all-comers study enrolled patients with de novo lesions as well as in-stent restenotic lesions in bare metal stents (BMS-ISR) and drug-eluting stents (DES-ISR). The primary endpoint was the target lesion failure (TLF) rate at 9 months (ClinicalTrials.gov Identifier NCT02554292).
RESULTS
A total of 481 patients (496 lesions) were recruited to treat de novo lesions (78.4%, 377), BMS-ISR (4.0%, 19), and DES-ISR (17.6%, 85). Overall risk factors were acute coronary syndrome (ACS, 20.6%, 99), diabetes mellitus (46.8%, 225), and atrial fibrillation (8.5%, 41). Average lesion lengths were 16.7 ± 10.4 mm in the de novo group, and 20.1 ± 8.9 mm (BMS-ISR) and 16.2 ± 9.8 mm (DES-ISR) in the ISR groups. Scoring balloon diameters were 2.43 ± 0.41 mm (de novo), 2.71 ± 0.31 mm (BMS-ISR), and 2.92 ± 0.42 mm (DES-ISR) whereas DCB diameters were 2.60 ± 0.39 mm (de novo), 3.00 ± 0.35 mm (BMS-ISR), and 3.10 ± 0.43 mm (DES-ISR), respectively. The overall accumulated TLF rate of 3.0% (14/463) was driven by significantly higher target lesion revascularization rates in the BMS-ISR (5.3%, 1/19) and the DES-ISR group (6.0%, 5/84). In de novo lesions, the TLF rate was 1.1% (4/360) without differences between calcified and non-calcified lesions (p = 0.158) and small vs. large reference vessel diameters with a cutoff value of 3.0 mm (p = 0.901).
CONCLUSIONS
The routine use of a non-slip element scoring balloon catheter to prepare lesions suitable for drug-coated balloon angioplasty is associated with high procedural success rates and low TLF rates in de novo lesions.
Topics: Aged; Angioplasty, Balloon, Coronary; Coronary Artery Disease; Drug-Eluting Stents; Female; Humans; Male; Middle Aged; Practice Guidelines as Topic; Prospective Studies; Risk Factors; Treatment Outcome
PubMed: 32274746
DOI: 10.1007/s12325-020-01320-2 -
Circulation. Cardiovascular... Oct 2018
Topics: Angioplasty, Balloon, Coronary; Brachytherapy; Drug-Eluting Stents
PubMed: 30354643
DOI: 10.1161/CIRCINTERVENTIONS.118.007365 -
JACC. Cardiovascular Interventions Sep 2016Coronary bifurcations are frequent and account for approximately 20% of all percutaneous coronary interventions. Nonetheless, they remain one of the most challenging... (Review)
Review
Coronary bifurcations are frequent and account for approximately 20% of all percutaneous coronary interventions. Nonetheless, they remain one of the most challenging lesion subsets in interventional cardiology in terms of a lower procedural success rate and increased rates of long-term adverse cardiac events. Provisional side branch stenting should be the default approach in the majority of cases and we propose easily applicable and reproducible stepwise techniques associated with low risk of failure and complications.
Topics: Angioplasty, Balloon, Coronary; Cardiac Catheters; Cardiovascular Agents; Coated Materials, Biocompatible; Coronary Angiography; Coronary Artery Disease; Coronary Circulation; Coronary Vessels; Drug-Eluting Stents; Humans; Prosthesis Design; Risk Factors; Treatment Outcome
PubMed: 27659563
DOI: 10.1016/j.jcin.2016.06.056