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Aims: Isolated, high-grade coronary bifurcation lesions located at the side branch (SB) ostium (Medina type 0,0,1) are uncommon and their specific treatment has not been described., Methods and Results: We have developed an "inverted" technique for the treatment of these lesions, derived from the usual provisional T stenting. We implant the stent from the proximal main branch through the SB, with reopening of the strut through the distal main branch (DMB) and systematic final kissing balloon. We retrospectively reviewed results in 40 patients. The procedural success was 100%, no failure was observed to rewire the DMB or perform the kissing balloon, and a second sent was implanted in the DMB in only three patients (7.5%). No death, myocardial infarction, stent thrombosis or repeat revascularisation occurred within the first 30 days of follow-up. At a mean of 22+/-14 months, three patients underwent repeat percutaneous coronary intervention (7.5%), with target lesion restenosis (n=2; 5%), other vessel treated (n=1, 2.5%), target lesion revascularisation (n=1; 2.5%), and target vessel revascularisation (n=1, 2.5%)., Conclusions: The "inverted" provisional T stenting technique was safe and highly effective in the management of Medina 0,0,1 coronary bifurcation lesions. Larger trials are needed before its routine application can be recommended.

To assess the outcomes of direct coronary stenting (DS) using long stents and examine predictive factors of DS failure, this prospective multicenter registry included 128 consecutive patients who underwent the implantation of stents >or= 18 mm in length without balloon predilation for de novo coronary artery stenoses. Mean lesion and stent lengths were 20.7 +/- 5.4 and 21.4 +/- 3.8 mm, respectively. Rates of DS success, lesion success, and primary success were 82%, 99%, and 97.7%, respectively. At 6 months, rates of MACE and TVR were 12.5% and 6.3%, respectively. In multivariate analysis, factors predictive of DS failure vs. DS success were presence of calcifications (78% vs. 45%; P = 0.004) and reference vessel diameter (2.77 +/- 0.4 vs. 3.13 +/- 0.42 mm; P = 0.0002). DS of complex lesions with stents >or= 18 mm in length was performed safely and with a high success rate. This strategy was less successful in the treatment of small vessels and in presence of calcifications., (Copyright 2003 Wiley-Liss, Inc.)

The aim of this study was to determine the incidence, angiographic characteristics, clinical consequences, therapeutic implications and evolution of coronary arterial aneurysms after percutaneous transluminal coronary angioplasty (PTCA) based on a series of 13 cases out of a total population of 752 patients undergoing balloon dilatation. Before BTCA, 10 patients had unstable angina and 3 had stable angina. The stenoses were of type A in 6 cases and, more complex, type B, in 7 cases. The results of PTCA were good except in 1 case in which the procedure was complicated by a rudimentary infarct due to an extensive intra mural rupture. The frequency of coronary aneurysms evaluated in a series of 150 patients dilated and controlled systematically was 4 p. 100. This complication was observed relatively late, 2 to 13 months after PTCA. The length of aneurysm ranged from 2 to 13 mm (3.9 +/- 2.9 mm). Nine aneurysms were sacciform and 4 were fusiform. They were isolated in 6 cases and associated with restenosis in 7 cases. The predisposing role of an oversized angioplasty balloon was a probable etiological factor; the balloon/artery ratio was over 1.1 in 4 cases and over 1.2 in 3 cases. Intramural rupture observed at the time of PTCA (8/13 cases) did not seem to be a predisposing factor as the incidence of coronary aneurysm was not significantly different in patients without this complication in the group of 150 patients dilated and controlled systematically by angiography (5.8% vs 3%; NS). In the 6 cases of isolated coronary aneurysm the patients were asymptomatic and were followed up with medical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Between January 1986 and December 1988, 558 patients underwent percutaneous transluminal coronary angioplasty (PTCA) of whom 40 per cent were dilated at the time of diagnostic coronary arteriography. In order to assess the value of this therapeutic strategy we compared the results of 221 patients dilated at the time of diagnostic coronary arteriography (Group 1) with those of 337 patients who underwent deferred PTCA. In Group 1, the incidence of stable angina was lower (26.7% vs 46.3%, p less than 10-5), that of thrombolysed myocardial infarction was higher (24% vs 2.7%, p less than 10-9) and a higher proportion of patients had previously undergone PTCA (29.4% vs 3.2%, p less than 10-9). The proportion of patients with single vessel disease was higher in Group 1 (84.6% vs 74.7%, p less than 0.01) as was that of angioplasty of a single lesion (97.7% vs 88.1%, p less than 10-4). There were fewer dilations of the left circumflex artery in Group 1 (17.2% vs 27.3%, p less than 0.05) which was compensated by a higher number involving the right coronary artery (26.1% vs 15.5%, p less than 0.01). The immediate results were comparable in the two groups with 87.8 per cent primary successes, 3.6 per cent of myocardial infarcts and 1.3 per cent of coronary bypass operations with no fatalities in Group 1. These favorable results encourage the development of PTCA at the time of diagnostic coronary arteriography in the following indications: unstable angina, thrombolysed myocardial infarction and restenosis irrespective of the patient's symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)

Frequency of PTCA performed at the time of initial coronary angiography has increased to 47% of all PTCA performed in 1988. The aim of this study is to assess the efficacy and safety of this strategy by comparing the results in 2 groups of patients: in group 1 (179 patients), PTCA was performed at the time of initial coronary angiography and in group 2 (549 patients) PTCA was performed, 15 to 30 days after initial coronary angiography. Clinical differences between the two groups concerned: stable angina (25.1% vs 41%; p less than 0.001) and myocardial infarction treated with thrombolytic therapy (23.7% vs 7.7%; p less than 10(-9)). The extent of coronary artery disease was similar in the two groups but the incidence of single vessel PTCA was higher in group 1 (96% vs 90%; p less than 0.01). The immediate results of PTCA were similar and led us to develop this strategy for unstable angina, myocardial infarction treated with thrombolytic therapy, as well as total coronary obstruction and restenosis whatever their symptoms and signs. This strategy requires high quality fluoroscopic and video replay images, and allows a reduction in hospital costs.