31 results on '"Chen, Shao-Liang"'
Search Results
2. 3-Year Outcomes After 2-Stent With Provisional Stenting for Complex Bifurcation Lesions Defined by DEFINITION Criteria.
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Kan J, Zhang JJ, Sheiban I, Santoso T, Munawar M, Tresukosol D, Xu K, Stone GW, and Chen SL
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- Coronary Angiography, Coronary Artery Disease diagnostic imaging, Humans, Risk Factors, Time Factors, Treatment Outcome, Coronary Artery Disease complications, Coronary Artery Disease therapy, Coronary Vessel Anomalies therapy, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Stents classification
- Abstract
Background: The multicenter and randomized DEFINITION II (Two-Stent vs Provisional Stenting Techniques for Patients With Complex Coronary Bifurcation Lesions) trial showed less 1-year target lesion failure (TLF) after a 2-stent approach for complex coronary bifurcation lesions compared with provisional stenting (PS). The authors report the 3-year clinical outcome of the DEFINITION II trial., Objectives: The aim of the present study was to investigate the difference in TLF at 3 years after a planned 2-stent approach vs PS for complex coronary bifurcation lesions stratified by DEFINITION (Definitions and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents) criteria., Methods: A total of 653 patients with complex coronary bifurcation lesions were randomly assigned to either the 2-stent group or the PS group in the DEFINITION II trial and were followed for 3 years. The primary endpoint was the occurrence of TLF at 3 years. Stent thrombosis was the safety endpoint., Results: At 3 years, TLF had occurred in 52 patients (16.0%) in the PS group and in 34 (10.4%) patients in the 2-stent group (HR: 0.63; 95% CI: 0.41-0.97; P = 0.035), driven mainly by increased target vessel myocardial infarction (8.0% vs 3.7%; HR: 0.45; 95% CI: 0.23-0.89; P = 0.022) and target lesion revascularization (8.3% vs 4.3%; HR: 0.50; 95% CI: 0.26-0.96; P = 0.038). There was no difference in TLF between the 2 groups between year 1 and year 3., Conclusions: For patients with complex coronary bifurcations who reach 1-year postprocedure without experiencing endpoint events, there is still a risk for future events. The type of procedure performed initially is no longer a future event risk determinant. (Two-Stent vs Provisional Stenting Techniques for Patients With Complex Coronary Bifurcation Lesions; NCT02284750)., Competing Interests: Funding Support and Author Disclosures This work was funded by the National Science Foundation of China (grants NSFC 81770441 and NSFC 82121001) and jointly supported by the Jiangsu Provincial Special Program of Medical Science (BE2019615), Microport, Sino Medical, and Medtronic. Dr Stone has received speaker or other honoraria from Cook, Terumo, Qool Therapeutics and Orchestra Biomed; serves as a consultant to Valfix, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, Matrizyme; and holds equity or options in Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, the Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, the MedFocus family of funds, and Valfix. Dr Chen is the developer of the double-kissing crush technique; and is a consultant for Boston International Scientific, Microport, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2022
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3. Potential Mechanisms of In-stent Neointimal Atherosclerotic Plaque Formation.
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Zhang DM and Chen SL
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- Animals, Coronary Restenosis diagnostic imaging, Coronary Restenosis pathology, Coronary Thrombosis diagnostic imaging, Coronary Thrombosis pathology, Coronary Vessels diagnostic imaging, Drug-Eluting Stents, Humans, Percutaneous Coronary Intervention adverse effects, Predictive Value of Tests, Risk Factors, Tomography, Optical Coherence, Treatment Outcome, Coronary Artery Disease therapy, Coronary Restenosis etiology, Coronary Thrombosis etiology, Coronary Vessels pathology, Neointima, Percutaneous Coronary Intervention instrumentation, Plaque, Atherosclerotic, Stents
- Abstract
Abstract: Percutaneous coronary intervention has become the main revascularization strategy for coronary artery disease. Compared with early percutaneous coronary angioplasty and the extensive clinical application of bare metal stents, drug-eluting stents can significantly reduce the stenosis caused by the elastic retraction of plaque and neoatherosclerosis (NA), but there is still a high incidence of in-stent restenosis (ISR), which restricts the clinical efficacy of stent implantation. In-stent neoatherosclerosis (ISNA), defined as atherosclerotic lesions in the neointima, is one of the main causes of late stent failure. ISNA plays an important role in stent thrombosis and ISR. The rate of target lesion revascularization and in-stent thrombosis is high when NA arises. Therefore, it is of great clinical significance to explore the occurrence of NA and its development mechanism after stent implantation to prevent ISR and improve stent implantation efficacy and associated clinical prognosis. In this article, we systematically reviewed the existing clinical research on ISNA and the role of optical coherence tomography in its evaluation., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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4. Identification of the type of stent with three-dimensional optical coherence tomography: the SPQR study.
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Cortes C, Chu M, Schincariol M, Martínez-Hervás Alonso MÁ, Reisbeck B, Zhang R, Murasato Y, Chen SL, Lavarra F, Tu S, Silber S, and Gutiérrez-Chico JL
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- Coronary Vessels, Humans, Retrospective Studies, Stents, Tomography, Optical Coherence
- Abstract
Background: The ability of optical coherence tomography (OCT) to identify specific types of stent has never been systematically studied., Aims: The aim of this study was to test the accuracy of OCT imaging to identify patterns of stent platform and subsequently identify the type of stent implanted., Methods: Consecutive patients from six international centres were retrospectively screened, searching for OCT studies with metallic stents or scaffolds. The sample was analysed by two blinded operators, applying a dedicated protocol in four steps to identify the type of stent: 1) 3D and automatic strut detection (ASD), 2) 3D tissue view, 3) longitudinal view with ASD, 4) mode "stent only" and ASD., Results: A series of 212 patients underwent OCT in the study centres, finding 294 metallic stents or scaffolds in 146 patients. The protocol correctly identified 285 stents (96.9%, kappa 0.965), with excellent interobserver agreement (kappa 0.988). The performance tended to be better in recently implanted stents (kappa 0.993) than in stents implanted ≥3 months before (kappa 0.915), and in pullback speed 18 mm/s as compared with 36 mm/s (kappa 0.969 vs 0.940, respectively)., Conclusions: The type of stent platform can be accurately identified in OCT by trained analysts following a dedicated protocol, combining 3D-OCT, ASD and longitudinal view. This might be clinically helpful in scenarios of device failure and for the quantification of apposition. The blinding of analysts in OCT studies should be revisited.
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- 2021
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5. European Bifurcation Club white paper on stenting techniques for patients with bifurcated coronary artery lesions.
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Burzotta F, Lassen JF, Louvard Y, Lefèvre T, Banning AP, Daremont O, Pan M, Hildick-Smith D, Chieffo A, Chatzizisis YS, Džavík V, Gwon HC, Hikichi Y, Murasato Y, Koo BK, Chen SL, Serruys P, and Stankovic G
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- Angioplasty, Balloon, Coronary adverse effects, Clinical Decision-Making, Coronary Artery Disease diagnostic imaging, Humans, Treatment Outcome, Angioplasty, Balloon, Coronary instrumentation, Coronary Artery Disease therapy, Stents
- Abstract
Background: Defining the optimal conduction of percutaneous-coronary-intervention (PCI) to treat bifurcation lesions has been the subject of many clinical studies showing that the applied stenting technique may influence clinical outcome. Accordingly, bifurcation stenting classifications and technical sequences should be standardized to allow proper reporting and comparison., Methods: The European Bifurcation Club (EBC) is a multidisciplinary group dedicated to optimize the treatment of bifurcations and previously created a classification of bifurcation stenting techniques that is based on the first stent implantation site. Since some techniques have been abandoned, others have been refined and dedicated devices became available, EBC promoted an international task force aimed at updating the classification of bifurcation stenting techniques as well as at highlighting the best practices for most popular techniques. Original descriptive images obtained by drawings, bench tests and micro-computed-tomographic reconstructions have been created in order to serve as tutorials in both procedure reporting and clinical practice., Results: An updated Main-Across-Distal-Side (MADS)-2, classification of bifurcation stenting techniques has been realized and is reported in the present article allowing standardized procedure reporting in both clinical practice and scientific studies. The EBC-promoted task force deeply discussed, agreed on and described (using original drawings and bench tests) the optimal steps for the following major bifurcation stenting techniques: (a) 1-stent techniques ("provisional" and "inverted provisional") and (b) 2-stent techniques ("T/TAP," "culotte," and "DK-crush")., Conclusions: The present EBC-promoted paper is intended to facilitate technique selection, reporting and performance for PCI on bifurcated lesions during daily clinical practice., (© 2020 Wiley Periodicals LLC.)
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- 2020
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6. In the face of cunning enemy: DK crush writes legend.
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Chen SL
- Subjects
- Humans, Angioplasty, Balloon, Coronary, Stents
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- 2020
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7. Modified kissing balloon inflation associated with better results after Culotte stenting for bifurcation lesions: A bench test.
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Liu J, Li L, Chen C, Wei J, Chen X, Li B, Chen Y, Luo J, and Chen SL
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- Angioplasty, Balloon, Coronary adverse effects, Equipment Failure Analysis, Humans, Materials Testing, Models, Anatomic, Models, Cardiovascular, Prosthesis Failure, Angioplasty, Balloon, Coronary instrumentation, Coronary Artery Disease therapy, Coronary Vessels diagnostic imaging, Stents
- Abstract
Background: Main vessel (MV) stent deformation and overstretch caused by classical kissing balloon inflation (C-KBI) using two balloons with a longer overlapping in the MV for bifurcation lesions has caused a widespread concern., Purpose: This bench study tested our hypothesis that mini-KBI (M-KBI) with a shorter protrusion of side branch (SB) balloon would ascertain a better result after Culotte stenting., Methods: Twenty-four coronary stents were deployed using Culotte approach in twelve bifurcation models with a bifurcation angle of 45°, 3.5 mm in MV diameter, and 3.0 mm in SB diameter. After stent implantation, the final KBI were assigned to C-KBI (two kissing balloons juxtaposed within the MV stent, at least overlap for 3 mm; n = 6) and M-KBI (the proximal marker of SB balloon just sited at the level of upper edge of SB ostium; n = 6). Proximal optimization technique (POT) was performed after KBI. Stent geometry was visually evaluated based on bench photos, microscopy, videoscopy, micro-CT, and scanning electron microscopy. Stent deformation index, minimal lumen diameter, and cross-sectional area at either carina level of MV and ostium of SB were measured from optical coherence tomography (OCT)., Results: In Culotte technique, C-KBI was associated with visually significant stent deformation, overexpansion and the "bottleneck" effect of the MV stent, which could not be effectively rectified by POT, while M-KBI could keep the circle shape of MV stent with good stent apposition in both MV and SB stent. By quantitative measurements, deformation index of MV was 0.06 ± 0.01 after M-KBI, significantly lower than 0.25 ± 0.02 if C-KBI was performed. In the line in carina, compared to C-KBI, M-KBI has smaller CSA-stent/CSA-reference, which indicated a less overstretch of MV stent. However, minimal lumen diameter and cross-sectional area of SB ostium was not different in the mini-KBI group (3.0958 ± 0.0285 mm and 7.9667 ± 0.1741 mm), when compared those after C-KBI (3.1217 ± 0.0772 mm and 7.9083 ± 0.3115 mm, p > .05)., Conclusions: Followed by POT, M-KBI is preferable than C-KBI in preventing stent deformation, overexpansion in MV stent and could get well apposed of MV stent and well-opened SB stent as expected in a Culotte technique., (© 2019 Wiley Periodicals, Inc.)
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- 2020
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8. Reply: Percutaneous Intervention in Bifurcations After the DKCRUSH-V Trial: Case Closed?
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Chen SL
- Subjects
- Treatment Outcome, Drug-Eluting Stents, Stents
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- 2020
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9. Make Perfection More Perfect.
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Chen SL
- Subjects
- Cross-Over Studies, Humans, Cardiovascular Diseases therapy, Stents
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- 2019
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10. Treatment effects of systematic two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: rationale and design of a prospective, randomised and multicentre DEFINITION II trial.
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Zhang JJ, Gao XF, Han YL, Kan J, Tao L, Ge Z, Tresukosol D, Lu S, Ma LK, Li F, Yang S, Zhang J, Munawar M, Li L, Zhang RY, Zeng HS, Santoso T, Xie P, Jin ZN, Han L, Yin WH, Qian XS, Li QH, Hong L, Paiboon C, Wang Y, Liu LJ, Zhou L, Wu XM, Wen SY, Lu QH, Yuan JQ, Chen LL, Lavarra F, Rodríguez AE, Zhou LM, Ding SQ, Vichairuangthum K, Zhu YS, Yu MY, Chen C, Sheiban I, Xia Y, Tian YL, Shang ZL, Jiang Q, Zhen YH, Wang X, Ye F, Tian NL, Lin S, Liu ZZ, and Chen SL
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- Aged, Coronary Artery Disease pathology, Coronary Vessels pathology, Drug-Eluting Stents, Female, Humans, Male, Middle Aged, Myocardial Infarction etiology, Myocardial Infarction prevention & control, Percutaneous Coronary Intervention methods, Prospective Studies, Prosthesis Design, Research Design, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Coronary Artery Disease surgery, Coronary Stenosis therapy, Coronary Vessels surgery, Stents
- Abstract
Introduction: Provisional stenting (PS) for simple coronary bifurcation lesions is the mainstay of treatment. A systematic two-stent approach is widely used for complex bifurcation lesions (CBLs). However, a randomised comparison of PS and two-stent techniques for CBLs has never been studied. Accordingly, the present study is designed to elucidate the benefits of two-stent treatment over PS in patients with CBLs., Methods and Analysis: This DEFINITION II study is a prospective, multinational, randomised, endpoint-driven trial to compare the benefits of the two-stent technique with PS for CBLs. A total of 660 patients with CBLs will be randomised in a 1:1 fashion to receive either PS or the two-stent technique. The primary endpoint is the rate of 12-month target lesion failure defined as the composite of cardiac death, target vessel myocardial infarction (MI) and clinically driven target lesion revascularisation. The major secondary endpoints include all causes of death, MI, target vessel revascularisation, in-stent restenosis, stroke and each individual component of the primary endpoints. The safety endpoint is the occurrence of definite or probable stent thrombosis., Ethics and Dissemination: The study protocol and informed consent have been approved by the Institutional Review Board of Nanjing First Hospital, and accepted by each participating centre. Written informed consent was obtained from all enrolled patients. Findings of the study will be published in a peer-reviewed journal and disseminated at conferences., Trial Registration Number: NCT02284750; Pre-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2018
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11. Stent fracture is associated with a higher mortality in patients with type-2 diabetes treated by implantation of a second-generation drug-eluting stent.
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Ge Z, Liu ZZ, Kan J, Zhang JJ, Li SJ, Tian NL, Ye F, Qian XS, Yang S, Chen MX, Rab TS, and Chen SL
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- Aged, Chi-Square Distribution, China, Coronary Angiography, Coronary Artery Disease complications, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Coronary Restenosis etiology, Coronary Restenosis mortality, Coronary Restenosis therapy, Databases, Factual, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 diagnosis, Female, Humans, Kaplan-Meier Estimate, Logistic Models, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction etiology, Myocardial Infarction mortality, Myocardial Infarction therapy, Odds Ratio, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Prospective Studies, Prosthesis Design, Retreatment, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Coronary Artery Disease therapy, Diabetes Mellitus, Type 2 mortality, Percutaneous Coronary Intervention instrumentation, Prosthesis Failure, Stents
- Abstract
Type 2 diabetes correlates with clinical events after the implantation of a second-generation drug-eluting stent (DES). The rate and prognostic value of stent fracture (SF) in patients with diabetes who underwent DES implantation remain unknown. A total of 1160 patients with- and 2251 without- diabetes, who underwent surveillance angiography at 1 year after DES implantation between June 2004 and August 2014, were prospectively studied. The primary endpoints included the incidence of SF and a composite major adverse cardiac event [MACE, including myocardial infarction (MI), cardiac death, and target-vessel revascularization (TVR)] at 1-year follow-up and at the end of follow-up for overall patients, and target lesion failure [TLF, including cardiac death, target vessel myocardial infarction (TVMI) and target lesion revascularization (TLR)] at the end of study for SF patients. In general, diabetes was associated with a higher rate of MACE at 1-year (18.4 vs. 12.9%) and end of follow-up (24.0 vs. 18.6%, all p < 0.001), compared with those in patients who did not have diabetes. The 1-year SF rate was comparable among patients with diabetes (n = 153, 13.2%) and non-diabetic patients (n = 273, 12.1%, p > 0.05). Diabetic patients with SF had a 2.6-fold increase of SF-related cardiac death at the end of study and threefold increase of re-repeat TLR when compared with non-diabetic patients with SF (5.9 vs. 2.2%, p = 0.040; 6.5 vs. 2.2%, p = 0.032), respectively. Given the fact that diabetes is correlated with increased MACE rate, SF in diabetic patients translates into differences in mortality and re-repeat TLR compared with the non-diabetic group.
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- 2017
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12. Double Kissing Crush Versus Provisional Stenting for Left Main Distal Bifurcation Lesions: DKCRUSH-V Randomized Trial.
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Chen SL, Zhang JJ, Han Y, Kan J, Chen L, Qiu C, Jiang T, Tao L, Zeng H, Li L, Xia Y, Gao C, Santoso T, Paiboon C, Wang Y, Kwan TW, Ye F, Tian N, Liu Z, Lin S, Lu C, Wen S, Hong L, Zhang Q, Sheiban I, Xu Y, Wang L, Rab TS, Li Z, Cheng G, Cui L, Leon MB, and Stone GW
- Subjects
- Aged, Angiography, Angioplasty, Balloon, Coronary methods, Coronary Restenosis surgery, Coronary Stenosis surgery, Drug-Eluting Stents, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction surgery, Myocardial Revascularization, Thrombosis, Treatment Outcome, Coronary Artery Disease surgery, Percutaneous Coronary Intervention methods, Stents
- Abstract
Background: Provisional stenting (PS) is the most common technique used to treat distal left main (LM) bifurcation lesions in patients with unprotected LM coronary artery disease undergoing percutaneous coronary intervention. The double kissing (DK) crush planned 2-stent technique has been shown to improve clinical outcomes in non-LM bifurcations compared with PS, and in LM bifurcations compared with culotte stenting, but has never been compared with PS in LM bifurcation lesions., Objectives: The authors sought to determine whether a planned DK crush 2-stent technique is superior to PS for patients with true distal LM bifurcation lesions., Methods: The authors randomized 482 patients from 26 centers in 5 countries with true distal LM bifurcation lesions (Medina 1,1,1 or 0,1,1) to PS (n = 242) or DK crush stenting (n = 240). The primary endpoint was the 1-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Routine 13-month angiographic follow-up was scheduled after ascertainment of the primary endpoint., Results: TLF within 1 year occurred in 26 patients (10.7%) assigned to PS, and in 12 patients (5.0%) assigned to DK crush (hazard ratio: 0.42; 95% confidence interval: 0.21 to 0.85; p = 0.02). Compared with PS, DK crush also resulted in lower rates of target vessel myocardial infarction I (2.9% vs. 0.4%; p = 0.03) and definite or probable stent thrombosis (3.3% vs. 0.4%; p = 0.02). Clinically driven target lesion revascularization (7.9% vs. 3.8%; p = 0.06) and angiographic restenosis within the LM complex (14.6% vs. 7.1%; p = 0.10) also tended to be less frequent with DK crush compared with PS. There was no significant difference in cardiac death between the groups., Conclusions: In the present multicenter randomized trial, percutaneous coronary intervention of true distal LM bifurcation lesions using a planned DK crush 2-stent strategy resulted in a lower rate of TLF at 1 year than a PS strategy. (Double Kissing and Double Crush Versus Provisional T Stenting Technique for the Treatment of Unprotected Distal Left Main True Bifurcation Lesions: A Randomized, International, Multi-Center Clinical Trial [DKCRUSH-V]; ChiCTR-TRC-11001213)., (Copyright © 2017 American College of Cardiology Foundation. All rights reserved.)
- Published
- 2017
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13. Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of Coronary Artery Bifurcation Lesions: The 5-Year Follow-Up Results From a Randomized and Multicenter DKCRUSH-II Study (Randomized Study on Double Kissing Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions).
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Chen SL, Santoso T, Zhang JJ, Ye F, Xu YW, Fu Q, Kan J, Zhang FF, Zhou Y, Xie DJ, and Kwan TW
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- Aged, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary methods, Angioplasty, Balloon, Coronary mortality, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Coronary Thrombosis etiology, Female, Humans, Male, Middle Aged, Myocardial Infarction etiology, Platelet Aggregation Inhibitors administration & dosage, Risk Factors, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary instrumentation, Coronary Artery Disease therapy, Stents
- Abstract
Background: Provisional stenting is effective for anatomic simple bifurcation lesions. Double kissing crush stenting reduces the 1-year rate of target lesion revascularization. This study aimed to investigate the 5-year clinical results of the DKCRUSH-II study (Randomized Study on Double Kissing Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions)., Methods and Results: A total of 370 patients with coronary bifurcation lesions who were randomly assigned to either the double kissing crush or provisional stenting group in the DKCRUSH-II study were followed for 5 years. The primary end point was the occurrence of a major adverse cardiac event at 5 years. Patients were classified by simple and complex bifurcation lesions according to the DEFINITION criteria (Definitions and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents). At 5 years, the major adverse cardiac event rate (23.8%) in the provisional stenting group was insignificantly different to that of the double kissing group (15.7%; P=0.051). However, the difference in the target lesion revascularization rate between 2 groups was sustained through the 5-year follow-up (16.2% versus 8.6%; P=0.027). The definite and probable stent thrombosis rate was 2.7% in each group (P=1.0). Complex bifurcation was associated with a higher rate of target lesion revascularization (21.6%) at 5 years compared with 11.1% in patients with a simple bifurcation (P=0.037), with an extremely high rate in the provisional stenting group (36.8% versus 12.5%, P=0.005) mainly because of final kissing balloon inflation (19.4% versus 5.2%; P=0.036)., Conclusions: The double kissing crush stenting technique for coronary bifurcation lesions is associated with a lower rate of target lesion revascularization. The optimal stenting approach based on the lesions' complexity may improve the revascularization for patients with complex bifurcations., Clinical Trial Registration: URL: http://www.chictr.org. Unique identifier: ChiCTR-TRC-0000015., (© 2017 The Authors.)
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- 2017
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14. Reply: Aggressive Post-Dilation of Coronary Stents and Restenosis.
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Kan J, Ge Z, Rab TS, and Chen SL
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- Constriction, Pathologic, Coronary Angiography, Coronary Restenosis, Humans, Dilatation, Stents
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- 2016
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15. Incidence and Clinical Outcomes of Stent Fractures on the Basis of 6,555 Patients and 16,482 Drug-Eluting Stents From 4 Centers.
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Kan J, Ge Z, Zhang JJ, Liu ZZ, Tian NL, Ye F, Li SJ, Qian XS, Yang S, Chen MX, Rab T, and Chen SL
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- Aged, China epidemiology, Coronary Angiography, Coronary Restenosis diagnostic imaging, Coronary Restenosis mortality, Coronary Restenosis therapy, Coronary Thrombosis diagnostic imaging, Coronary Thrombosis mortality, Coronary Thrombosis therapy, Female, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Prevalence, Registries, Retreatment, Risk Factors, Time Factors, Treatment Outcome, Coronary Restenosis epidemiology, Coronary Thrombosis epidemiology, Percutaneous Coronary Intervention instrumentation, Prosthesis Failure, Stents
- Abstract
Objectives: The present study aimed to analyze the incidence of SF and its correlation with clinical events after DES implantation and the outcome of re-intervention for symptomatic in-stent restenosis (ISR) induced by stent fracture (SF)., Background: SF is associated with a high rate of clinical events after the implantation of drug-eluting stents (DES). However, the chronological rate of SF and the effect of SF on clinical outcomes from a large patient population remain underreported., Methods: A total of 6,555 patients with 16482 DES in 10751 diseased vessels and surveillance angiography between November 2003 and January 2014 were prospectively studied. The primary endpoints included the incidence of SF, in-stent restenosis (ISR), target lesion revascularization (TLR), and definite stent thrombosis (ST) at the end of follow-up before and after propensity score matching. Clinical outcomes after TLR were also followed up., Results: The SF rate was detected in 803 (12.3%) patients, 3,630 (22.0%) stents, and 1,852 (17.2%) diseased vessels. SF increased over time. SF was associated with higher unadjusted rates of ISR (42.1%), TLR (24.8%, n = 379), and definite ST (4.6%) compared with stents without fracture (10.7%, 6.6%, and 1.03%, all p < 0.001), and the differences remained significant after propensity score matching (all p < 0.05). There was no significant difference in any-cause or cardiac mortality between patients with and without SF. After 1,523 days of follow-up since the first surveillance angiography, repeat ISR was detected in 90 of 379 (23.8%) stents after reintervention, and 6 (7.5%) stents required repeat TLR., Conclusions: SF is more frequently observed after DES implantation. TLR was required in almost one-fourth of fractured stents. Increased events in the SF group did not translate into a difference in mortality compared with the non-SF group. Reintervention was associated with acceptable clinical results., (Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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16. Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left Main Bifurcation Lesions: The 3-Year Follow-Up Results of the DKCRUSH-III Study.
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Chen SL, Xu B, Han YL, Sheiban I, Zhang JJ, Ye F, Kwan TW, Paiboon C, Zhou YJ, Lv SZ, Dangas GD, Xu YW, Wen SY, Hong L, Zhang RY, Wang HC, Jiang TM, Wang Y, Sansoto T, Chen F, Yuan ZY, Li WM, and Leon MB
- Subjects
- Aged, Asia, Coronary Artery Disease diagnosis, Coronary Artery Disease mortality, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction etiology, Myocardial Infarction mortality, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Prospective Studies, Risk Factors, Thrombosis etiology, Thrombosis mortality, Time Factors, Treatment Outcome, Coronary Artery Disease therapy, Percutaneous Coronary Intervention instrumentation, Percutaneous Coronary Intervention methods, Stents
- Abstract
Objectives: The present study aimed to investigate the difference in major adverse cardiac events (MACE) at 3 years after double-kissing (DK) crush versus culotte stenting for unprotected left main distal bifurcation lesions (LMDBLs)., Background: The multicenter and randomized DKCRUSH-III (Comparison of double kissing crush versus culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective study) showed that DK crush stenting was associated with fewer MACE at 1-year follow-up in patients with LMDBLs compared with culotte stenting. Here, we report the 3-year clinical outcome of the DKCRUSH-III study., Methods: A total of 419 patients with LMDBLs who were randomly assigned to either the DK crush or culotte group in the DKCRUSH-III study were followed for 3 year. The primary endpoint was the occurrence of a MACE at 3 years. Stent thrombosis (ST) was the safety endpoint. Patients were classified by simple and complex LMDBLs according to the DEFINITION (Definition and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents) study criteria., Results: At 3 years, MACE occurred in 49 patients the culotte group and in 17 patients in the DK crush group (cumulative event rates of 23.7% and 8.2%, respectively; p < 0.001), mainly driven by increased myocardial infarction (8.2% vs. 3.4%, respectively; p = 0.037) and target-vessel revascularization (18.8% vs. 5.8%, respectively; p < 0.001) between groups. Definite ST rate was 3.4% in the culotte group and 0% in the DK crush group (p = 0.007). Complex LMDBLs were associated with a higher rate of MACE (35.3%) at 3 years compared with a rate of 8.1% in patients with simple LMDBLs (p < 0.001), with an extremely higher rate in the culotte group (51.5% vs. 15.1%, p < 0.001)., Conclusions: Culotte stenting for LMDBLs was associated with significantly increased rates of MACE and ST. (Double Kissing [DK] Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions: DKCRUSH-III, a Multicenter Randomized Study Comparing Double-Stent Techniques; ChiCTR-TRC-11001877)., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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17. Comparison of the efficacy of drug-eluting stents versus bare-metal stents for the treatment of left main coronary artery disease.
- Author
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Wang XZ, Xu K, Li Y, Jing QM, Liu HW, Zhao X, Wang G, Wang B, Ma YY, Chen SL, and Han YL
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Percutaneous Coronary Intervention methods, Prospective Studies, Treatment Outcome, Coronary Artery Disease surgery, Drug-Eluting Stents, Stents
- Abstract
Background: Recent studies reported that percutaneous coronary intervention with stent implantation was safe and feasible for the treatment of left main coronary artery (LMCA) disease in select patients. However, it is unclear whether drug-eluting stents (DESs) have better outcomes in patients with LMCA disease compared with bare-metal stent (BMS) during long-term follow-up in Chinese populations., Methods: From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups: 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events (MACEs), including cardiovascular (CV) death, myocardial infarction (MI), and target lesion revascularization (TLR) at 5 years postimplantation., Results: Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE (19.4% vs. 31.8%, P = 0.022), CV death (7.0% vs. 14.7%, P = 0.045), and MI (5.4% vs. 12.4%, P = 0.049) than the BMS group. There were no significant differences in the rate of TLR (10.9% vs. 17.8%, P = 0.110) and stent thrombosis (4.7% vs. 3.9%, P = 0.758). The rates of MACE (80.6% vs. 68.2%, P = 0.023), CV death (93.0% vs. 85.3%, P = 0.045), TLR (84.5% vs. 72.1%, P = 0.014), and MI (89.9% vs. 80.6%, P = 0.029) free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and MI were 0.41 (95% confidence interval [CI]: 0.21-0.63, P = 0.029) and 0.29 (95% CI: 0.08-0.92, P = 0.037), respectively., Conclusions: DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.
- Published
- 2015
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18. Classic crush and DK crush stenting techniques.
- Author
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Zhang JJ and Chen SL
- Subjects
- Humans, Percutaneous Coronary Intervention instrumentation, Coronary Artery Disease surgery, Percutaneous Coronary Intervention methods, Stents
- Abstract
Clinical data have supported the advantages of the double kissing (DK) crush technique, which consists of stenting the side branch (SB), balloon crush, first kissing, stenting the main vessel (MV) and final kissing balloon inflation, for complex coronary bifurcation lesions compared to other stenting techniques. Careful rewiring from the proximal cell of the MV stent to make sure the wire is in the true lumen of the SB stent is key to acquiring optimal angiographic results. Balloon anchoring from the MV, alternative inflation and each kissing inflation using large enough non-compliant balloons at high pressure, and the proximal optimisation technique are mandatory to improve both angiographic and clinical outcomes. Stratification of a given bifurcation lesion is recommended before decision making.
- Published
- 2015
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19. Bifurcation stenting in patients with ST-segment elevation myocardial infarction: an analysis from dkcrush II randomized study.
- Author
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Kwan TW, Gujja K, Liou MC, Huang Y, Wong S, Coppola J, and Chen SL
- Subjects
- Aged, Angioplasty, Balloon, Coronary mortality, Coronary Angiography, Female, Hospital Mortality, Humans, Male, Middle Aged, Myocardial Infarction diagnostic imaging, Myocardial Infarction mortality, Randomized Controlled Trials as Topic, Recurrence, Retrospective Studies, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary instrumentation, Myocardial Infarction therapy, Stents
- Abstract
Objective: We sought to study the clinical outcomes of bifurcation stenting in patients who presented with stent thrombosis segment elevation myocardial infarction (STEMI)., Background: Patients with STEMI are usually excluded from randomized bifurcation studies. There is limited information for bifurcation stenting in this population., Methods: All STEMI patients who were randomized were retrospectively reviewed from DKCRUSH II (double kissing, double crush) database. DKCRUSH II is a multicenter, randomized study of provisional stenting (PS) versus the DK crush stenting techniques. A total of 370 patients with bifurcation lesions were randomized and of this group a total of 63 patients with STEMI were found. This group of STEMI included 30 patients in the PS group and 33 patients in the DK crush stenting group., Results: There were no differences in terms of contrast used, procedure time, and fluoroscopy time. Procedural success rates were 97% in all patients with STEMI, with 100% in the PS group and 94% in the DK crush stenting group. During the procedure, there were two patients with less than TIMI 3 (thrombolysis in myocardial infarction) flow in the main vessel of the DK crush group However, TIMI 3 flow was 100% in the side branch for both groups. Cumulative 12-month major adverse cardiac event (MACE) was 22% in the whole STEMI group, whereas PS and DK crush groups were 23% versus 21%, respectively (P = NS). There were no differences in in-hospital, 6-month, and 12-month MACE in these two groups. At 6 and 12 months, there were two cardiac deaths in the PS group but without statistical significance when compared with the DK crush stenting group (7% vs. 0%, P = NS)., Conclusion: Bifurcation stenting in patients with STEMI is safe and feasible. The immediate and midterm clinical outcomes were comparable between PS and DK crush stenting., (Copyright © 2013 Wiley Periodicals, Inc.)
- Published
- 2013
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20. Comparison of double kissing crush versus Culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective DKCRUSH-III study.
- Author
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Chen SL, Xu B, Han YL, Sheiban I, Zhang JJ, Ye F, Kwan TW, Paiboon C, Zhou YJ, Lv SZ, Dangas GD, Xu YW, Wen SY, Hong L, Zhang RY, Wang HC, Jiang TM, Wang Y, Chen F, Yuan ZY, Li WM, and Leon MB
- Subjects
- Aged, Chi-Square Distribution, Coronary Angiography methods, Coronary Restenosis physiopathology, Coronary Stenosis diagnostic imaging, Coronary Stenosis mortality, Drug-Eluting Stents, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Middle Aged, Proportional Hazards Models, Prospective Studies, Risk Assessment, Severity of Illness Index, Survival Rate, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary methods, Coronary Restenosis diagnostic imaging, Coronary Stenosis therapy, Stents
- Abstract
Objectives: The study aimed to investigate the difference in major adverse cardiac event (MACE) at 1-year after double kissing (DK) crush versus Culotte stenting for unprotected left main coronary artery (UPLMCA) distal bifurcation lesions., Background: DK crush and Culotte stenting were reported to be effective for treatment of coronary bifurcation lesions. However, their comparative performance in UPLMCA bifurcation lesions is not known., Methods: A total of 419 patients with UPLMCA bifurcation lesions were randomly assigned to DK (n = 210) or Culotte (n = 209) treatment. The primary endpoint was the occurrence of a MACE at 1 year, including cardiac death, myocardial infarction, and target vessel revascularization (TVR). In-stent restenosis (ISR) at 8 months was secondary endpoint, and stent thrombosis (ST) served as a safety endpoint. Patients were stratified by SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) and NERS (New Risk Stratification) scores., Results: Patients in the Culotte group had significant higher 1-year MACE rate (16.3%), mainly driven by increased TVR (11.0%), compared with the DK group (6.2% and 4.3%, respectively; all p < 0.05). ISR rate in side branch was 12.6% in the Culotte group and 6.8% in the DK group (p = 0.037). Definite ST rate was 1.0% in the Culotte group and 0% in the DK group (p = 0.248). Among patients with bifurcation angle ≥70°, NERS score ≥20, and SYNTAX score ≥23, the 1-year MACE rate in the DK group (3.8%, 9.2%, and 7.1%, respectively) was significantly different to those in the Culotte group(16.5%, 20.4%, and 18.9%, respectively; all p < 0.05)., Conclusions: Culotte stenting for UPLMCA bifurcation lesions was associated with significantly increased MACEs, mainly due to the increased TVR. (Double Kissing [DK] Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions: DKCRUSH-III, a Multicenter Randomized Study Comparing Double-Stent Techniques; ChiCTR-TRC-00000151)., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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21. Clinical outcomes after recanalization of a chronic total occluded vessel with bifurcation lesions: results from single-center, prospective, chronic total occlusion registry study.
- Author
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Chen SL, Ye F, Zhang JJ, Kan J, Lin S, Liu ZZ, Tian NL, Zhu ZS, and Xu HM
- Subjects
- Aged, Female, Humans, Logistic Models, Male, Middle Aged, Prospective Studies, Registries, Treatment Outcome, Angioplasty, Balloon, Coronary adverse effects, Coronary Stenosis therapy, Stents adverse effects
- Abstract
Background: Stenting strategies and clinical outcomes of bifurcation lesions in a chronic total occlusion (CTO) vessel after successful recanalization remain to be unknown., Methods: Between January 2001 and December 2009, 195 (41.1%) patients with 254 (47.0%) bifurcation lesions in CTO vessels from a pool of 564 patients with 659 CTO lesions were included and divided into proximal (n = 134) and distal (n = 120) groups, according to the location of the bifurcation lesions. The primary endpoint was the occurrence of major adverse cardiac events (MACE) at the end of clinical follow-up, including cardiac death, myocardial infarction, or target vessel revascularization (TVR)., Results: Collaterals with Rentrop class 3 were seen more in distal group (100% and 68.3%), compared to proximal group (76.9% and 45.6%). Two-stent technique for proximal bifurcation lesions was used in 24.6%, significantly different from the distal group (6.7%, P < 0.001), without significant difference in composite MACE between proximal and distal groups, or between one- and two-stent subgroups in proximal group. The composite MACE after 1-year in complete revascularization subgroup was 17.9% relative to 29.6% in the incomplete revascularization group (P = 0.044). Stents in long false lumen in main vessel were mainly attributive to decreased TIMI grade flow, with resultant increased in-stent restenosis, total occlusion, TVR and coronary aneurysms. Imcomplete revasculzarization (HR 2.028, P = 0.049, 95%CI 1.002 - 4.105) and post-stenting TIMI flow (HR 6.122, P = 0.020, 95%CI 1.334 - 28.092) were two independent predictors of composite MACE at the 1-year follow-up., Conclusions: Two-stent was more used for proximal bifurcation lesions. No significant difference was observed in MACE between proximal and distal, or between one- and two-stent subgroups in the proximal group. Placement of a safety wire was critical for proximal bifurcation lesions. Complete revascularization was mandatory to improve clinical outcomes.
- Published
- 2012
22. Tips and tricks for stenting of bifurcation coronary lesions.
- Author
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Kwan TW, Vales L, Liou M, Kanei Y, and Chen SL
- Subjects
- Aged, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Female, Humans, Male, Middle Aged, Angioplasty, Balloon, Coronary methods, Coronary Artery Disease pathology, Coronary Artery Disease therapy, Coronary Vessels pathology, Stents
- Abstract
Although the provisional stenting technique to treat coronary bifurcation lesions is the preferred method, many bifurcation lesions still require a two-stent technique to optimize the result and clinical outcome. This manuscript summarizes the tips and tricks of bifurcation stenting with cases illustrations. As interventionists are encountering more complex and difficult cases, one may find the tips and tricks in this manuscript helpful in daily practice.
- Published
- 2010
23. Editorial: at the bifurcation of the last frontiers.
- Author
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Nguyen T, Chen SL, Xu B, Kwan T, Nguyen K, Nanjundappa A, Van Ho B, and Gao RL
- Subjects
- Angioplasty, Balloon, Coronary, Coronary Artery Bypass, Coronary Restenosis prevention & control, Humans, Thrombosis prevention & control, Coronary Artery Disease therapy, Stents
- Abstract
The concept of coronary angioplasty percutaneous coronary intervention (PCI) was pioneered by Andreas Gruntzig. Since then, several modifications, innovative devices, techniques, and advances have revolutionized the practice of interventional cardiology. Coronary bifurcation and chronic total occlusion are the last two frontiers that continue to challenge the skills of the interventional cardiologists. Proceedings of the second Bifurcation Summit held from November 26 to 28, 2009 in Nanjing, China are published in this symposium. In a general review, the state of the art in management of bifurcation lesion is summarized in the statement of the "Bifurcation Club in KOKURA." A new-presented concept was the "extension distance" between the main vessel and the sidebranch ostia and its association with restenosis. The results of two studies on shear stress (SS) after PCI showed that contradictory lower SS after stenting was associated with lower in-stent restenosis. There was better fractional flow reserve after double kissing crush technique than provisional one-stent technique. There was also lower rate of stent thrombosis after bifurcation stenting with excellent final angiographic results. In a negative note, the SYNTAX score had no predictive values on trifurcated left main stenting. In summary, different aspects of percutaneous management for bifurcated lesion are described seen from different perspectives and evidenced by novel techniques and strategies.
- Published
- 2010
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24. Contradictory shear stress distribution prevents restenosis after provisional stenting for bifurcation lesions.
- Author
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Zhang JJ, Chen SL, Hu ZY, Kan J, Xu HM, Shan SJ, Liu ZZ, Ye F, Kwan TW, Nguyen K, Nanjundappa A, and Nguyen T
- Subjects
- Acute Coronary Syndrome therapy, Angioplasty, Balloon, Coronary Angiography, Coronary Artery Disease therapy, Coronary Circulation, Female, Finite Element Analysis, Follow-Up Studies, Humans, Imaging, Three-Dimensional, Male, Middle Aged, Models, Cardiovascular, Coronary Stenosis therapy, Endothelium, Vascular physiopathology, Stents, Stress, Physiological physiology
- Abstract
Background: Endothelial shear stress is one of the local hemodynamic factors suspected in the development of coronary atherosclerosis in bifurcation lesions. In patients with provisional stenting, the endothelial shear stress (SS) distribution is unknown., Objective: The aim of this study was to investigate the magnitude and distribution of the SS of coronary bifurcation lesions stenting by the provisional approach., Methods: Ten consecutive patients were included in this study. Quantitative coronary analysis, flow study, and three-dimensional computational analysis with the aid of the commercial software CD STAR-CCM+ were done before and after the provisional stenting procedure and also 8 months later., Results: Clinical and angiographic follow-up were available in all patients. No patient had a side branch (SB) stent. At the 8-month follow-up, no major adverse cardiac event (MACE) occurred. There was also no clinical and angiographic restenosis. Before PCI, the distal main vessel (MV)-lateral, and the SB-lateral subsegments had relative nonsignificant lower SS value (4.08 +/- 2.78 Pa and 4.35 +/- 5.04 Pa, respectively) when compared to other segments. After 8-month follow-up, sustained decreased SS value was shown in the distal MV-lateral segment (4.08 +/- 2.78-1.68 +/- 1.65 Pa), when compared with significantly increased SS value in the SB-lateral subsegment 4.35 +/- 5.04-16.50 +/- 40.45 Pa). The explanation is that after stenting in the MV, the flow was redistributed immediately after percutaneous coronary intervention (PCI) and reversed back to its original 8 months later. However, the growth of the fibrous tissue causing in-stent restenosis (ISR) is prohibited by sirolimus on the stent struts. In contrast, in a branch opened up by plain old balloon angioplasty (POBA), the flow did not change much, the flow could even be worse because it is shifted to the MV after the cross-sectional area of the MV improved by stenting. However, thanks to POBA, there is increased fibrous tissue formation, enough to increase the SS and prevent further accumulation of cell and cholesterol needed for more restenosis., Conclusion: In the provisional approach, low endothelial SS correlated with no restenosis for patients who underwent stenting of the MV, while a contradictory combination of high SS and no restenosis was seen in the SB after only POBA. The mechanism of prevention of restenosis in the SB is by increasing the SS while in the MV, the mechanism of prevention of ISR is secondary to sirolimus on the stents struts.
- Published
- 2010
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25. The acute changes of fractional flow reserve in DK (double kissing), crush, and 1-stent technique for true bifurcation lesions.
- Author
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Ye F, Zhang JJ, Tian NL, Lin S, Liu ZZ, Kan J, Xu HM, Zhu Z, and Chen SL
- Subjects
- Coronary Angiography, Coronary Artery Disease diagnostic imaging, Coronary Stenosis diagnostic imaging, Female, Humans, Male, Middle Aged, Angioplasty, Balloon, Coronary, Coronary Artery Disease therapy, Coronary Stenosis therapy, Fractional Flow Reserve, Myocardial physiology, Stents
- Abstract
Background: While many studies confirmed the importance of fractional flow reserve (FFR) in guiding complex percutaneous coronary interventions (PCI), data regarding the significance of FFR for bifurcation lesions are still lacking., Methods: Between October 2008 and October 2009, 51 patients with true bifurcation lesions were consecutively enrolled and randomized into double kissing (DK) crush (n = 25), and provisional 1-stent (n = 26) groups. FFR measurements at baseline and hyperemia were measured at pre-PCI, post-PCI, and at 8-month follow-up., Results: Clinical follow-ups were available in 100% of patients while only 33% of patients underwent angiographic follow-up. Baseline clinical and angiographic characteristics were matched between the 2 groups. Pre-PCI FFR of the main branch (MB) in the DK group was 0.76 +/- 0.15, which was significantly lower than in the provisional 1-stent group (0.83 +/- 0.10, P = 0.029). This difference disappeared after the PCI procedure (0.92 +/- 0.04 vs. 0.92 +/- 0.05, P = 0.58). There were no significant differences in terms of baseline, angiographic, procedural indexes, and FFR of side branch (SB) between the 2 treatment arms. However, immediately after PCI, the patient with DK crush had higher FFR in the SB as compared to the provisional 1-stent group (0.94 +/- 0.03 vs. 0.90 +/- 0.08, P = 0.028, respectively) and also they had lower diameter stenosis (8.59 +/- 6.41% vs. 15.62 +/- 11.69%, P = 0.015, respectively)., Conclusion: In the acute phase, immediately after PCI for bifurcation lesion, DK crush stenting was associated with higher FFR and lower residual diameter stenosis in the SB, as compared with the provisional 1-stent group.
- Published
- 2010
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26. Clinical outcome after management of unprotected left main in-stent restenosis after bare metal or drug-eluting stents.
- Author
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Chen SL, Xu B, Mintz G, Ye F, Zhang JJ, Kan J, Sun XW, Zhang AP, Chen JG, Qian J, and Kwan TW
- Subjects
- Aged, Aged, 80 and over, Angioplasty, Balloon, Coronary, Coronary Angiography, Coronary Restenosis pathology, Female, Humans, Male, Middle Aged, Treatment Outcome, Coronary Restenosis therapy, Drug-Eluting Stents adverse effects, Stents adverse effects
- Abstract
Background: Implantation of either bare metal stent (BMS) or drug-eluting stent (DES) has been used in every day practice for patients with unprotected left main stenosis (UPLMS). There are still a lack of data regarding the subsequent results of UPLMS in-stent restenosis (ISR). The present study aimed at determining the clinical outcome of UPLMS ISR patients after implantation of either BMS or DES., Methods: Patients with UPLMS ISR after stenting were included. The primary endpoint was the cumulative major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR)., Results: UPLMS ISR rate was 14.8% (n = 73, 15.7% after BMS, 14.5% for DES) after average of (3.89 +/- 2.01) years (range from 1 to 10.5 years) follow-up. Angiographic follow-up between 6 - 8 months was available in 85.3%. Of these, repeat percutaneous coronary intervention (PCI) was used in 62 (84.9%) patients, with medicine only in 9 (12.4%) and coronary artery bypass graft (CABG) in 2 (2.7%). Most repeat PCI patients were with unstable angina (87.0%), and had decreased left ventricular ejection fraction ((42.58 +/- 5.12)%), fewer focal/ostial left circumflex branch (LCX) lesions, in relative to medicine only group. After (31.9 +/- 23.3) months, the MACE, MI, TVR and cardiac death were 31.5%, 1.4%, 24.1% and 8.2%, respectively. Definite and possible stent thrombosis occurred in 1 (1.4%) patient., Conclusions: Medical therapy for asymptomatic isolated ostial LCX was safe. Repeat PCI for UPLMS ISR was associated with acceptable early and short-term clinical outcome. Further study was needed to elucidate the role of CABG in treating UPLMS ISR.
- Published
- 2010
27. Mechanisms and clinical significance of quality of final kissing balloon inflation in patients with true bifurcation lesions treated by crush stenting technique.
- Author
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Zhang JJ, Chen SL, Ye F, Yang S, Kan J, Liu YQ, Zhou Y, Sun XW, Zhang AP, Wang X, and Chen J
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Coronary Disease therapy, Stents
- Abstract
Background: The mechanisms responsible for the occurrence of a kissing unsatisfied (KUS) result after classical crush stenting remain unclear. The present study aimed at analyzing the mechanisms and clinical significance of KUS., Methods: Two hundred and thirteen patients with true bifurcation lesions treated with classical crush stenting and final kissing balloon inflation (FKBI) were assigned to upper, middle, and lower groups according to the position of the side branch re-wiring assessed by visual estimation, quantitative coronary analysis (QCA) and intravascular ultrasound (IVUS). Angiographic follow-up was indexed at 12 months., Results: The upper group was characterized by a larger bifurcation angle of 55.53 degrees +/- 25.25 degrees (P = 0.030) and a longer procedural time (42.43 +/- 23.92) minutes (P = 0.015). The overall rate of KUS by visual estimation was 10.48%, with 5.4% in the upper group, 3.9% in middle group, and 36.1% in lower group (P < 0.001). For the diagnosis of KUS, visual inspection demonstrated a good correlation with both QCA and IVUS. Smaller stent diameter was the main reason for KUS in the upper group, while extra-stent side wire location, or re-wire in a low position was the main mechanism attributed to KUS in the lower group. The Lower group had more restenosis, with most restenotic lesions at a lower position of the side branch ostium. KUS (HR 1.652, 95% CI 1.332 - 2.088, P < 0.001) and re-wiring position (HR 2.341, 95% CI 1.780 - 4.329, P < 0.001) were two independent predictors of side branch restenosis. Re-wiring position (OR 0.458, 95%CI 0.336 - 0.874, P = 0.001) and side stent expansion (OR 3.122, 95%CI 2.883 - 5.061, P = 0.014) were factors predicting the findings of KUS., Conclusions: Side wire outside side stents resulted in more KUS and restenosis. Different restenotic lesion types reflected individual mechanisms contributing to the development of plaque proliferation.
- Published
- 2009
28. Perspective on bifurcation PCI.
- Author
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Chen SL, Louvard Y, and Runlin G
- Subjects
- Coronary Stenosis classification, Coronary Stenosis epidemiology, Coronary Vessels pathology, Drug Delivery Systems, Humans, Angioplasty, Balloon, Coronary methods, Blood Vessel Prosthesis Implantation methods, Coronary Stenosis therapy, Stents
- Abstract
Coronary bifurcation lesion is a complex lesion with suboptimal angiographic and clinical results. There has been no satisfactory classification of the lesion that can guide selection of strategies and predict short- and long-term outcomes. The difference between left main (LM) bifurcation lesions and non-LM bifurcation is striking. So many stenting strategies have been proposed and tried in trials. They include the V, T, Y, one-stent, two-stent, crush, mini-crush, DK, and SKS techniques. However, because these techniques are time and labor intensive, dedicated bifurcated stents have been invented and trialed in humans. This review presents a historical perspective of interventions in bifurcated lesions, with the strengths and weaknesses of the major strategies and of the new dedicated stents.
- Published
- 2009
- Full Text
- View/download PDF
29. The world belongs to the brave.
- Author
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Chen SL, Kwan TW, Gao RL, Louvard Y, and Nguyen T
- Subjects
- China, Congresses as Topic, Coronary Vessels pathology, Humans, Angioplasty, Balloon, Coronary methods, Blood Vessel Prosthesis Implantation methods, Coronary Stenosis therapy, Stents
- Published
- 2009
- Full Text
- View/download PDF
30. Effect of coronary bifurcation angle on clinical outcomes in Chinese patients treated with crush stenting: a subgroup analysis from DKCRUSH-1 bifurcation study.
- Author
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Chen SL, Zhang JJ, Ye F, Chen YD, Fang WY, Wei M, He B, Sun XW, Yang S, Chen JG, Shan SJ, Tian NL, Li XB, Liu ZZ, Kan J, Michael L, and W KT
- Subjects
- Aged, Asian People ethnology, Coronary Stenosis ethnology, Coronary Stenosis pathology, Drug-Eluting Stents, Female, Humans, Male, Middle Aged, Myocardial Infarction ethnology, Myocardial Infarction pathology, Myocardial Infarction therapy, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Coronary Angiography methods, Coronary Stenosis therapy, Stents
- Abstract
Background: Bifurcation angles may have an impact on the clinical outcomes of crush stenting. We sought to compare high (> or = 60 degrees ) with low (< 60 degrees ) bifurcation angle in patients who underwent either classical or double kissing (DK) crush stenting for bifurcation lesions from the DKCRUSH-1 data base., Methods: There were 212 patients with 220 lesions, some with low-angle (n = 138) and some with high-angle (n = 74). Angiography was indexed at 8-month after procedure. Primary endpoint was the occurrence of major adverse cardiac events (MACEs), defined as cardiac death, myocardial infarction and target lesion revascularization (TLR). Secondary endpoint included late lumen loss, the rate of restenosis, and final kissing balloon inflation (FKBI)., Results: At 8 months, clinical follow-up was 100%; angiographic follow-up was 75% in the low-angle group and 83.3% in the high-angle group. There were no significant differences in the FKBI between the high-angle group (91.43%) and the low-angle group (82.39%). In the high angle group, there was a significant difference in contrast volume used (P = 0.005) but no significant difference in acute gain, minimum lumen diameter (MLD), late loss and diameter stenosis in the pre-bifurcation segment, post-bifurcation segment or side branch. When lesions were assigned into with-(n = 133) and without-FKBI (n = 42), significant side-branch late loss was seen in the group without-FKBI ((0.65 +/- 0.49) mm vs (0.47 +/- 0.62) mm, P = 0.02), with a resultant greater restenosis rate (37.68% vs 18.32%, P = 0.001). No difference was detected in the MACE free survival rate between the high and low angle groups (82.39% vs 82.36%, P = 0.84). The rate of stent thrombosis tended to be higher in the lower-angle group although there was no significant difference (P = 0.38). The TLR free survival rate was 87.2% in the with-FKBI group vs 73.5% in the without-FKBI group (P = 0.001). Cox regression analysis showed that the independent predictors for target vessel revascularization were the side branch stent MLD post stenting (hazard ratios (HR) 1.028, 95% CI 2.357 - 16.233, P = 0.002), lack of FKBI (HR 4.910, 95% CI 4.706 - 8.459, P = 0.001) and unsatisfactory kissing (HR 3.120, 95% CI 2.975 - 5.431, P = 0.001)., Conclusions: Bifurcation angles do not influence the clinical outcome of crush stenting. Successful final kissing balloon inflation, regardless of bifurcation angles, can predict TLR.
- Published
- 2009
31. [DK crush technique: modified treatment of bifurcation lesions in coronary artery].
- Author
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Chen SL, Ye F, Zhang JJ, Zhu ZS, Lin S, Shan SJ, Liu ZZ, Liu Y, Duan BX, and Ge JB
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Ultrasonography, Interventional, Angioplasty, Balloon, Coronary methods, Blood Vessel Prosthesis Implantation methods, Coronary Stenosis therapy, Stents
- Published
- 2005
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