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The aim. To study the effectiveness of left main coronary artery (LMCA) stenting in patients with coronary heart disease and to optimize the choice of percutaneous coronary intervention technique based on the experience of one clinic. Materials and methods. The study, which was conducted at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, included 107 patients with LMCA disease, who underwent stenting from January 2019 to December 2023. During the study, the patients were divided into two groups. One group underwent stenting using the single-stent method (44 patients, 41.1%), while the other group underwent stenting using the double-stent method (63 patients, 58.9%). Results. In the group of surveyed patients after stenting, an analysis was conducted regarding adherence to drug therapy and achievement of target lipid spectrum levels. It was found that one of the reasons for the active progression of atherosclerosis can be considered low adherence to drug therapy. A group of patients with recurrence of angina after stenting, the cause of which was restenosis in the stented segment, was analyzed. In the analysis of the frequency of repeated interventions in patients with hemodynamically significant lesions of the LMCA, who initially underwent stenting, it was found that 24.5% of patients (n = 24) underwent stenting again at the second visit and only 4 patients (4.1%) underwent bypass surgery, which is statistically significant (p ≤ 0.001). Conclusions. LMCA stenting is an effective way of treating patients with hemodynamically significant damage to it (effectiveness of the technique is 71.4%). Recurrence of angina was observed in 28 patients (28.6%). Both single-stent and double-stent procedures are effective: recurrence of angina was observed in 13.3% and 15.3% of cases, respectively. One of the main reasons for the recurrence of angina pectoris is the progression of atherosclerosis in new locations (39.3%) and restenosis in stenting segment (39.3%).

Planning and guiding PCI in a complex intervention is very important and one of the most important decisions is the one on whether to use one or two stent bifurcation techniques. Unfortunately, this can easily turn into complication and the need to alter the procedural strategy. The main points to be considered when deciding on the PCI strategy are related to both procedural safety and long-term outcomes. Provisional stenting has been recommended as the default technique for most coronary bifurcation lesions. In this paper, we describe the case of a patient scheduled for elective procedure of bifurcation lesion of LAD/D1. Our planned strategy was provisional stenting of LAD, using one stent for LAD, DCB for D1. Due to the complication that occurred, i.e., dissection of LAD after LAD stenting, we changed the strategy to two-stents technique strategy, using Culotte technique.

The aim. To study the long-term results of stenting in patients with coronary artery disease with hemodynamically significant left main coronary artery (LMCA) stenoses. Materials and methods. The study included 67 patients (56 men, 11 women) with a mean age of 63 ± 2.1 years. Results. Among the 67 patients included in the study, 29 patients (43.3%) underwent percutaneous coronary inter-vention using a single-stent technique. These were patients with ostial LMCA lesions, lesions of the middle third of the LMCA and some patients with Medina 1.1.0; 1.0.1; 1.0.0; 0.1.0; 0.0.1 lesions of the distal part of the LMCA. The median follow-up was 2 years. Using a questionnaire, we managed to establish contact with 25 patients (86.2%). Among these, 1 patient (3.4%) died of non-cardiac causes and 7 patients (24.1%) had a recurrence of angina within 2 years. The causes of angina recurrence in 2 cases (6.9%) were restenosis in the stent with transition to the mouth of the side branch, which required repeated stenting of the LMCA with transition to the left circumflex artery. In 5 patients (17.2%), angina recur-rence was associated with progression of coronary atherosclerosis of another localization. Among 67 patients with LMCA stenting, the two-stent technique was used in 38 patients (56.7%). These were pa-tients with Medina 1.1.0; 1.0.1; 1.0.0; 0.1.0; 0.0.1 lesions of the distal part of the LMCA. The median follow-up was 2 years. Using a questionnaire, we managed to contact 35 patients (92.1%). Among these, 4 patients (10.5%) died, but only one of them due to cardiac causes (2.6%), and 3 patients (7.9%) had recurrent angina within 2 years, two of whom underwent stenting by the T and protrusion (TAP) technique and one by culotte. The first two patients underwent angioplasty of restenosis in stents using balloons with a therapeutic coating. In the last patient, stent recoil in the left circumflex artery mouth was observed due to severe calcification, so this patient underwent re-implantation of the stent system in the recoil zone. Conclusions. The problem of choosing a method of revascularization for patients with hemodynamically significant LMCA lesions remains controversial to this day, despite the wide range of evidence. Doctors should jointly decide on the choice of treatment methodology solely in the interests of the patient, taking into account all the factors that may affect the patient’s quality of life in the long term.

Percutaneous coronary intervention can be a high-risk procedure that would benefit from optimizing device-tissue interactions between stents and coronary vessels. Using a perfusion-fixed human heart with coronary artery disease, we performed a percutaneous coronary intervention of the left main coronary artery bifurcation. This heart was perfused and multimodal imaging was utilized to view the procedure with direct visualization, fluoroscopy, and optical coherence tomography (OCT). We followed the European Bifurcation Club's guidelines to perform a single-stent bifurcation before transitioning to a two-stent Culotte technique. After each procedural step, the heart was removed from the perfusion apparatus and transferred to a micro-CT scanner to obtain unique scans. We conducted apposition analyses of the computational 3D models from micro-CT DICOM datasets, and compared them to the results from direct visualization and commercial OCT's Apposition Indicator software. Additional measurements of resulting coronary anatomic expansions were taken to determine the potential roles of each step in improving procedural outcomes. Micro-CT images show stent deformation during a percutaneous coronary intervention (provisional to Culotte bifurcation procedure) in an isolated diseased human heart. [ABSTRACT FROM AUTHOR]

Stent implantation in bifurcated coronary lesions is technically challenging so that procedural refinements are continuously investigated. Novel procedure modeling and intracoronary imaging techniques may offer critical insights on stent deformations and stent-wall interactions during bifurcation stenting procedures. Thus, we assessed coronary bifurcation stenting techniques using multimodal imaging and 3D modeling in reanimated swine hearts. Harvested swine hearts were reanimated using Visible Heart® methodologies and (under standard fluoroscopic guidance) used to test 1-stent (provisional and inverted provisional) and 2-stent (culotte, TAP and DK-crush) techniques on bifurcations within various coronary vessels using commercially available devices. Intracoronary angioscopy and frequency-domain optical-coherence-tomography (OCT) were obtained during the procedures. 3D OCT reconstruction and micro-computed tomography 3D modeling (post heart fixations) were used to assess stent deformations and stent-wall interactions. We conducted multiple stenting procedures and collected unique endoscopic and OCT images (and subsequent computational models from micro-CT) to assess stent deformations and device/wall interactions during different steps of bifurcation stenting procedures. Endoscopy, micro-CT and virtual reality processing documented that different 1- and 2-stent techniques, practiced according to experts' recommended steps, achieve optimal post-intervention stent conformation. As compared with intra-procedural endoscopy, software-generated 3D OCT images accurately depicted stent deformations during 1-stent techniques. On the opposite, during more complex 2-stent techniques, some defects were appreciated at 3D OCT reconstruction despite optimal 2D OCT images. This study provided unique insights regarding both stent deformations occurring in the course of bifurcation stenting and the efficacy of OCT to visualize them. [ABSTRACT FROM AUTHOR]

Bifurcation lesions are common and associated with higher risks of major cardiac events and restenosis after percutaneous coronary intervention (PCI). Treatment requires understanding of lesion characteristics, stent design and therapeutic options. We review the evidence for provisional vs 2-stent techniques. We conclude that provisional stenting is suitable for most bifurcation lesions. We detail situations where a 2-stent technique should be considered and the steps for performing each of the 2-step techniques. We review the importance of lesion preparation, intracoronary imaging, proximal optimization (POT) and kissing balloon inflation [ABSTRACT FROM AUTHOR]

Aim: Complex left main (LM) bifurcation disease seems to be better approached by a planned double stent technique. Materials & methods: Medline search for articles including randomized trials, prospective series, large registries and retrospective studies >50 patients has been performed. Results: Double kissing crush demonstrated its superiority over culotte stenting and cross over, while other techniques such as the T-stenting and T-stent and Protrusion have not been extensively reported in LM setting. The nano inverted-T-stenting has provided evidences that the use of ultrathin strut stents and very minimal crush is beneficial for both the physiological and rheological properties. Conclusion: The double stenting techniques used in LM should be evaluated in terms of procedural differences and technical simplicity. [ABSTRACT FROM AUTHOR]

Purpose: Crush and Culotte techniques have been used increasingly to treat patients with complex unprotected left main coronary artery bifurcation lesions. This article compares published data on these two techniques.Methods: Databases, including PubMed, Embase, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure, were searched for articles published before Aug 21, 2019 to identify all relevant studies on left main coronary artery bifurcation lesions treated by Crush versus Culotte techniques. The pooled data were analyzed using either fixed- or random-effects model depending on heterogeneity (assessed via the I2 index). The endpoints were major adverse cardiac events, target lesion revascularization, cardiac death, stent thrombosis, myocardial infarction and target vessel revascularization.Results: Eight articles with a total of 1,283 patients were included, and 710 patients were treated with Crush, and 573 ones with Culotte. Crush group was trend to decreased major adverse cardiac event compared with Culotte group [Relative ratio (RR) 0.63,95% confidence interval(CI) 0.39-1.04, I2 =72.7%], mainly driven by decreased cardiac death [RR 0.49, 95% CI(0.25-0.99), I2 =0%], decreased myocardial infarction [RR 0.40, 95% CI(0.21-0.76), I2 =21.6%],and lower stent thrombosis [RR 0.39, 95% CI(0.16-0.98), I2 =39.4%]. There was no significant difference in target lesion revascularization and target vessel revascularization between Crush and Culotte [RR 0.77, 95% CI 0.46-1.28, I2=61.1%; RR 0.78, 95% CI (0.30-2.02), I2 =73.1%, respectively].Conclusion: Crush was superior to Culotte for treatment of left main coronary artery bifurcation lesions with a trend of lower incidence of long-term major adverse cardiac events, mainly derived from decreased myocardial infarction, stent thrombosis and cardiac death. [ABSTRACT FROM AUTHOR]

Stent implantation in coronary bifurcations presents unique challenges and currently there is no universally accepted stent deployment approach. Despite clinical and computational studies, the effect of each stent implantation method on the coronary artery hemodynamics is not well understood. In this study the hemodynamics of stented coronary bifurcations under pulsatile flow conditions were investigated experimentally. Three implantation methods, provisional side branch (PSB), culotte (CUL), and crush (CRU), were investigated using time-resolved particle image velocimetry to measure the velocity fields. Subsequently, hemodynamic parameters including wall shear stress, oscillatory shear index (OSI), and relative residence time (RRT) were calculated. The pressure field through the vessel was non-invasively quantified and pressure wave speeds were computed. The effects of each stented case were evaluated and compared against an un-stented case. CRU provided the lowest compliance mismatch, but demonstrated detrimental stent interactions. PSB, the clinically preferred method, and CUL maintained many normal flow conditions. However, PSB provided about a 300% increase in both OSI and RRT. CUL yielded a 10 and 85% increase in OSI and RRT, respectively. The results of this study support the concept that different bifurcation stenting techniques result in hemodynamic environments that deviate from that of un-stented bifurcations, to varying degrees. [ABSTRACT FROM AUTHOR]

Aims: Percutaneous coronary intervention (PCI) of bifurcation lesions can be performed using various techniques. The aim of this study was to analyse the outcome of various techniques of bifurcation stenting in all patients undergoing bifurcation stenting at one large intervention centre in 2013, taking into account that more complex lesions might more often warrant a two-stent technique. Methods and results: This retrospective study included 260 consecutive patients who underwent non-primary PCI of a bifurcation lesion at the Catharina Hospital, Eindhoven, in 2013. Patients were classified into two groups: one-stent technique (provisional stenting), and two-stent techniques (culotte, crush and T-stenting). The primary endpoint was the rate of restenosis at 1 year. The secondary endpoints were procedural complications (side branch occlusion, periprocedural infarction, and death) and major adverse cardiac events (MACE) at 1 year. Periprocedural complications occurred in 15 patients (5.8 %) with no difference between the groups ( p = 0.27). After 1 year, restenosis occurred in 3.2 % of the patients in the one-stent technique group and 7.3 % in the two-stent technique group ( p = 0.20). MACE at 1 year did not differ between the groups at 11.9 % and 12.2 % respectively ( p = 1.00). Conclusions: This study shows that there is no significant difference between restenosis rate, or any other outcome parameter, with the different techniques of bifurcation stenting. Since provisional stenting is the simplest, most straightforward and cheapest approach, if technically feasible this technique has our preference as the initial approach, and an upgrade can be considered if the result is insufficient. [ABSTRACT FROM AUTHOR]

Background: Coronary bifurcation stenting constitutes 20% of all PCI performed. Given the extensive prevalence of bifurcation lesions, various techniques have sought to optimally stent the bifurcation to improve revascularization while also decreasing rates of stent thrombosis and lesion recurrence. Advanced techniques, such as planned two-stent approaches, have been shown to have improved outcomes but also require fluoroscopy and procedure time, posing an economic argument as well as a patient-outcome one., Objective: Because of the many strategies posited in the literature, it becomes essential to objectively evaluate evidence from randomized controlled trials and meta-analyses to help determine the optimal stenting strategy., Methods: We reviewed the clinical evidence on the efficacy of coronary bifurcation stenting., Results: In this paper, we review the most recent randomized controlled trials and meta-analyses on the efficacy of various stenting techniques and advances in stenting technologies published to gauge the current state of understanding and chart where the field is heading., Conclusion: Bifurcation stenting is a maturing problem in the field of interventional cardiology that is adapting to the needs of the patients and advances in technology., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Abstract: Background: The crush and culotte are probably the most common two-stent techniques utilized for percutaneous coronary intervention (PCI) of complex bifurcation lesions. Long-term outcome associated with the utilization of these techniques is unknown. Our objective was to evaluate the long-term outcomes after bifurcation PCI utilizing these 2 techniques with a prospective PCI registry. Methods: Between 11/1/2003 and 12/31/2007, 360 patients were treated with either crush (n=304) or culotte (n=56). Primary outcome was the occurrence of major adverse cardiac events (MACE) defined as the composite of death, myocardial infarction and target vessel revascularization. The major secondary outcome measure was MACE or occurrence of CCS Class ≥2 angina. Results: After a median follow-up of 4.1years (3.0–5.1), the occurrence of MACE was 23.9%. MACE or CCS Class ≥2 angina occurred in 27.5% of patients. Multivariable analysis revealed that creatinine clearance <60ml/min (odds-ratio [OR]=1.71, 95% CI 1.08–2.71; p=0.022) and left ventricular ejection fraction <40% (OR=2.14, 95% CI 1.21–3.79; p=0.008) were independent predictors of MACE or CCS Class ≥2 angina. A larger main vessel reference diameter (OR=0.57, 95% CI 0.61–0.92), bifurcation angle <50% (OR=0.59, 95% CI 0.35–0.92) and a final kissing-balloon inflation (OR=0.75, 95% CI 0.35–0.99) were associated with a lower risk of MACE or CCS Class ≥2 angina. Conclusions: Application of the crush and culotte techniques is associated with efficacy and safety at long-term follow-up. Bifurcation angle, a final kissing balloon inflation and vessel reference diameter are important variables that impact on very long-term outcomes. [Copyright &y& Elsevier]

Objectives: This study sought to assess the impact of coronary bifurcation stenting on health-related functional status, using the Seattle Angina Questionnaire (SAQ), for participants in the BBC ONE (British Bifurcation Coronary; Old, New, and Evolving Strategies) trial and to compare simple versus complex bifurcation stenting strategies in this regard. Background: Large randomized studies have examined outcomes from bifurcation stenting with drug-eluting stents. They have reported on major adverse cardiovascular events and angiographic follow-up. However, a principal goal of percutaneous coronary intervention is symptom control and improvement in quality of life, yet there are no published data from these trials on this aspect. Furthermore, it is unknown whether simple versus complex stenting strategies have different effects on angina control and quality of life. Methods: The BBC ONE study randomized 500 subjects to bifurcation stenting using either a simple (provisional T) or complex (crush or culotte) approach. Subjects completed the SAQ at baseline and at 9 months after percutaneous coronary intervention. Canadian Cardiovascular Society class and antianginal drug use were also evaluated. Results: Bifurcation stenting was associated with significant improvements on SAQ scales and in Canadian Cardiovascular Society class (baseline: 5.3% subjects were class 0; follow-up: 64.0% were class 0; p < 0.001) and a significant reduction in the number of antianginal drugs used (median decrease: 1; p < 0.001). Simple and complex strategies did not differ significantly for changes in the SAQ, actual SAQ scores, or use of antianginal drugs. Conclusions: Regardless of chosen strategy, bifurcation stenting produced significant functional improvements in angina-related health. No significant difference between simple and complex strategies was found in this regard. [ABSTRACT FROM AUTHOR]

The article focuses on visual representation of gender relations in the family. The author examines the historical social differences between men and women concerning sexuality, power relationships in couples, and gender roles within families. The first images presented, during the thirteenth century, describe women's sexual desire and male authority, portraying women as trying to assume a dominant role through a desire to wear “culottes” (pants, trousers). Later, the denunciation of female domination over men is emphasized, showing reversed situations where women would physically abuse their husbands. The medieval manuscript “Roman de la Rose” and the theme of eroticism are also discussed.

Transradial approach is well established and often used for percutaneous coronary intervention (PCI). The usual opinion is that transfemoral approach is preferable to transradial for complex PCI using a 7 French guiding catheter.1'3 We report a case of a 60-year-old male with a medical history of peripheral artery disease and stable angina who presented to the Emergency Department with phlegmon of the fourth digit on the left foot. The patient had significant cardiovascular risk factors including insulin-dependent type II diabetes mellitus, arterial hypertension and hyperlipidemia. Due to stable angina and presence of risk factors, coronary angiography was recommended. Coronary angiography revealed 70% stenosis of the distal left main artery that extended to the proximal circumflex and left anterior descending artery with first obtuse marginal artery also significantly narrowed. Coronary intervention was delayed because of the coexisting active phlegmon. Surgical revascularization was recommended but the patient refused surgical intervention (SYNTAX score 23). The patient was scheduled for an elective PCI the following month. The transradial PCI controlled by intravascular ultrasound (IVUS) was performed using a 7 French guiding catheter. Using the "culotte” technique, 2 drug-eluting stents were implanted in the left main coronary artery while additional stenting of the left anterior descending artery and the first obtuse marginal branch was performed with another two drug eluting stents. The total procedural radiation time was 25 minutes and 220 ml of iodine contrast was used. A complex PCI using a 7 French guiding catheter via transradial approach can be performed successfully and safely and it represents a good alternative to transfemoral approach in suitable patients. [ABSTRACT FROM AUTHOR]