Treatment of a true CXA-OM bifurcation lesion using a one stent drug-coated balloons provisional technique

    Authors

    Keywords

    bifurcation lesions, acute coronary syndrome, drug coated balloons

    DOI

    https://doi.org/10.15836/ccar2020.51

    Full Text

    Background : Provisional stenting is a favorable option for most bifurcation lesions, while two stent techniques show benefits in true bifurcation performed by experts. Using one stent and DCB in true bifurcation lesions still remains questionable. ( 1 , 2 ) Case report : 76-year-old male presented with persisting chest pain. ECG showed no specific ischemic changes, while hsTnI was highly elevated. He had gone PCI LAD 14 years ago. Diagnosis: right coronary angiography revealed occlusion of RCA, while left coronary angiography revealed LLS of 20% in proximal LAD stent, 70% stenosis of mid LAD, and acute occlusion of secondary OM branch on bifurcation level, while CxA was stenosed 70-80%. Management: PCI CxA-OM2 was performed with DES Xience expedition 2,75/33mm in CxA-OM2 with POT 3,25/12mm proximally, then after rewiring and adequate lesion preparation a DEB Sequent please 2,5/25mm in CxA distally was performed. After two months we performed an elective PCI LAD and checked out the result of CxA bifurcation which was optimal. Conclusion : Using one stent and DCB in true bifurcation lesions still remains questionable. There are no data from a prospective study, while there are data from the observational study which enrolled 130 patients. DCB-only strategy was performed in 54% patients, 34.6% had at least one stent in the main branch, 8.5% had at least one stent in the side branch and 3.1% at least one stent in the main branch and side branch. Study follow up lasted for 9.8 months. The TLR rate was 4.5%, MACE was 6.1%, and no stent thrombosis was detected. This study suggested that the DCB+one stent, and DCB-only strategy was safe and effective in selected bifurcations, possibly allowing for an abbreviated antiplatelet regimen.

    Cardiologia Croatica
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    Treatment of a true CXA-OM bifurcation lesion using a one stent drug-coated balloons provisional technique

    Extended Abstract
    Issue3-4
    Published
    Pages51
    PDF via DOIhttps://doi.org/10.15836/ccar2020.51
    bifurcation lesions
    acute coronary syndrome
    drug coated balloons

    Authors

    Krešimir Gabaldo*ORCIDCroatia
    Božo VujevaORCIDCroatia
    Katica Cvitkušić LukendaORCIDCroatia
    Marijana Knežević PravečekORCIDCroatia
    Domagoj VučićCroatia

    Full Text

    Background : Provisional stenting is a favorable option for most bifurcation lesions, while two stent techniques show benefits in true bifurcation performed by experts. Using one stent and DCB in true bifurcation lesions still remains questionable. ( 1 , 2 ) Case report : 76-year-old male presented with persisting chest pain. ECG showed no specific ischemic changes, while hsTnI was highly elevated. He had gone PCI LAD 14 years ago. Diagnosis: right coronary angiography revealed occlusion of RCA, while left coronary angiography revealed LLS of 20% in proximal LAD stent, 70% stenosis of mid LAD, and acute occlusion of secondary OM branch on bifurcation level, while CxA was stenosed 70-80%. Management: PCI CxA-OM2 was performed with DES Xience expedition 2,75/33mm in CxA-OM2 with POT 3,25/12mm proximally, then after rewiring and adequate lesion preparation a DEB Sequent please 2,5/25mm in CxA distally was performed. After two months we performed an elective PCI LAD and checked out the result of CxA bifurcation which was optimal. Conclusion : Using one stent and DCB in true bifurcation lesions still remains questionable. There are no data from a prospective study, while there are data from the observational study which enrolled 130 patients. DCB-only strategy was performed in 54% patients, 34.6% had at least one stent in the main branch, 8.5% had at least one stent in the side branch and 3.1% at least one stent in the main branch and side branch. Study follow up lasted for 9.8 months. The TLR rate was 4.5%, MACE was 6.1%, and no stent thrombosis was detected. This study suggested that the DCB+one stent, and DCB-only strategy was safe and effective in selected bifurcations, possibly allowing for an abbreviated antiplatelet regimen.