Complications in Coronary Bifurcation Interventions
Dr. Engin Algül
Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye
ABSTRACT
Coronary bifurcation lesions pose significant challenges in percutaneous coronary interventions (PCI) due to their complex anatomy and increased risk of procedural complications. Unlike simpler coronary lesions, bifurcation lesions are prone to complications such as side branch occlusion, stent thrombosis, dissection, and equipment entrapment. Each of these issues carries critical clinical implications, requiring careful strate- gies and techniques to minimize adverse outcomes. Preventive measures, advanced imaging modalities, and bifurcation-specific techniques play a crucial role in managing these risks. Ongoing advancements in stent technology and PCI techniques are expected to further reduce complication rates and improve outcomes for patients undergoing bifurcation lesion interventions.
Keywords: Coronary artery disease; Percutaneous coronary intervention; Angioplasty, Balloon, Coronary
Citation
Referanslar
- Fischman DL, Savage MP, Leon MB, Schatz RA, Ellis S, Cleman MW, et al. Fate of lesion-related side branch- es after coronary artery stenting. Journal of the American College of Cardiology. 1993;22(6):1641-6. [Crossref] [PubMed]
- Lefèvre T, Louvard Y, Morice MC, Dumas P, Loubeyre C, Benslimane A, et al. Stenting of bifurcation lesions: clas- sification, treatments, and results. Catheterization and car- diovascular interventions. 2000;49(3):274-83. [Crossref]
- Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. Jama. 2005;293(17):2126-30. [Crossref] [PubMed]
- Lassen JF, Albiero R, Johnson TW, Burzotta F, Lefèvre T, Iles TL, et al. Treatment of coronary bifurcation lesions, part II: implanting two stents. The 16th expert consensus docu- ment of the European Bifurcation Club. EuroIntervention. 2022;18(6):457. [Crossref] [PubMed] [PMC]
- Yamashita T, Nishida T, Adamian MG, Briguori C, Vaghet- ti M, Corvaja N, et al. Bifurcation lesions: two stents ver- sus one stent-immediate and follow-up results. Journal of the American College of Cardiology. 2000;35(5):1145-51. [Crossref] [PubMed]
- Chen S-L, Sheiban I, Xu B, Jepson N, Paiboon C, Zhang J-J, et al. Impact of the complexity of bifurcation lesions treated with drug-eluting stents: the DEFINITION study (Definitions and impact of complEx biFurcation lesIons on clinical outcomes after percutaNeous coronary Interven- TIOn using drug-eluting steNts). JACC: Cardiovascular In- terventions. 2014;7(11):1266-76. [Crossref] [PubMed]
- Ormiston JA, Webster MW, Ruygrok PN, Stewart JT, White HD, Scott DS. Stent deformation following simulated side- branch dilatation: A comparison of five stent designs. Cathe- terization and Cardiovascular Interventions. 1999;47(2):258-64. [Crossref]
- Narbute I, Jegere S, Kumsars I, Juhnevica D, Knipse A, Erglis A. Real-life Bifurcation-Challenges and Potential Complications. European Caridology Review. 2011. [Crossref]
- Doll JA, Hira RS, Kearney KE, Kandzari DE, Riley RF, Marso SP, et al. Management of percutaneous coronary in- tervention complications: algorithms from the 2018 and 2019 Seattle Percutaneous Coronary Intervention Complica- tions Conference. Circulation: Cardiovascular Interventions. 2020;13(6):e008962. [Crossref] [PubMed]
- Rigatelli G, Zuin M, Vassilev D, Dell'Avvocata F, Giordan M, Conte L, et al. Risk of dislodgement of ultrathin drug eluting stents versus thick drug eluting stents. The American Journal of Cardiology. 2020;125(11):1619-23. [Crossref] [PubMed]
- Kandan SR, Johnson TW. Management of percutaneous cor- onary intervention complications. Heart. 2019;105(1):75-86. [Crossref] [PubMed]
- Movahed MR. Coronary artery bifurcation lesion classifi- cations, interventional techniques and clinical outcome. Ex- pert Review of Cardiovascular Therapy. 2008;6(2):261-74. [Crossref] [PubMed]
- Kumar D, Ahmed I, Bardooli F, Saghir T, Sial JA, Khan KA, et al. Techniques to Treat Slow-Flow/No-Reflow During Primary Percutaneous Coronary Intervention. Cardiovas- cular Revascularization Medicine. 2023;47:1-4. [Crossref] [PubMed]
- Means G, End C, Kaul P. Management of percutaneous coronary intervention complications. Current treatment op- tions in cardiovascular medicine. 2017;19:1-14. [Crossref] [PubMed]
- Kim Y-H, Lee J-H, Roh J-H, Ahn J-M, Yoon S-H, Park D-W, et al. Randomized comparisons between different stenting approaches for bifurcation coronary lesions with or without side branch stenosis. JACC: Cardiovascular Interventions. 2015;8(4):550-60. [Crossref] [PubMed]
- Khanna, Roopali, et al. "Post-stenting angiographically si- lent coronary dissection: OCT comes to the rescue." The British Journal of Cardiology 28.4 (2021). [Link]
- Rigatelli G, Zuin M, Vassilev D, Rodino' G, Marchese G, Pasquetto G. Technical complications of coronary bi- furcation percutaneous interventions. Journal of Clini- cal Medicine. 2022;11(22):6801. [Crossref] [PubMed] [PMC]
- Li C, Chen Z, Wang M. Retrieving entrapped guidewire using rotablation technique: case series and literature review. European Heart Journal-Case Reports. 2022;6(7):ytac261. [Crossref] [PubMed] [PMC]
- Yeo KK, Mahmud E, Armstrong EJ, Bennett WE, Shunk KA, MacGregor JS, et al. Contemporary clinical charac- teristics, treatment, and outcomes of angiographically con- firmed coronary stent thrombosis: results from a multicenter California registry. Catheterization and Cardiovascular Interventions. 2012;79(4):550-6. [Crossref] [PubMed]