Materials Required in the Catheter Laboratory  for Bifurcation Interventions

Assoc. Prof. Dr. Kamuran Kalkan

Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

Bifurcation lesions present a significant challenge in interventional cardiology, where the right equipment plays a crucial role in procedural success. Key components include appropriate access sheaths, guiding cath- eters, guidewires, balloons, stents, and imaging devices. The access sheath size is crucial, with a 6 French (Fr) sheath sufficient for most procedures, though complex techniques may require 7 Fr sheaths. Guide catheters provide ostial engagement, with specific catheters like the Amplatz Left(AL) for right coronary artery lesions and Extra Backup (EBU) for the left main coronary artery.

For difficult lesion crossings, guiding catheter extensions like Guideliner and Guidezilla facilitate equipment passage. Microcatheters aid inside branch access, especially in complex bifurcation and calcified lesions. Guidewires vary by flexibility, coating, and support level; specialized wires for chronic total occlusion cases enhance procedural efficacy.

Balloons are essential for lesion preparation, with low-profile and specialized balloons like non-compliant bal- loons required for proximal optimization treatment in bifurcation procedures. Drug-coated balloons are use- ful in cases involving in-stent restenosis. Stent selection focuses on maintaining side branch flow, preferring stents with wide strut spacing and an ideal crossing profile for bifurcation interventions.

Intravascular ultrasound, and optical coherence tomography are valuable for imaging and guiding stent place- ment, improving procedural outcomes. Atherectomy devices like Rotablator are recommended for calcified lesions. Essential equipment for emergency scenarios includes graft-covered stents, coils, and pericardiocen- tesis kits for managing potential coronary perforation, which carries a high mortality risk. Temporary pace- makers should also be readily available, particularly during right coronary artery interventions.

Keywords: Percutaneous coronary intervention; Material; Stent; Ballon; Wire

Referanslar

  1. Brilakis E. Manual of percutaneous coronary interventions: a step-by-step approach.: Academic Press; 2020. [Link]
  2. Burzotta F, Louvard Y, Lassen JF, Lefèvre T, Finet G, Collet C, et al. Percutaneous coronary intervention for bifurcation coronary lesions using optimised angiographic guidance: the 18th consensus document from the European Bifurcation Club. EuroIntervention 2024; 20(15): e915-e26. 20240805. [Crossref]  [PubMed]
  3. Price MJ, Boutis L, Kirtane AJ, Chetcuti S, Poliačiková P, Dens J, et al. Three-Year Outcomes After Bifurcation Stent- ing With Zotarolimus-Eluting Stents: Final Results From the RESOLUTE ONYX Postapproval Study. J Soc Cardiovasc Angiogr Interv 2023; 2(6Part A): 101116. 20230805. [Crossref]  [PubMed]  [PMC]
  4. Rigatelli G, Zuin M, Vassilev D, Rodino G, Marchese G, Pasquetto G. Technical Complications of Coronary Bifurca- tion Percutaneous Interventions. J Clin Med 2022; 11(22). 20221117. [Crossref]  [PubMed]  [PMC]
  5. Pavei A, Marco J. Tools & techniques: choice and use of guiding catheters. EuroIntervention 2010; 6(4): 543-4. [Crossref]  [PubMed]
  6. S YH, de Palma R. A Novel guide extension assisted stenting technique for coronary bifurcation lesions. World J Cardiol 2021; 13(6): 155-62. [Crossref]  [PubMed]  [PMC]
  7. Lefèvre T, Pan M, Stankovic G, Ojeda S, Boudou N, Brilakis ES, et al. CTO and Bifurcation Lesions: An Expert Consen- sus From the European Bifurcation Club and EuroCTO Club. JACC Cardiovasc Interv 2023; 16(17): 2065-82. [Crossref]  [PubMed]
  8. Watanabe S, Saito N, Bao B, Tokushige A, Watanabe H, Ya- mamoto E, et al. Microcatheter-facilitated reverse wire tech- nique for side branch wiring in bifurcated vessels: an in vitro evaluation. EuroIntervention 2013; 9(7): 870-77. [Crossref]  [PubMed]
  9. Jourani S, Perier M, Benamer H. [How to solve difficult side branch access: case report and literature review]. Ann Cardi- ol Angeiol (Paris) 2024; 73(4): 101792. 20240807. [Crossref]  [PubMed]
  10. Colleran R, Kastrati A. Percutaneous coronary interven- tion: balloons, stents and scaffolds. Clin Res Cardiol 2018; 107(Suppl 2): 55-63. 20180723. [Crossref]  [PubMed]
  11. Tsujimura T, Ishihara T, Takahashi K, Iida O, Hata Y, Toy- oshima T, et al. Cutting balloons versus conventional bal- loons for treating patients with coronary artery disease pre- senting with moderate-to-severely calcified lesions: impact on post-interventional minimum stent area. Cardiovasc Interv Ther 2022; 37(4): 700-09. 20220417. [Crossref]  [PubMed]
  12. Mangier A, Testa L, Heang TM, Bossi I, Lee CY, Perez IS, et al. Safety and efficacy of single antiplatelet therapy in a large cohort of patients treated with sirolimus-coated balloon: Post hoc analysis from the prospective EASTBOURNE reg- istry. Cardiovasc Revasc Med 2024. 20240730. [Crossref]  [PubMed]
  13. Stella P, Wykrzykowska J. Bifurcation PCI: keep it safe and simple! Neth Heart J 2017; 25(4): 289. [Crossref]  [PubMed]  [PMC]
  14. Zlatko Mehmedbegović, Dario Jelić, Đorđe Mladenović, Goran Stanković. DES Selection for Left Main and Coronary Bifurcation Stenting. Rev. Cardiovasc. Med. 2023,24(9), 266 https://doi.org/10.31083/j.rcm2409266 [Crossref]  [PubMed]  [PMC]
  15. Lichaa H. Coronary stent positioning under live IVUS guidance in low contrast percutaneous coronary interven- tions: The live IVUS stenting technique. Catheter Cardio- vasc Interv 2021; 98(7): E977-e84. 20210831. [Crossref]  [PubMed]
  16. Kuno T, Miyamoto Y, Numasawa Y, Ueda I, Suzuki M, Noma S, et al. Enhancing Coronary Intervention Outcomes Using Intravascular Ultrasound: Analysis of Long-Term Benefits in a Japanese Multicenter Registry. J Soc Cardio- vasc Angiogr Interv 2024; 3(1): 101190. 20231024. [Crossref]  [PubMed]  [PMC]
  17. Goldberg A, Shlofmitz E, Sosa F, Thomas S, Nguyen J, Tsioulias A, et al. BOOM: A novel bifurcation stent technique using optical coherence tomography co-registration. Cardio- vasc Revasc Med 2024. 20240722. [Crossref]
  18. Gupta A, Shrivastava A, Dugal JS, Chhikara S, Vi-jayvergiya R, Singh N, et al. Coronary intravascular lithotripsy in contemporary practice: challenges and opportunities in coronary intervention. Ther Adv Car- diovasc Dis 2024; 18: 17539447241263444. [Crossref]  [PubMed]  [PMC]
  19. Nathan A, Hashemzadeh M, Movahed MR. Percutaneous coronary intervention involving coronary bifurcation is associated with higher mortality and complications. Am J Cardiovasc Dis 2024; 14(3): 180-87. 20240615. [Crossref]  [PubMed]  [PMC]