Summary of 18Th European Bifurcation Club Reccomendations

Prof. Dr. Eftal Murat Bakırcı1
Dr. Saner Bahadır Gök2

1Binali Yıldırım University, Mengücek Gazi Education and Research Hospital, Department of Cardiology, Erzincan, Türkiye
2Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

At the 2023 European Bifurcation Club meeting, the latest evidence regarding the use of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in optimizing percutaneous coronary interventions (PCI) for coronary bifurcation lesions (CBL) was discussed. Although IVUS and OCT are acknowledged as valuable tools, particularly in guiding complex bifurcation lesions and left main coronary artery PCI, angiography is expected to remain the primary imaging modality in these procedures due to educational and economic barriers. Recognizing this context, the EBC has proposed strategies to enhance the success of angiographyguided PCI, which include detailed imaging through multiple angiographic views prior to the procedure, careful application of technical steps, the use of stent enhancement technologies during or after the procedure, and resorting to intravascular imaging when necessary.

Keywords: Interventional ultrasonography, Optical coherence tomography, Percutaneous coronary intervention

Referanslar

  1. Burzotta F, Lassen JF, Lefevre T, Banning AP, Chatzizisis YS, Johnson TW, Ferenc M, et al. Percutaneouscoronary intervention for bifurcation coronarylesions: the 15th con- sensus document from the EuropeanBifurcation Club. Eu- roIntervention. 2021;16:1307-17. [Crossref]  [PubMed]  [PMC]
  2. Burzotta F, Lassen JF, Banning AP, Lefevre T, Hildick-Smith D, Chieffo A, Darremont O, et al. Percutaneous coronary intervention in left main coronary arterydisease: the 13th consensus document from the European Bifurcation Club. EuroIntervention. 2018;14:112-20. [Crossref]  [PubMed]
  3. Burzotta F, Lassen JF, Louvard Y, Lefevre T, Banning AP, Daremont O, Pan M, et al. European Bifurcation Club white paper on stenting techniques for patients with bifur- cated coronary arterylesions. Catheter Cardiovasc Interv. 2020;96:1067-79. [Crossref]  [PubMed]  [PMC]
  4. Albiero R, Burzotta F, Lassen JF, Lefevre T, Banning AP, Chatzizisis YS, Johnson TW, et al. Treatment of coronary bi- furcation lesions, part I:implanting the first stent in the provi- sional pathway. The 16th expert consensus document of the EuropeanBifurcation Club. EuroIntervention. 2022;18:e362-76. [Crossref]  [PubMed]  [PMC]
  5. Lassen JF, Albiero R, Johnson TW, Burzotta F, Lefevre T, Iles TL, Pan M, et al. Treatment ofcoronary bifurcation le- sions, part II: implanting two stents. The 16th expert con- sensus document of the EuropeanBifurcation Club. Eu- roIntervention. 2022;18:457-70. [Crossref]  [PubMed]  [PMC]
  6. Pan M, Lassen JF, Burzotta F, Ojeda S, Albiero R, Lefevre T, Hildick- Smith D, et al. The 17th expert consensusdoc- ument of the European Bifurcation Club - techniques to preserve access to the side branch during stepwiseprovision- al stenting. EuroIntervention. 2023;19:26-36. [Crossref]  [PubMed]  [PMC]
  7. Mintz GS, Lefevre T, Lassen JF, Testa L, Pan M, Singh J, Stankovic G, Banning AP. Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the EuropeanBifurcation Club. EuroIntervention. 2018;14:e467-74. [Crossref]  [PubMed]
  8. Onuma Y, Katagiri Y, Burzotta F, Holm NR, Amabile N, Okamura T, Mintz GS, et al. Joint consensus on the use of OCT in coronary bifurcationlesions by the European and Jap- anese bifurcation clubs. EuroIntervention. 2019;14:e1568-77. [Crossref]  [PubMed]
  9. Candreva A, Gallinoro E, Fournier S, Izaga E, Finet G, De Bruyne B, Gutierrez-Barrios A. Absolute Blood Flow in the Left Main Coronary Artery and Its Distribution. JACC Cardiovasc Interv. 2021;14:482-4. [Crossref]  [PubMed]
  10. Finet G, Gilard M, Perrenot B, Rioufol G, Motreff P, Gavit L, Prost R. Fractal geometry of arterial coronarybifurcations: a quantitative coronary angiography and intravascular ultra- sound analysis. EuroIntervention.2008;3:490-8. [Crossref]  [PubMed]
  11. Zieliński J, Nowosielski JM. Finet's Law as a Special Case of the Generalised Murray's Law. SN ComputSci. 2020;1:42. [Crossref]
  12. Huo Y, Finet G, Lefevre T, Louvard Y, Moussa I, Kassab GS. Optimal diameter of diseased bifurcationsegment: a practical rule for percutaneous coronary intervention. EuroInterven- tion. 2012;7:1310-6. [Crossref]  [PubMed]
  13. Kassab GS, Finet G. Anatomy and function relation in the coronary tree: from bifurcations to myocardialflow and mass. EuroIntervention. 2015;11 Suppl V:V13-7. [Crossref]  [PubMed]
  14. Arunothayaraj S, Behan MW, Lefevre T, Lassen JF, Chieffo A, Stankovic G, Burzotta F, et al. Stepwise provisional versus systematic culotte for stenting of true coronary bifurcation- lesions: five-year follow-up of the multicentre randomised EBC TWO Trial. EuroIntervention. 2023;19:e297-304. [Crossref]  [PubMed]  [PMC]
  15. Hildick-Smith D, Egred M, Banning A, Brunel P, Ferenc M, Hovasse T, Wlodarczak A, et al. The European bifurcation club Left Main Coronary Stent study: a randomized compari- son of stepwise provisional vs. systematic dual stenting strat- egies (EBC MAIN). Eur HeartJ. 2021;42:3829-39. [Crossref]  [PubMed]
  16. Lunardi M, Louvard Y, Lefevre T, Stankovic G, Burzotta F, Kassab GS, Lassen JF, et al. Definitions and Standard- ized Endpoints for Treatment of Coronary Bifurcations. EuroIntervention2023;19:e807-31. [Crossref]  [PubMed]  [PMC]
  17. Chen X, Li X, Zhang JJ, Han Y, Kan J, Chen L, Qiu C, et al. 3-Year Outcomes of the DKCRUSH-V Trial Comparing DK Crush With Provisional Stenting for Left Main Bifurcation Lesions. JACC Cardiovasc Interv. 2019;12:1927-37. [Crossref]
  18. Barbato E, Gallinoro E, Abdel-Wahab M, Andreini D, Carrie D, Di Mario C, Dudek D, et al. Management strat- egies for heavily calcifiedcoronary stenoses: an EAPCI clinical consensus statement in collaboration with the EU- RO4C-PCR group. Eur Heart J. 2023;44:4340-56. [Crossref]  [PubMed]
  19. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, et al. 2019 ESC Guide- lines for the diagnosis and management of chronic coro- nary syndromes. Eur Heart J. 2020;41: 407-77. [Link]
  20. Serruys PW, Kotoku N, Norgaard BL, Garg S, Nieman K, Dweck MR, Bax JJ, et al. Computed tomographic angiogra- phy in coronary artery disease. EuroIntervention. 2023;18: e1307-27. [Crossref]  [PubMed]  [PMC]
  21. Andreini D, Collet C, Leipsic J, Nieman K, Bittencurt M, De Mey J, Buls N, et al. Pre-procedural planning of coro- naryrevascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. EuroIntervention. 2022;18:e872-87. [Crossref]  [PubMed]  [PMC]
  22. Kotoku N, Ninomiya K, Ding D, O'Leary N, Tobe A, Mi- yashita K, Masuda S, et al. Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projectionmatters. Int J Cardiovasc Imag- ing. 2024;40:195-206. [Crossref]  [PubMed]  [PMC]
  23. Lee SH, Lee JM, Song YB, Park TK, Yang JH, Hahn JY, Choi SH, et al. Prediction of side branch occlusions in percutane- ous coronary interventions by coronary computedtomogra- phy: the CT bifurcation score as a novel tool for predicting intraprocedural side branch occlusion. EuroIntervention. 2019;15:e788-95. [Crossref]  [PubMed]
  24. Monizzi G, Sonck J, Nagumo S, Buytaert D, Van Hoe L, Grancini L, Bartorelli AL, et al. Quantification of calci- um burden by coronary CT angiography compared to op- tical coherence tomography. Int J Cardiovasc Imaging. 2020;36:2393-402. [Crossref]  [PubMed]
  25. Collet C, Collison D, Mizukami T, McCartney P, Sonck J, Ford T, Munhoz D, et al. Differential Improvement in Angina and Health-Related Quality of Life After PCI in Focal and- Diffuse Coronary Artery Disease. JACC Cardiovasc Interv. 2022;15:2506-18. [Crossref]  [PubMed]
  26. Sonck J, Nagumo S, Norgaard BL, Otake H, Ko B, Zhang J, Mizukami T, et al. Clinical Validation of a Virtual Planner for Coronary Interventions Based on Coronary CT Angiog- raphy. JACC Cardiovasc Imaging. 2022;15:1242-55. [Crossref]  [PubMed]
  27. Ohashi H, Zivelonghi C, Seki R, Sakai K, Collet C, Scott B, Vermeersch P, Agostoni P. Virtual 2-Stent Bifurcation Percutaneous Coronary Intervention Using the Fractional Flow Reserve Computed TomographyPlanner. JACC Car- diovasc Interv. 2023;16:863-4. [Crossref]  [PubMed]
  28. Grundeken MJ, Collet C, Ishibashi Y, Genereux P, Mur- amatsu T, LaSalle L, Kaplan AV, et al. Visual estimation versus differentquantitative coronary angiography methods to assess lesion severity in bifurcation lesions. Catheter Car- diovascInterv. 2018;91:1263-70. [Crossref]  [PubMed]
  29. Grundeken MJ, Ishibashi Y, Ramcharitar S, Tuinenburg JC, Reiber JH, Tu S, Aben JP, et al. The need for dedicated bi- furcation quantitative coronary angiography(QCA) software algorithms to evaluate bifurcation lesions. EuroIntervention. 2015;11 Suppl V:V44-9. [Crossref]  [PubMed]
  30. Kubo T, Akasaka T, Shite J, Suzuki T, Uemura S, Yu B, Kozuma K, et al. OCT compared with IVUS in a coronary lesion assessment: the OPUS-CLASSstudy. JACC Cardio- vasc Imaging. 2013;6:1095-104. [Crossref]  [PubMed]
  31. Lee PH, Hong SJ, Kim HS, Yoon YW, Lee JY, Oh SJ, Lee JS, et al. Quantitative Coronary Angiography vs In- travascular Ultrasonographyto Guide Drug-Eluting Stent Implantation: A Randomized Clinical Trial. JAMA Car- diol. 2024;13:e240059. [Link]
  32. Lefevre T, Bernard A, Bayet G. Interet de l'etalonnage des ballons d'angioplastie coronaire [Value of thecalibra- tion of coronary angioplasty balloons]. Arch Mal Coeur Vaiss. 1989;82:1839-42. [PubMed]
  33. Amstutz C, Behr J, Krebs S, Haeberlin A, Vogel R, Zurbu- chen A, Burger J. Design of percutaneoustransluminal cor- onary angioplasty balloon catheters. Biomed Eng Online. 2023;22:94. [Crossref]  [PubMed]  [PMC]
  34. Skowroński J, Wolny R, Jastrzębski J, Tyczyński P, Szlazak K, Pręgowski J, Mintz GS, et al. Impact of the Balloon Inflation Time and Pattern on the CoronaryStent Expan- sion. J Interv Cardiol. 2019;2019:6945372. [Crossref]  [PubMed]  [PMC]
  35. Dong P, Colmenarez J, Lee J, Hassani NS, Wilson DL, Bezerra HG, Gu L. Load-sharing characteristics of stenting and post-dilation in heavily calcified coronary artery. Sci Rep. 2023;13:16878. [Crossref]  [PubMed]  [PMC]
  36. Y. Hikichi. Importance of stent selection in LMT Bifurcation stenting - Insights from the bench test, distal low pressure dilatation technique. EBC meeting. 13 Oct 2023. Warsaw, Poland.
  37. Burzotta F, Aurigemma C, Paraggio L, Romagnoli E, Leone AM, Vergallo R, Cangemi S, et al. Under-deployment of extralarge drug-eluting stent: an adapted provisional tech- nique for selected patientswith distal lesions in large left main. Minerva Cardiol Angiol. 2023;71:20-6. [Crossref]
  38. Cangemi S, Burzotta F, Bianchini F, DeVos A, Valenzuela T, Trani C, Aurigemma C, et al. Configuration of two-stent coronary bifurcation techniques in explanted beatinghearts: the MOBBEM study. EuroIntervention. 2023;19:e423-31. [Crossref]  [PubMed]  [PMC]
  39. Vural M, Hancıoğlu E. A Novel Technique for Stent Optimi- zation: A Stepwise STENT PUFF Sign and POT PUFF Sign. Turk Kardiyol Dern Ars. 2024;52:77-8. English. [Crossref]  [PubMed]
  40. Aminfar F, Rubimbura V, Maillard L, Noble S, Range G, Belle L, Derimay F, et al. The POT-PUFF sign: an angio- graphic mark of stent malapposition during proximal opti- misation. EuroIntervention. 2023;18: 1456-7. [Crossref]  [PubMed]  [PMC]
  41. Burzotta F, De Vita M, Sgueglia G, Todaro D, Trani C. How to solve difficult side branch access? EuroIntervention. 2010;6 Suppl J:J72-80. [Crossref]  [PubMed]
  42. Yamawaki M, Okamura T, Nagoshi R, Fujimura T, Murasato Y, Ono S, Serikawa T, et al. Vascular healing after kissing bal- loon inflation: Nine-month 3D opticalcoherence tomography analysis in corelab. Int J Cardiol Heart Vasc. 2022;40:101034. [Crossref]  [PubMed]  [PMC]