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Angiographic study of the clinical liaison of drug-eluting stent and paclitaxel-eluting balloon in unifocal side branch ostium stenosis (ASCLEPIUS)

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Abstract

A reliable stenting strategy for treating isolated side branch (SB) ostium stenosis is not well established. The purpose of this study was to examine the 6-month angiographic outcome of a novel technique, called the shoulder technique, on this lesion subtype. Symptomatic patients with isolated SB ostium stenosis, defined as ≥75% diameter stenosis at SB ostium and <50% diameter stenosis in main vessel (MV), were treated with paclitaxel-eluting balloon in MV and drug-eluting stent in SB using the shoulder technique. Angiographic restudy was performed at 5–9 months and clinical follow-up was scheduled regularly every 3 months. There were 46 patients of age 66 ± 12 years with male predominance (76%) recruited. Diagonal ostium (67%) was the most frequent target lesion site. The size and length of paclitaxel-eluting balloon and drug-eluting stent used in MV and SB were 3.01 ± 0.25 and 20 ± 4 mm, and 2.39 ± 0.25 and 17 ± 6 mm, respectively. Angiographic restudy was performed on 43 (93.5%) patients at 6.5 ± 1.6 months. The late loss in MV and SB were 0.04 ± 0.19 and 0.19 ± 0.32 mm, respectively. Angiographic restensosis was seen in 2 (4.7%) patients at SB, whereas no stenosis was induced in MV. Improvement of symptom was reported in 36 (78%) patients. At 1-year follow-up, no death, myocardial infarction, and stent thrombosis was observed; target vessel revascularization was performed on 3 (6.5%) patients. Treatment of isolated SB ostium stenosis using the shoulder technique is associated with a favorable short-term angiographic outcome.

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References

  1. Louvard Y, Thomas M, Dzavik V, Hildick-Smith D, Galassi AR, Pan M, Burzotta F, Zelizko M, Dudek D, Ludman P, Sheiban I, Lassen JF, Darremont O, Kastrati A, Ludwig J, Iakovou I, Brunel P, Lansky A, Meerkin D, Legrand V, Medina A, Lefèvre T (2008) Classification of coronary artery bifurcation lesions and treatments: time for a consensus Catheter Cardiovasc Interv 71:175–183

    Article  PubMed  Google Scholar 

  2. Lassen JF, Holm NR, Banning A, Burzotta F, Lefèvre T, Chieffo A, Hildick-Smith D, Louvard Y, Stankovic G (2016) Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. EuroIntervention 12:38–46

    Article  Google Scholar 

  3. Colombo A, Moses JW, Morice MC, Ludwig J, Holmes DR Jr, Spanos V, Louvard Y, Desmedt B, Di Mario C, Leon MB (2004) Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation 109:1244–1249

    Article  PubMed  Google Scholar 

  4. Costa RA, Mintz GS, Carlier SG, Lansky AJ, Moussa I, Fujii K, Takebayashi H, Yasuda T, Costa JR Jr, Tsuchiya Y, Jensen LO, Cristea E, Mehran R, Dangas GD, Iyer S, Collins M, Kreps EM, Colombo A, Stone GW, Leon MB, Moses JW (2005) Bifurcation coronary lesions treated with the “crush” technique: an intravascular ultrasound analysis. J Am Coll Cardiol 46:599–605

    Article  PubMed  Google Scholar 

  5. Hahn JY, Song YB, Lee SY, Choi JH, Choi SH, Kim DK, Lee SH, Gwon HC (2009) Serial intravascular ultrasound analysis of the main and side branches in bifurcation lesions treated with the T-stenting technique. J Am Coll Cardiol 54:110–117

    Article  PubMed  Google Scholar 

  6. Colombo A, Bramucci E, Saccà S, Violini R, Lettieri C, Zanini R, Sheiban I, Paloscia L, Grube E, Schofer J, Bolognese L, Orlandi M, Niccoli G, Latib A, Airoldi F (2009) Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (coronary bifurcations: application of the crushing technique using sirolimus-eluting stents) study. Circulation 119:71–78

    Article  PubMed  Google Scholar 

  7. Steigen TK, Maeng M, Wiseth R, Erglis A, Kumsars I, Narbute I, Gunnes P, Mannsverk J, Meyerdierks O, Rotevatn S, Niemelä M, Kervinen K, Jensen JS, Galløe A, Nikus K, Vikman S, Ravkilde J, James S, Aarøe J, Ylitalo A, Helqvist S, Sjögren I, Thayssen P, Virtanen K, Puhakka M, Airaksinen J, Lassen JF, Thuesen L, Nordic PCI Study Group (2006) Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study. Circulation 114:1955–1961

    Article  Google Scholar 

  8. Erglis A, Kumsars I, Niemelä M, Kervinen K, Maeng M, Lassen JF, Gunnes P, Stavnes S, Jensen JS, Galløe A, Narbute I, Sondore D, Mäkikallio T, Ylitalo K, Christiansen EH, Ravkilde J, Steigen TK, Mannsverk J, Thayssen P, Hansen KN, Syvänne M, Helqvist S, Kjell N, Wiseth R, Aarøe J, Puhakka M, Thuesen L, Nordic PCI Study Group (2009) Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study. Circulation 2:27–34

    Google Scholar 

  9. Jim MH, Wu EB, Fung RC, Ng AK, Yiu KH, Siu CW, Ho HH (2015) Angiographic result of T-stenting with small protrusion using drug-eluting stents in the management of ischemic side branch: the ARTEMIS study. Heart Vessels 30:427–431

    Article  PubMed  Google Scholar 

  10. Jim MH (2014) Shoulder technique: a modified sleeve technique devised for treating isolated coronary stenosis at side branch ostium. Int J Cardiol 171:94–95

    Article  PubMed  Google Scholar 

  11. Thygesen K, Alpert JS, White HD (2007) Joint ESC/ACCF/AHA/WHF task force for the redefinition of myocardial infarction. J Am Coll Cardiol 50:2173–2195

    Article  PubMed  Google Scholar 

  12. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW, Academic Research Consortium (2007). Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351

    Article  Google Scholar 

  13. Ito S, Kinoshita K, Endo A, Nakamura M, Muramatsu T (2016) Impact of catheter size on reliability of quantitative coronary angiographic measurements (comparison of 4Fr and 6Fr catheters). Heart Vessels 31:1752–1757

    Article  PubMed  Google Scholar 

  14. Jim MH, Ho HH, Miu R, Chow WH (2006) Modified crush technique with double kissing balloon inflation (sleeve technique): a novel technique for coronary bifurcation lesions. Catheter Cardiovasc Interv 67:403–409

    Article  PubMed  Google Scholar 

  15. Jim MH, Ho HH, Ko RL, Siu CW, Yiu KH, Chow WH (2009) Long-term clinical and angiographic outcomes of the sleeve technique on non-left-main coronary bifurcation lesions. EuroIntervention 5:104–108

    Article  PubMed  Google Scholar 

  16. Schwartz L, Morsi A (2002) The draw-back stent deployment technique: a strategy for the treatment of coronary branch otial lesions. J Invasive Cardiol 14:66–71

    PubMed  Google Scholar 

  17. Applegate RJ, Davis JM, Leonard JC (2008) Treatment of ostial lesions using the Szabo technique: a case series. Catheter Cardiovasc Interv 72:823–828

    Article  PubMed  Google Scholar 

  18. Kern MJ, Ouellette D, Frianeza T (2006) A new technique to anchor stents for exact placement in ostial stenoses: the stent tail wire or Szabo technique. Catheter Cardiovasc Interv 68:901–906

    Article  PubMed  Google Scholar 

  19. Gutiérrez-Chico JL, Villanueva-Benito I, Villanueva-Montoto L, Vázquez-Fernández S, Kleinecke C, Gielen S, Iñiguez-Romo A (2010) Szabo technique versus conventional angiographic placement in bifurcations 010–001 of Medina and in aorto-ostial stenting: angiographic and procedural results. EuroIntervention 5:801–808

    Article  PubMed  Google Scholar 

  20. Ferrer-Gracia MC, Sánchez-Rubio J, Calvo-Cebollero I (2011) Stent dislodgement during Szabo technique. Int J Cardiol 147:e8–e9

    Article  PubMed  Google Scholar 

  21. Sadamatsu K, Okahara A, Nakano Y, Mine D, Koga Y (2015) Balloon crushing of a protruding everolimus-eluting stent for isolated coronary stenosis at the side branch ostium. Int J Cardiol 199:261–263

    Article  PubMed  Google Scholar 

  22. Latib A, Colombo A, Castriota F, Micari A, Cremonesi A, de Felice F, Marchese A, Tespili M, Presbitero P, Sgueglia GA, Buffoli F, Tamburino C, Varbella F, Menozzi A (2012) A randomized multicenter study comparing a paclitaxel drug-eluting balloon with a paclitaxel-eluting stent in small coronary vessels: the BELLO (balloon elution and late loss optimization) study. J Am Coll Cardiol 60:2473–2480

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cardiac Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong, Hong Kong

    Man-Hong Jim, Ka-Lam Wong & Raymond Chi-yan Fung

  2. Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, Hong Kong

    Eugene Brian Wu & Chi-Yuen Chan

  3. Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong

    Kai-Hang Yiu

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  1. Man-Hong Jim
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  2. Eugene Brian Wu
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  3. Chi-Yuen Chan
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  4. Ka-Lam Wong
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  5. Raymond Chi-yan Fung
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  6. Kai-Hang Yiu
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Correspondence to Man-Hong Jim.

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This study is not financially sponsored by any organization. The authors declare that they have no conflict of interest in all aspects involving this manuscript.

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Jim, MH., Wu, E.B., Chan, CY. et al. Angiographic study of the clinical liaison of drug-eluting stent and paclitaxel-eluting balloon in unifocal side branch ostium stenosis (ASCLEPIUS). Heart Vessels 32, 1045–1050 (2017). https://doi.org/10.1007/s00380-017-0970-y

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  • DOI: https://doi.org/10.1007/s00380-017-0970-y

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