What does this research mean for the field?

Planning a double-wire sequential dilation technique during bifurcation lesion angioplasty significantly improves the salvage rate of occluded branch vessels and reduces residual ischemia compared to main-vessel-only dilation, despite being associated with high late restenosis rates. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the angiographic success, side branch loss and salvage rates, and early and late clinical outcomes of bifurcation lesion coronary angioplasty.

January 1, 1991Catheterization and Cardiovascular Diagnosis

Salvage of branch vessels during bifurcation lesion angioplasty: Acute and long‐term follow‐up

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Why the study?

Does attempted dilation of both the main vessel and involved branch vessels using a double-wire technique improve branch vessel salvage compared to dilation of the main vessel alone in patients undergoing PTCA of bifurcation lesions?

Population

56 consecutive patients who underwent percutaneous transluminal coronary angioplasty of bifurcation lesions…

Comparison

PTCA strategy attempting dilation of both the… vs PTCA attempt confined to the main vessel alone.

Design

Cohort

Follow-up

late (greater than 6 weeks)

Authors

JWJoseph WeinsteinComprehensive Cardiovascular DBDonald S. BaimInterventional Cardiology MSMary Ellen SipperlyBrigham and Women's Hospital

Discussion

Member takes

Implication

Sequential planning may enhance branch salvage in bifurcation lesions; leaves open whether randomized trials confirm net benefit.

Key Points

To evaluate the angiographic success, side branch loss and salvage rates, and early and late clinical outcomes of bifurcation lesion coronary angioplasty.
Analyzed 56 consecutive patients undergoing PTCA for bifurcation lesions involving the LAD or LCx coronary arteries with >70% stenosis in both parent and branch vessels.
Compared attempted dilation of both vessels predominantly using a double-wire sequential balloon technique (n=35) versus dilation confined to the main vessel alone (n=21).
Transient branch occlusion occurred in 32% of dual-vessel attempts and 38% of single-vessel attempts (p = NS), but occluded branches were salvaged in 91% vs 38%, respectively (p < .05).
Predischarge exercise testing demonstrated residual ischemia in 6% of patients with both vessels dilated versus 37% with main-vessel dilation alone (p < .01).
Clinical restenosis after >6 weeks of follow-up occurred in 42% of patients who underwent successful dual-vessel dilation.

Structured PICO

Population

56 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA) of bifurcation lesions involving the left anterior descending or left circumflex coronary artery, with stenoses greater than 70% in both the parent and an involved branch vessel.

Intervention

PTCA strategy attempting dilation of both the main vessel and the involved branch vessels using predominantly a double-wire, sequential balloon technique.

Comparator

PTCA attempt confined to the main vessel alone.

Outcome

Angiographic success, frequency of branch vessel loss and salvage, and long-term outcome.surrogate

A double-wire sequential balloon technique for bifurcation lesions improves branch vessel salvage and reduces early residual ischemia compared to main vessel dilation alone, though it is associated with a high rate of late restenosis.

Cite This Study

Weinstein et al. (1991) studied this question.

synapsesocial.com/papers/6a129af21d9aa3bb4e34687a https://doi.org/10.1002/ccd.1810220102

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Salvage of branch vessels during bifurcation lesion angioplasty: Acute and long‐term follow‐up

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Salvage of branch vessels during bifurcation lesion angioplasty: Acute and long‐term follow‐up

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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