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Intervention for jailed diagonal branch is not necessary while stenting the left anterior descending artery
Nobutaka Ikeda1, Suguru Yajima, Toshiyuki Asahara
1Division of Cardiovascular Medicine, Tokyo Rosai Hospital,Ohmori-minami, Ohta-ku, Tokyo, Japan. ikedanobutaka@yahoo.co.jp
Insights
Treating diagonal branches during sirolimus-eluting stent (SES) implantation in the left anterior descending artery (LAD) is not always necessary. Angiography showed temporary stenosis in diagonal branches, which resolved by follow-up without adverse cardiac events.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Percutaneous coronary intervention (PCI) for bifurcation lesions is complex, potentially increasing procedure risks.
- Complex PCI strategies may lead to higher contrast use, longer fluoroscopy times, and increased device utilization.
Purpose of the Study:
- To determine the necessity of interventional treatment for diagonal branches during sirolimus-eluting stent (SES) implantation in the left anterior descending artery (LAD).
Main Methods:
- Retrospective analysis of 35 patients with stable angina and 40 LAD/diagonal branch bifurcation lesions treated with SES.
- Diagonal branches >1.5 mm diameter were not stented if TIMI flow grade 3 was achieved, despite ostial stenosis.
- Quantitative coronary angiography (QCA) assessed LAD and diagonal branch ostia at baseline, post-PCI, and 6-month follow-up.
Main Results:
- Diagonal branch ostial stenosis worsened immediately post-PCI but returned to baseline levels at follow-up.
- No significant difference in stenosis was observed between baseline and follow-up.
- Follow-up stenosis was significantly improved compared to post-PCI measurements.
- No major adverse cardiac events (MACE) such as heart failure, angina, or cardiac death occurred.
- One LAD restenosis and no diagonal branch occlusion were reported at follow-up.
Conclusions:
- Temporary progression of diameter stenosis in diagonal branches post-PCI is not clinically significant.
- Interventional treatment of select diagonal branches during LAD stenting may be safely deferred.
- Favorable lumen recovery in diagonal branches suggests a conservative approach is viable.
Objectives:
To evaluate whether or not to treat diagonal branches interventionally while implanting sirolimus-eluting stents (SES) in left anterior descending artery (LAD).
Background:
Percutaneous coronary intervention (PCI) procedures are complicated, especially in the case of a bifurcation lesion. The complicated strategy of PCI may increase the quantity of contrast medium, fluoroscopy time, and the number of devices.
Methods:
We retrospectively included 35 patients with stable angina who were treated with SES between July 2005 and December 2006. They had 40 LAD/diagonal branch bifurcation lesions. The diagonal branches had a diameter greater than 1.5 mm. We finished the procedure without inflating diagonal branches when their flow showed thrombolysis in myocardial infarction (TIMI) flow grade 3, even if the ostium of the branches had severe stenosis. Follow-up angiographies were performed 6 months later. The LAD and ostium of diagonal branches were evaluated according to the quantitative coronary angiography (QCA) measurements.
Results:
The percent diameter stenosis (%DS) of the ostium of diagonal branches was worse post-PCI than at baseline (P = 0.0101). When comparing the follow-up values with the baseline values, there were no significant differences. Additionally, follow-up values were significantly better than the post-PCI values (P = 0.0016). There was no hospitalization for heart failure, angina, or cardiac death. There was only one restenosis in LAD at follow-up, and no diagonal branch became totally occluded or delayed.
Conclusions:
In the diagonal branches, the minimal lumen diameter decreased and diameter stenosis progressed temporarily; however, both parameters recovered at the time of follow-up.
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