Percutaneous coronary intervention bifurcation lesions

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Overview

PCI Approaches:

CAD Revascularization:

Heart Team Approach to Revascularization Decisions
Left Main Coronary Artery Disease
Intervention in left main coronary artery disease
Non-Left Main Coronary Artery Disease
Revascularization to Improve Symptoms
Dual Antiplatelet Therapy Compliance and Stent Thrombosis
Hybrid Coronary Revascularization

Pre-procedural Considerations:

Contrast-Induced Acute Kidney Injury
Anaphylactoid Reactions
Statin Treatment
Bleeding Risk
Role of Onsite Surgical Backup

Procedural Considerations:

Vascular Access
PCI in Specific Clinical Situations:
Asymptomatic Ischemia or CCS Class I or II Angina
CCS Class III Angina
Unstable Angina/Non–ST-Elevation Myocardial Infarction
ST-Elevation Myocardial Infarction:
General and Specific Considerations
Coronary Angiography Strategies in STEMI
Primary PCI of the Infarct Artery
Delayed or Elective PCI in patients with STEMI
Fibrinolytic-Ineligible Patients
Facilitated PCI
Rescue PCI
After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion
Cardiogenic Shock
Prior Coronary Bypass Surgery
Revascularization Before Non-cardiac Surgery
Adjunctive Diagnostic Devices:
Fractional Flow Reserve
Intravascular Ultrasound
Adjunctive Therapeutic Devices:
Coronary Atherectomy
Thrombectomy
Laser Angioplasty
Cutting Balloon Angioplasty
Embolic Protection Devices
Percutaneous Hemodynamic Support Devices
Antiplatelet therapy:
Oral Antiplatelet Therapy
Glycoprotein IIb/IIIa Receptor Antagonists
Intravenous Antiplatelet therapy:
STEMI
UA/NSTEMI
SIHD
Anticoagulant Therapy:
Parenteral Anticoagulants During PCI
Unfractionated Heparin
Enoxaparin
Bivalirudin and Argatroban
Fondaparinux
No-Reflow Pharmacological Therapies
PCI in Specific Anatomic Situations:
Chronic Total Occlusions
Saphenous Vein Grafts
Bifurcation Lesions
Aorto-Ostial Stenoses
Calcified Lesions
PCI in Specific Patient Populations:
Chronic Kidney Disease
Peri-procedural Myocardial Infarction Assessment
Vascular Closure Devices

Post-Procedural Considerations:

Post-procedural Antiplatelet Therapy
Proton Pump Inhibitors and Antiplatelet Therapy
Clopidogrel Genetic Testing
Platelet Function Testing
Restenosis
Exercise Testing
Cardiac Rehabilitation

Quality and Performance Considerations:

Quality and Performance
Certification and Maintenance of Certification
Operator and Institutional Competency and Volume

Percutaneous coronary intervention bifurcation lesions On the Web

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Ongoing Trials at Clinical Trials.gov

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NICE Guidance

FDA on Percutaneous coronary intervention bifurcation lesions

CDC on Percutaneous coronary intervention bifurcation lesions

Percutaneous coronary intervention bifurcation lesions in the news

Blogs on Percutaneous coronary intervention bifurcation lesions

Directions to Hospitals Treating Percutaneous Coronary Intervention

Risk calculators and risk factors for Percutaneous coronary intervention bifurcation lesions

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[1]

Bifurcation Lesions (DO NOT EDIT)[1]

Class I
"1. Provisional side-branch stenting should be the initial approach in patients with bifurcation lesions when the side branch is not large and has only mild or moderate focal disease at the ostium.[2][3][4][5] (Level of Evidence: A)"
Class IIa
"1. It is reasonable to use elective double stenting in patients with complex bifurcation morphology involving a large side branch where the risk of side-branch occlusion is high and the likelihood of successful side-branch reaccess is low.[6][7][8][9] (Level of Evidence: B)"

References

  1. 1.0 1.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  2. 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 (1): 71–8. doi:10.1161/CIRCULATIONAHA.108.808402. PMID 19103990. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  3. Ferenc M, Gick M, Kienzle RP, Bestehorn HP, Werner KD, Comberg T, Kuebler P, Büttner HJ, Neumann FJ (2008). "Randomized trial on routine vs. provisional T-stenting in the treatment of de novo coronary bifurcation lesions". European Heart Journal. 29 (23): 2859–67. doi:10.1093/eurheartj/ehn455. PMC 2638653. PMID 18845665. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  4. Hildick-Smith D, de Belder AJ, Cooter N, Curzen NP, Clayton TC, Oldroyd KG, Bennett L, Holmberg S, Cotton JM, Glennon PE, Thomas MR, Maccarthy PA, Baumbach A, Mulvihill NT, Henderson RA, Redwood SR, Starkey IR, Stables RH (2010). "Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies". Circulation. 121 (10): 1235–43. doi:10.1161/CIRCULATIONAHA.109.888297. PMID 20194880. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  5. 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 (2006). "Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study". Circulation. 114 (18): 1955–61. doi:10.1161/CIRCULATIONAHA.106.664920. PMID 17060387. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  6. Chen SL, Santoso T, Zhang JJ, Ye F, Xu YW, Fu Q, Kan J, Paiboon C, Zhou Y, Ding SQ, Kwan TW (2011). "A Randomized Clinical Study Comparing Double Kissing Crush With Provisional Stenting for Treatment of Coronary Bifurcation Lesions Results From the DKCRUSH-II (Double Kissing Crush versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions) Trial". Journal of the American College of Cardiology. 57 (8): 914–20. doi:10.1016/j.jacc.2010.10.023. PMID 21329837. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  7. Moussa ID (2011). "Coronary artery bifurcation interventions: the disconnect between randomized clinical trials and patient centered decision-making". Catheterization and Cardiovascular Interventions :Official Journal of the Society for Cardiac Angiography & Interventions. 77 (4): 537–45. doi:10.1002/ccd.22865. PMID 21351230. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  8. Aliabadi D, Tilli FV, Bowers TR, Benzuly KH, Safian RD, Goldstein JA, Grines CL, O'Neill WW (1997). "Incidence and angiographic predictors of side branch occlusion following high-pressure intracoronary stenting". The American Journal of Cardiology. 80 (8): 994–7. PMID 9352966. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)
  9. Galassi AR, Tomasello SD, Capodanno D, Barrano G, Ussia GP, Tamburino C (2009). "Mini-crush versus T-provisional techniques in bifurcation lesions: clinical and angiographic long-term outcome after implantation of drug-eluting stents". JACC. Cardiovascular Interventions. 2 (3): 185–94. doi:10.1016/j.jcin.2008.12.005. PMID 19463424. Retrieved 2011-12-15. Unknown parameter |month= ignored (help)

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