Science Current Events | Science News | Brightsurf.com
 

New study compares provisional and two-stent strategies for coronary bifurcation lesions

October 31, 2013
A new clinical trial shows that a two-stent technique for treatment of bifurcation lesions with a large stenotic side branch was not associated with significant improved outcomes compared to a provisional stenting approach. The findings from the Nordic-Baltic Bifurcation IV study were presented today at the 25th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium. Sponsored by the Cardiovascular Research Foundation (CRF), TCT is the world's premier educational meeting specializing in interventional cardiovascular medicine.

Coronary bifurcation lesions are caused from a build-up of plaque in the heart at a location where one artery branches from another. In provisional side branch stenting, the main vessel branch is stented and the side branch only if compromised. Currently, provisional side branch stenting is the preferred strategy for treatment of bifurcation lesions.

The safety and effectiveness of provisional stenting for bifurcations that involve a large side branch of the coronary arteries is unknown. The Nordic-Baltic IV trial was a randomized, controlled, non-blinded, multicenter, superiority trial that compared provisional stenting with a two-stent strategy for the treatment of coronary bifurcation lesions involving a major side branch.

The primary endpoint was the composite of major adverse cardiac events (MACE) including cardiac death, non-procedure-related myocardial infarction, target vessel revascularization and stent thrombosis after six months. Follow up is planned until five years. A total of 450 patients with coronary bifurcation lesions were randomized 1:1 to the provisional strategy (stenting of the main vessel and provisional stenting of the side branch) or a complex two-stent strategy (planned stenting of both the main vessel and the side branch).

After six months, the MACE rate was not significantly different between provisional and two-stent techniques (4.6 percent and 1.8 percent, respectively, p=0.09). Individual endpoints were also similar between the two techniques including total death (0 and 0.4 percent, p=0.32), non-procedural myocardial infarction (1.8 percent and 0.9 percent, p=0.50) and target vessel revascularization (3.7 percent and 1.3 percent, p=0.11). There were no incidents of cardiac death in either group.

However, in contrast to prior studies, longer and more complex procedures in the two-stent group did not translate into more procedural myocardial infarctions.

"Results of this trial indicate that a two-stent technique does not significantly improve mid-term outcomes for patients with bifurcation lesions compared to provisional stenting," said lead investigator Indulis Kumsars, MD. Dr. Kumsars is Head of the Cardiac Catheterization Laboratory at the Latvian Cardiology Center in Riga, Latvia.

Given the fact that there was a weak trend towards lower MACE in the two stent strategy and follow up is continuing for five years, the Nordic-Baltic investigators concluded, "Recommendations on optimal strategies for this lesion subset should await longer term follow up."

Cardiovascular Research Foundation



More Coronary Bifurcation Lesions Current Events and Coronary Bifurcation Lesions News Articles

Tips and Tricks in Interventional Therapy of Coronary Bifurcation Lesions

Tips and Tricks in Interventional Therapy of Coronary Bifurcation Lesions
by Issam Moussa (Editor), Antonio Colombo (Editor)


There is much discussion in the field of interventional cardiovascular therapy as to what is the best approach to treating coronary bifurcation lesions. Many advocate for provisional stenting, stenting of the main vessel with subsequent stenting of the side branch as needed, while some advocate for elective double stenting of both branches. This book is the first of its kind to take a unique approach to this issue by considering the management of bifurcation lesions in the context of the individual patient’s bifurcation anatomy. A highly-illustrated, evidence-based and practical guide, this text offers a patient-centered outlook on the technical decision making in the treatment of coronary bifurcation lesions.

Coronary Stenting: A Companion to Topol's Textbook of Interventional Cardiology (Expertconsult.Com)

Coronary Stenting: A Companion to Topol's Textbook of Interventional Cardiology (Expertconsult.Com)
by Saunders


Make optimal use of the latest coronary stenting techniques and adjunctive devices with well-rounded guidance from Coronary Stenting, a companion volume to Dr. Topol’s Textbook of Interventional Cardiology. This comprehensive, up-to-date interventional cardiology book keeps you abreast of the latest trial data on efficacy and safety as well as cutting-edge clinical applications in coronary stenting.Achieve optimal outcomes and minimize complications with expert guidance from the foremost teachers and writers in the field of interventional cardiology.Implement the latest knowledge on cutting-edge topics such as drug-eluting stent design; appropriate interpretation of randomized clinical trials and comparative effectiveness studies of coronary stents; the use of fractional flow reserve,...

Cases in Interventional Cardiology: Expert Consult

Cases in Interventional Cardiology: Expert Consult
by Saunders


Cases in Interventional Cardiology, by Dr. Michael Ragosta, offers practical, clinical guidance on coronary and peripheral interventional cardiology through 100 well-presented case histories. Brief clinical presentations, representative illustrations, and dynamic online videos of angiograms, aortograms, and intravascular echos optimize your understanding of these procedures and help you better recognize and manage a wide array of conditions. You'll find valuable advice on patient selection, complications, complex lesion subsets, management dilemma controversies, and much more. Through expertconsult.com you’ll have convenient access to the full text, illustrations, and videos online.Access the fully searchable text online at expertconsult.com and view videos of the angiograms,...

interventional treatment of coronary bifurcation lesions

interventional treatment of coronary bifurcation lesions
by CHEN JI LIN BIAN ZHU (Author)




  Interventional treatment of coronary bifurcation lesions T37 Essentials ( Author : Lianglong Chen ) ( Price: 96.00 ) ( Publisher: People's Health Publishing House ) ( ISBN : 978.711(Chinese Edition)
by CHEN LIANG LONG ZHU BIAN (Author)




Interventional treatment of coronary bifurcation lesions technology(Chinese Edition)

Interventional treatment of coronary bifurcation lesions technology(Chinese Edition)
by BEN SHE.YI MING (Author)




Tips and Tricks in Interventional Therapy of Coronary Bifurcation Lesions. CRC Press. 2010.

Tips and Tricks in Interventional Therapy of Coronary Bifurcation Lesions. CRC Press. 2010.
by ISSAM; COLOMBO, ANTONIO. MOUSSA (Author)




Coronary Lesions: A Pragmatic Approach

Coronary Lesions: A Pragmatic Approach
by Patrick W. Serruys (Author), Martin B. Leon (Author), Antonio Colombo (Author), Michael J B Kutryk (Author)


The interventional cardiologist has to tackle a diverse and complex range of coronary lesions. For this reason, the experts who compiled this volume contribute the best practices for overcoming plaque and thrombus in the coronary arteries. From simple to complicated anatomy, the direct approach to achieving optimal results is clearly described and illustrated. Each chapter focuses on a specific problem, and top quality angiograms illustrate the various coronary lesions. The editors, all experts and pioneers in the field of interventional cardiology, from stenting to myocardial revascularization, have assembled a team of internationally renowned contributors to offer their practical advice on how to approach lesions in a straight-forward, pragmatic fashion. This guide is indispensable for...

Tumors of the Spine

Tumors of the Spine
by Saunders


Achieve optimal outcomes for your patients with this new multimedia reference. Organized by tumor then by region, this resource details diagnostic and therapeutic options for primary and malignant spinal tumors. Over 25 key procedures--including minimally invasive surgery--are presented in a concise, stepwise fashion, putting the key information you need right at your fingertips! Over 600 illustrations round out this exhaustive new reference.Keep up to date on the latest advances in diagnosis and therapy with discussions of the latest surgical techniques, including minimally invasive spine surgery.Chapter templating helps you understand the entire procedure as well as key aspects, pearls and pitfalls, before heading into the OR.Have all the information you need to make a diagnosis and...

Priorities in Critical Care Nursing, 6e (Urden, Priorities in Critical Care Nursing)

Priorities in Critical Care Nursing, 6e (Urden, Priorities in Critical Care Nursing)
by Linda D. Urden DNSc RN CNS NE-BC FAAN (Author), Kathleen M. Stacy PhD RN CNS CCRN PCCN CCNS (Author), Mary E. Lough PhD RN CNS CCRN CNRN CCNS (Author)


Priorities in Critical Care Nursing, 6th Edition is the perfect companion to any critical care course with its succinct coverage of all core critical care nursing topics. Using the latest, most authoritative research, this evidence-based resource helps you identify priorities to accurately and effectively manage patient care. Updated content spans the areas of medication, patient safety, patient education, nursing diagnosis, and collaborative management to fully prepare you for success in all aspects of critical care nursing.Evidence-based approach offers the most accurate and timely patient care recommendations based on the latest and most authoritative research, meta-analyses, and systematic reviews available. Patient Safety Priorities boxes in each therapeutic management chapter...

© 2014 BrightSurf.com