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,...

Practical Manual of Interventional Cardiology

Practical Manual of Interventional Cardiology
by Annapoorna Kini (Editor), Samin Sharma (Editor), Jagat Narula (Editor)


This practical handbook is based on an internal working manual developed by staff and fellows at Mount Sinai Heart Cardiovascular Catheterization Laboratory, renowned for its high-volume and low complication complex coronary procedures. The Practical Handbook of Interventional Cardiology captures the knowledge and methodological know-how from leaders in interventional cardiology, it intends to guide users in a stepwise, methodical and practical approach through various cardiac interventional procedures in order to achieve maximum patient safety and improved outcomes. From patient selection, preoperative work-up, setting up equipment to step-by-step illustrations of various procedural details and troubleshooting, this handbook captures all the details necessary to perform the simplest to...

interventional treatment of coronary bifurcation lesions

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




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...

Interventional treatment of coronary bifurcation lesions technology(Chinese Edition)

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

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)




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)




Endovascular Surgery: Expert Consult

Endovascular Surgery: Expert Consult
by Saunders


In the 4th edition of Endovascular Surgery, Drs. Wesley S. Moore, Samuel S. Ahn, and a host of experts guide you through the latest developments in this innovative field. New procedures and special features, such as key points and case reviews, help illustrate effective patient care, and new topics such as endoscopic management of aneurismal disease and traumatic injuries review with you the latest endovascular surgical techniques.Review basic principles and new techniques, and follow a practical, problem-solving approach to help address challenging areas. Gain greater detail and depth than other current texts, as well as fresh perspectives with contributions from new authors. Broaden your surgical skills with new chapters on endoscopic management of aneurismal disease and traumatic...

Essential Interventional Cardiology

Essential Interventional Cardiology
by Saunders Ltd.


This title is directed primarily towards health care professionals outside of the United States. This book has been prepared by professionals working in the UK. It covers the basic principles and practice of interventional cardiology, vascular and non-vascular, written specifically for the general cardiologist. Designed to facilitate easy access to key information, it contains numerous line illustrations, diagrams, graphs, and charts. The entire spectrum of interventional cardiology is covered in an easy-to-read format. In this new edition are fifteen new chapters written by experts from around the world. The excellent appendix of trials in interventional cardiology has been fully updated making this the best available source on how to apply trials to clinical practice.Includes editors...

© 2015 BrightSurf.com