Sol ana koroner arter bifurkasyonu için tek stentli crossover yaklaşımın tek merkez klinik sonuçları

Öz

Amaç: Perkütan koroner girişim ile tedavi edilen sol ana koroner arter (LM) bifurkasyon lezyonlarının çoğunda, kompleks çift stentleme tekniklerine kıyasla daha basit olan tek stentli crossover teknik ve yan dala provizyonel yaklaşım önerilmektedir. Bu çalışmada, LM bifurkasyonu için tek stentli crossover yaklaşımın klinik sonuçlarını ortaya koymayı amaçladık. Gereç ve Yöntemler: Merkezimizde Mayıs 2020 ile Kasım 2023 tarihleri arasında, korumasız LM bifurkasyon lezyonuna tek stentli crossover teknik uygulanan hastalar retrospektif gözlemsel bu çalışmaya dahil edildi. Hastaların klinik ve prosedürel özellikleri kaydedildi. Tüm hastalar veya yakınları aranarak klinik sonuçlar sorgulandı. Birincil sonlanım noktası; kliniğe dayalı hedef lezyon revaskülarizasyonu (TLR), hedef lezyonla ilişkili miyokart enfarktüsü (TL-MI) veya ani kardiyak ölüm (SCD) olarak tanımlanan hedef lezyon başarısızlığı (TLF) olarak belirlendi. Bulgular: Toplam 86 hasta çalışmaya dahil edildi. Bu hastaların 76'sında LM'den sol ön inen artere (LAD) doğru, 8'inde LM'den sol sirkumfleks artere (LCX) doğru crossover stentleme yapılmıştı. Ortanca takip süresi 22 (3-54) aydı. Hastaların 2'sinde kliniğe dayalı TLR, 1'inde TL-MI, 1'inde SCD gelişmişti. TLF kriterleri yalnızca 3 hastada gerçekleşmişti. Bu hastaların 2 tanesine LM-LAD, 1 tanesine LM-LCX crossover stentleme uygulanmıştı. Sonuç: LM bifurkasyon lezyonları için tek stentli crossover yaklaşım oldukça iyi klinik sonuçlarla ilişkilidir.

Anahtar Kelimeler

• tek stent
• crossover stentleme
• sol ana koroner arter bifurkasyonu

Clinical outcomes of one-stent crossover approach for left main bifurcation in a single center

Öz

Aim: For the majority of left main coronary artery (LM) bifurcation lesions treated with percutaneous coronary intervention, one-stent crossover technique and provisional approach to the side branch is recommended, which is simpler compared to complex two-stent techniques. In this study, we aimed to reveal the clinical outcomes of one-stent crossover approach for LM bifurcation. Material and Methods: Patients who underwent one-stent crossover technique for unprotected LM bifurcation lesion between May 2020 and November 2023 in our center were included in this retrospective observational study. Clinical and procedural characteristics of the patients were recorded. All patients or their relatives were called to inquire about clinical outcomes. The primary endpoint was determined as target lesion failure (TLF), which was defined as clinically driven target lesion revascularization (TLR), target lesion-related myocardial infarction (TL-MI), or sudden cardiac death (SCD). Results: A total of 86 patients were included in the study. Crossover stenting was performed from the LM to the left anterior descending artery (LAD) in 76 patients and from the LM to the left circumflex artery (LCX) in 8 patients. The median follow-up time was 22 (3-54) months. Clinically driven TLR occurred in 2 patients, TL-MI in 1 patient, and SCD in 1 patient. TLF criteria were met in only 3 patients. Of these patients, 2 had undergone LM-LAD and 1 had undergone LM-LCX crossover stenting. Conclusion: One-stent crossover approach for LM bifurcation lesions is associated with very good clinical outcomes.

Anahtar Kelimeler

• one-stent
• crossover stenting
• left main bifurcation

Kaynakça

1. Burzotta F, Lassen JF, Lefèvre T, et al. Percutaneous coronary intervention for bifurcation coronary lesions: the 15th consensus document from the European Bifurcation Club. EuroIntervention 2021; 16: 1307-17.
2. Cho S, Kim JS, Kang TS, et al. Long-Term Efficacy of Extended Dual Antiplatelet Therapy After Left Main Coronary Artery Bifurcation Stenting. Am J Cardiol 2020; 125: 320-7.
3. Kim WJ, Kim YH, Park DW, et al. Comparison of single- versus two-stent techniques in treatment of unprotected left main coronary bifurcation disease. Catheter Cardiovasc Interv 2011; 77: 775-82.
4. Zhang JJ, Ye F, Xu K, et al. Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial. Eur Heart J 2020; 41: 2523-36.
5. Chen SL, Zhang JJ, Han Y, et al. Double Kissing Crush Versus Provisional Stenting for Left Main Distal Bifurcation Lesions: DKCRUSH-V Randomized Trial. J Am Coll Cardiol 2017; 70: 2605-17.
6. Hildick-Smith D, Egred M, Banning A, et al. The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN). Eur Heart J 2021; 42: 3829-39.
7. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143-421.
8. Stevens PE, Levin A; Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013; 158: 825-30.

9. Kostantinis S, Rempakos A, Simsek B, et al. Impact of calcium on the procedural techniques and outcomes of chronic total occlusion percutaneous coronary intervention. Int J Cardiol 2023; 390: 131254.
10. Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011; 123: 2736-47.
11. Paradies V, Banning A, Cao D, et al. Provisional Strategy for Left Main Stem Bifurcation Disease: A State-of-the-Art Review of Technique and Outcomes. JACC Cardiovasc Interv 2023; 16: 743-758.
12. Paradies V, Lu S, Ng J, Ang HY, Joner M, Foin N. Thrombogenicity at the jailed side branch ostia in the provisional stenting technique: insights from an in vitro model. EuroIntervention 2018; 14: 826-7.
13. Ahn JM, Lee PH, Park DW, et al. Benefit of Final Kissing Balloon Inflation Mandatory After Simple Crossover Stenting for Left Main Bifurcation Narrowing. Am J Cardiol 2017; 119: 528-34.
14. Foin N, Secco GG, Ghilencea L, Krams R, Di Mario C. Final proximal post-dilatation is necessary after kissing balloon in bifurcation stenting. EuroIntervention 2011; 7: 597-604.
15. Naganuma T, Chieffo A, Basavarajaiah S, et al. Single-stent crossover technique from distal unprotected left main coronary artery to the left circumflex artery. Catheter Cardiovasc Interv 2013; 82: 757-64.