Vol 25, No 3 (2018)
Original articles — Interventional cardiology
Published online: 2017-06-20

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The impact of proximal cell rewiring compared with distal cell rewiring with single-stent deployment and subsequent kissing balloon inflation in the inadequate jailing of a Kaname stent on the side branch ostium

Fumiaki Nakao1
Pubmed: 28653310
Cardiol J 2018;25(3):317-326.


Background: The aim of the study was to identify differences between proximal and distal cell rewir­ing with subsequent kissing balloon inflation (KBI) in the presence of a link connected to a carina on the jailed side branch ostium (SBO).

Methods: Kaname stents were deployed in bifurcation models (n = 12) with subsequent KBI and were confirmed by optical coherence tomography. The jailing configuration and cell rewiring were completely controlled and classified as follows: FC-Dist, free carina (no links connected to a carina) and distal cell re­wiring; CC-Prox, connected to a carina (the presence of a link connected to a central carina) and proximal cell rewiring; CC-Dist, connected to a carina and distal cell rewiring; and FarDist, far-distal cell rewiring.

Results: The number of frames with malapposed struts (MS) in the SBO was significantly smaller in the CC-Prox group than in the CC-Dist group (26.7 ± 1.5 and 39.7 ± 0.6, respectively, p < 0.05). The number of frames with MS continuously present from the distal end to the proximal side of the SBO was significantly smaller in the CC-Prox group than in the CC-Dist group (17.0 ± 2.0 and 36.7 ± ± 5.8, respectively, p < 0.05). The ratio of the maximal opened stent cell area to the SBO area was significantly larger in the CC-Prox group than in the CC-Dist group (64.2 ± 1.2% and 38.8 ± 5.6%, respectively, p < 0.05).

Conclusions: This study showed that in cases with a link connected to a carina, fewer malapposed struts may be present in proximal cell rewiring with subsequent KBI than in distal cell rewiring.

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  1. Iakovou I, Ge L, Colombo A. Contemporary stent treatment of coronary bifurcations. J Am Coll Cardiol. 2005; 46(8): 1446–1455.
  2. Ferrante G, Presbitero P, Valgimigli M, et al. Percutaneous coronary intervention versus bypass surgery for left main coronary artery disease: a meta-analysis of randomised trials. EuroIntervention. 2011; 7(6): 738–746, 1.
  3. De Caterina AR, Cuculi F, Banning AP. Incidence, predictors and management of left main coronary artery stent restenosis: a comprehensive review in the era of drug-eluting stents. EuroIntervention. 2013; 8(11): 1326–1334.
  4. Hildick-Smith D, Lassen J, Koo BK. One or two stents for coronary bifurcation lesions? EuroIntervention. 2010; 6(J): J61–J64.
  5. Biondi-Zoccai G, Sheiban I, De Servi S, et al. To kiss or not to kiss? Impact of final kissing-balloon inflation on early and long-term results of percutaneous coronary intervention for bifurcation lesions. Heart Vessels. 2014; 29(6): 732–742.
  6. Yamashita T, Nishida T, Adamian MG, et al. Bifurcation lesions: two stents versus one stent--immediate and follow-up results. J Am Coll Cardiol. 2000; 35(5): 1145–1151.
  7. Song YB, Hahn JY, Choi SH, et al. Sirolimus- versus paclitaxel-eluting stents for the treatment of coronary bifurcations results: from the COBIS (Coronary Bifurcation Stenting) Registry. J Am Coll Cardiol. 2010; 55(16): 1743–1750.
  8. Park SM, Ahn CM, Hong SJ, et al. Acute changes of left ventricular hemodynamics and function during percutaneous coronary intervention in patients with unprotected left main coronary artery disease. Heart Vessels. 2015; 30(4): 432–440.
  9. Orvin K, Carrie D, Richardt G, et al. Comparison of sirolimus eluting stent with bioresorbable polymer to everolimus eluting stent with permanent polymer in bifurcation lesions: Results from CENTURY II trial. Catheter Cardiovasc Interv. 2016; 87(6): 1092–1100.
  10. Okamura T, Onuma Y, Garcia-Garcia HM, et al. High-speed intracoronary optical frequency domain imaging: implications for three-dimensional reconstruction and quantitative analysis. EuroIntervention. 2012; 7(10): 1216–1226.
  11. Okamura T, Onuma Y, Yamada J, et al. 3D optical coherence tomography: new insights into the process of optimal rewiring of side branches during bifurcational stenting. EuroIntervention. 2014; 10(8): 907–915.
  12. Hikichi Y, Umezu M, Node K, et al. Reduction in incomplete stent apposition area caused by jailed struts after single stenting at left main bifurcation lesions: micro-CT analysis using a three-dimensional elastic bifurcated coronary artery model. Cardiovasc Interv Ther. 2017; 32(1): 12–17.
  13. Murasato Y, Iwasaki K, Yamamoto T, et al. Optimal kissing balloon inflation after single-stent deployment in a coronary bifurcation model. EuroIntervention. 2014; 10(8): 934–941.
  14. Finet G, Gilard M, Perrenot B, et al. Fractal geometry of arterial coronary bifurcations: a quantitative coronary angiography and intravascular ultrasound analysis. EuroIntervention. 2008; 3(4): 490–498.
  15. Nakao F, Okamura T, Suetomi T, et al. Differences of side branch jailing between left main-left anterior descending artery stenting and left main-left circumflex artery stenting with Nobori biolimus-eluting stent. Heart Vessels. 2016; 31(12): 1895–1903.
  16. Nakao F. Importance of confirmation by instant stent-accentuated three-dimensional optical coherence tomography during bifurcation stenting: far distal rewiring of iSA3D-OCT. AsiaIntervention. 2015; 1: 71.
  17. Gutiérrez-Chico JL, Wykrzykowska J, Nüesch E, et al. Delayed coverage in malapposed and side-branch struts with respect to well-apposed struts in drug-eluting stents: in vivo assessment with optical coherence tomography. Circulation. 2011; 124(5): 612–623.
  18. Hariki H, Shinke T, Otake H, et al. Potential benefit of final kissing balloon inflation after single stenting for the treatment of bifurcation lesions--insights from optical coherence tomography observations. Circ J. 2013; 77(5): 1193–1201.
  19. Nakao F, Ueda T, Nishimura S, et al. Novel and quick coronary image analysis by instant stent-accentuated three-dimensional optical coherence tomography system in catheterization laboratory. Cardiovasc Interv Ther. 2013; 28(3): 235–241.
  20. Niemelä M, Kervinen K, Erglis A, et al. Nordic-Baltic PCI Study Group. Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic-Baltic Bifurcation Study III. Circulation. 2011; 123(1): 79–86.
  21. Alegría-Barrero E, Foin N, Chan PH, et al. Optical coherence tomography for guidance of distal cell recrossing in bifurcation stenting: choosing the right cell matters. EuroIntervention. 2012; 8(2): 205–213.
  22. Farooq V, Serruys PW, Heo JHo, et al. New insights into the coronary artery bifurcation hypothesis-generating concepts utilizing 3-dimensional optical frequency domain imaging. JACC Cardiovasc Interv. 2011; 4(8): 921–931.
  23. Murasato Y, Hikichi Y, Horiuchi M. Examination of stent deformation and gap formation after complex stenting of left main coronary artery bifurcations using microfocus computed tomography. J Interv Cardiol. 2009; 22(2): 135–144.
  24. Nakao F. Instant stent-accentuated 3-dimensional optical coherence tomography of struts pulled up by pulling stuck wire and folded by kissing balloon dilation. JACC Cardiovasc Interv. 2015; 8(8): e125–e126.
  25. Finet G, Derimay F, Motreff P, et al. Comparative analysis of sequential proximal optimizing technique versus kissing balloon inflation technique in provisional bifurcation stenting: fractal coronary bifurcation bench test. JACC Cardiovasc Interv. 2015; 8(10): 1308–1317.
  26. Nakao F, Ueda T, Nishimura S, et al. Guide wire shadow assessed by shading index is reduced in sparse spring coil wire in optical coherence tomography. Cardiovasc Interv Ther. 2013; 28(4): 362–367.