In vitro flow and optical coherence tomography comparison of two bailout techniques after failed provisional stenting for bifurcation percutaneous coronary interventions

Julien Adjedj, Fabien Picard, Satoshi Mogi, Kiyotaka Iwasaki, Hamid Aoumeur, Omar Alansari, Edem Agudze, William Wijns, Olivier Varenne

    Research output: Contribution to journalArticle

    Abstract

    Objectives: To evaluate, in vitro, SB stenting techniques after failed provisional stenting. We aimed to compare flows and stent strut apposition of T and protrusion (TAP) versus Reversed String (RS) techniques using a flow simulator, optical coherence tomography (OCT) using silicon bifurcation phantoms with different bifurcation angulations. Background: While bifurcation coronary artery stenoses are preferably treated with provisional T-stenting strategy, the preferred bailout two stents technique to treat the side branch remains unclear. Methods and results: Eleven 30°-angle and ten 60°-angle bifurcation phantoms were used. After performing provisional stenting, TAP and RS techniques were compared in six phantoms with 30° and five with 60° angles. Flow measurement was performed using absolute coronary flow and particle image velocimetry techniques. Strut apposition was evaluated using OCT. Flow analyses showed that disturbed flow regions were observed in the vicinity of floating struts protruded into the lumen both regardless of TAP and RS techniques. OCT analysis showed a higher proportion of floating struts protruding into the main branch with TAP compared to RS, respectively (13% vs. 1%; P <0.001) in both angles. Conclusions: RS reduces the proportion of floating struts protruding into the main branch compared to TAP, at comparable flow rates. Clinical studies are needed to evaluate feasibility and potential clinical benefit of this technique.

    Original languageEnglish
    Pages (from-to)E8-E16
    JournalCatheterization and Cardiovascular Interventions
    Volume93
    Issue number1
    DOIs
    Publication statusPublished - 2019 Jan 1

    Fingerprint

    Optical Coherence Tomography
    Percutaneous Coronary Intervention
    Stents
    Rheology
    Coronary Stenosis
    Silicon
    In Vitro Techniques

    Keywords

    • bifurcation angle
    • in vitro bifurcation models
    • provisional T-stenting
    • Reversed String
    • T and protrusion

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine

    Cite this

    In vitro flow and optical coherence tomography comparison of two bailout techniques after failed provisional stenting for bifurcation percutaneous coronary interventions. / Adjedj, Julien; Picard, Fabien; Mogi, Satoshi; Iwasaki, Kiyotaka; Aoumeur, Hamid; Alansari, Omar; Agudze, Edem; Wijns, William; Varenne, Olivier.

    In: Catheterization and Cardiovascular Interventions, Vol. 93, No. 1, 01.01.2019, p. E8-E16.

    Research output: Contribution to journalArticle

    Adjedj, Julien ; Picard, Fabien ; Mogi, Satoshi ; Iwasaki, Kiyotaka ; Aoumeur, Hamid ; Alansari, Omar ; Agudze, Edem ; Wijns, William ; Varenne, Olivier. / In vitro flow and optical coherence tomography comparison of two bailout techniques after failed provisional stenting for bifurcation percutaneous coronary interventions. In: Catheterization and Cardiovascular Interventions. 2019 ; Vol. 93, No. 1. pp. E8-E16.
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    abstract = "Objectives: To evaluate, in vitro, SB stenting techniques after failed provisional stenting. We aimed to compare flows and stent strut apposition of T and protrusion (TAP) versus Reversed String (RS) techniques using a flow simulator, optical coherence tomography (OCT) using silicon bifurcation phantoms with different bifurcation angulations. Background: While bifurcation coronary artery stenoses are preferably treated with provisional T-stenting strategy, the preferred bailout two stents technique to treat the side branch remains unclear. Methods and results: Eleven 30°-angle and ten 60°-angle bifurcation phantoms were used. After performing provisional stenting, TAP and RS techniques were compared in six phantoms with 30° and five with 60° angles. Flow measurement was performed using absolute coronary flow and particle image velocimetry techniques. Strut apposition was evaluated using OCT. Flow analyses showed that disturbed flow regions were observed in the vicinity of floating struts protruded into the lumen both regardless of TAP and RS techniques. OCT analysis showed a higher proportion of floating struts protruding into the main branch with TAP compared to RS, respectively (13{\%} vs. 1{\%}; P <0.001) in both angles. Conclusions: RS reduces the proportion of floating struts protruding into the main branch compared to TAP, at comparable flow rates. Clinical studies are needed to evaluate feasibility and potential clinical benefit of this technique.",
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    AU - Picard, Fabien

    AU - Mogi, Satoshi

    AU - Iwasaki, Kiyotaka

    AU - Aoumeur, Hamid

    AU - Alansari, Omar

    AU - Agudze, Edem

    AU - Wijns, William

    AU - Varenne, Olivier

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    AB - Objectives: To evaluate, in vitro, SB stenting techniques after failed provisional stenting. We aimed to compare flows and stent strut apposition of T and protrusion (TAP) versus Reversed String (RS) techniques using a flow simulator, optical coherence tomography (OCT) using silicon bifurcation phantoms with different bifurcation angulations. Background: While bifurcation coronary artery stenoses are preferably treated with provisional T-stenting strategy, the preferred bailout two stents technique to treat the side branch remains unclear. Methods and results: Eleven 30°-angle and ten 60°-angle bifurcation phantoms were used. After performing provisional stenting, TAP and RS techniques were compared in six phantoms with 30° and five with 60° angles. Flow measurement was performed using absolute coronary flow and particle image velocimetry techniques. Strut apposition was evaluated using OCT. Flow analyses showed that disturbed flow regions were observed in the vicinity of floating struts protruded into the lumen both regardless of TAP and RS techniques. OCT analysis showed a higher proportion of floating struts protruding into the main branch with TAP compared to RS, respectively (13% vs. 1%; P <0.001) in both angles. Conclusions: RS reduces the proportion of floating struts protruding into the main branch compared to TAP, at comparable flow rates. Clinical studies are needed to evaluate feasibility and potential clinical benefit of this technique.

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