Anatomical classification of chronic total occlusions in coronary bifurcations.

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) in coronary bifurcation lesions (CBL) is undergoing substantial technical progress and standardization, paralleling the evolution of dedicated devices, tools, and techniques. A standard consensus to classify CTO-CBL might be instrumental to homogenize data collection and description of procedures for scientific and educational purposes. The Medina-CTO classification replicates the classical three digits in Medina classification for bifurcations, representing the proximal main vessel, distal main vessel, and side branch, respectively.

Optical Coherence Tomography to Assess Proximal Side Optimization Technique in Crush Stenting.

Aim: The aim of this study was to explore the potential intraprocedural benefits of the Proximal Side Optimization (PSO) technique by Optical Coherence Tomography (OCT).

Methods: A case series of 10 consecutive true bifurcation lesions, with severe long pathology of long side branch (SB), were randomly assigned to be treated by standard DK Crush procedure (non-PSO group) as compared to DK Crush in PSO modification (PSO group). The data from OCT investigation before crushing of the SB Drug-Eluting Stent (DES), after crushing, after first kissing balloon inflation (KBI), and after final angiography were compared between the two groups (Public trials registry ISRCTN23355755).

Proximal Side-Branch Optimization in Crush Stenting: A Step-by-Step Technical Approach in a Silicone Phantom Model.

Provisional single drug-eluting stent (DES) strategy remains the standard of care in simple bifurcation lesions which comprise the vast majority of coronary bifurcations. Nevertheless, the presence of complex bifurcations which are defined based on the 1) Side Branch (SB) lesion length of >10 mm and 2) SB ostial diameter stenosis of >70% are approached with a 2-DES strategy upfront. The bifurcation angle will further define the most appropriate technique, with T-stenting more suitable in angulations close to 90°, Culotte and the family of Crush techniques more appropriate for acute angles of <75°.

Identification of the type of stent with three-dimensional optical coherence tomography: the SPQR study.

Background: The ability of optical coherence tomography (OCT) to identify specific types of stent has never been systematically studied.

Aims: The aim of this study was to test the accuracy of OCT imaging to identify patterns of stent platform and subsequently identify the type of stent implanted.

Methods: Consecutive patients from six international centres were retrospectively screened, searching for OCT studies with metallic stents or scaffolds.