Benefit of systematic "jailed wire" technique for bifurcation provisional stenting. A CABRIOLET sub-study.

Background: Jailed wire (JW) in the side branch (SB) is recommended during coronary bifurcation provisional stenting, but real benefit is unsure. Our objective was to evaluate benefit of a JW technique in the CABRIOLET registry.

Methods: In CABRIOLET, including 500 patients, we compared the primary composite endpoint poor final SB angiographic result (TIMI flowB, thrombosis, residual stenosis>70%, or additional SB stenting) whether JW was performed or not.

Percutaneous coronary intervention for bifurcation coronary lesions using optimised angiographic guidance: the 18th consensus document from the European Bifurcation Club.

The 2023 European Bifurcation Club (EBC) meeting took place in Warsaw in October, and the latest evidence for the use of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) to optimise percutaneous coronary interventions (PCI) on coronary bifurcation lesions (CBLs) was a major focus. The topic generated deep discussions and general appraisal on the potential benefits of IVUS and OCT in PCI procedures. Nevertheless, despite an increasing recognition of IVUS and OCT capabilities and their recognised central role for guidance in complex CBL and left main PCI, it is expected that angiography will continue to be the primary guidance modality for CBL PCI, principally due to educational and economic barriers.

Coronary CT Angiography with Photon-counting CT: First-In-Human Results.

Background Spatial resolution, soft-tissue contrast, and dose-efficient capabilities of photon-counting CT (PCCT) potentially allow a better quality and diagnostic confidence of coronary CT angiography (CCTA) in comparison to conventional CT. Purpose To compare the quality of CCTA scans obtained with a clinical prototype PCCT system and an energy-integrating detector (EID) dual-layer CT (DLCT) system. Materials and Methods In this prospective board-approved study with informed consent, participants with coronary artery disease underwent retrospective electrocardiographically gated CCTA with both systems after injection of 65-75 mL of 400 mg/mL iodinated contrast agent at 5 mL/sec.

First In-Human Results of Computed Tomography Angiography for Coronary Stent Assessment With a Spectral Photon Counting Computed Tomography.

Objectives: The aim of this study is to compare the image quality of in vivo coronary stents between an energy integrating detectors dual-layer computed tomography (EID-DLCT) and a clinical prototype of spectral photon counting computed tomography (SPCCT).

Materials And Methods: In January to June 2021, consecutive patients with coronary stents were prospectively enrolled to undergo a coronary computed tomography (CT) with an EID-DLCT (IQon, Philips) and an SPCCT (Philips). The study was approved by the local ethical committee and patients signed an informed consent.

Impact of Arterial Blood Pressure on Ultrasound Hemodynamic Assessment of Aortic Valve Stenosis Severity.

Background: Aortic stenosis (AS) severity assessment is based on several indices. Aortic valve area (AVA) is subject to inaccuracies inherent to the measurement method, while velocities and gradients depend on hemodynamic status. There is controversy as to whether blood pressure directly affects common indices of AS severity.

Toward a sequential provisional coronary bifurcation stenting technique. From kissing balloon to re-POT sequence.

The specific anatomy of coronary bifurcations makes them prime sites of atherogenesis and complicates revascularization. Account must be taken of the systematic difference in diameter between the 3 constituent vessels so as to minimize final side-branch ostium obstruction and maintain the law of conservation of flow, while respecting the bifurcation angles. Kissing balloon inflation (KBI) was long recommended, but never clearly demonstrated clinical benefit in single-stent provisional stenting.

Sequential coronary bifurcation revascularization with the Xposition S™ self-apposing stent: a comparative fractal bench study.

Coronary bifurcation revascularization needs to take account of the diameter differential between vessels and to limit side-branch obstruction (SBO). The self-apposing properties of the Xposition S™ stent (STENTYS, France) seem interesting in this regard. The present experimental fractal bench study determined the best provisional stenting technique using Xposition S™.

Optimal balloon positioning for the proximal optimization technique? An experimental bench study.

Aims: The proximal optimization technique (POT) in coronary bifurcation stenting improves apposition and side-branch obstruction. The POT balloon should be positioned with the distal radio-opaque marker at the carina cut plane. However, the real impact of positioning remains unknown.

Extracorporeal life support in the multidisciplinary management of cardiogenic shock complicating acute myocardial infarction.

Objectives: To analyze the results of extracorporeal life support (ECLS) for cardiogenic shock complicating acute myocardial infarction (AMI) in a single-center experience.

Background: Cardiogenic shock is still a leading cause of death for AMI. Conventional management carries mortality rates exceeding 50%.

Influence of Collaterals on True FFR Prediction for a Left Main Stenosis with Concomitant Lesions: An In Vitro Study.

With the aim of assisting interventional cardiologists during decision making for revascularization, reduced-order (0D) approaches have been developed to predict the true fractional flow reserve (FFR) of individual stenoses in multiple-lesion arrangements. In this study, a general equation was derived to predict the FFR of a left main (LM) coronary stenosis with downstream lesions, one in the left anterior descending (LAD) and the other in the left circumflex (LCx) artery, and distinct collateral circulations supplying each daughter artery. An in vitro model mimicking the fractal nature of LM bifurcation trees with collateral branches was developed to validate the FFR values obtained with the prediction model (FFR ).

Intraluminal Ultrasonic Palpation Imaging Technique Revisited for Anisotropic Characterization of Healthy and Atherosclerotic Coronary Arteries: A Feasibility Study.

Accurate mechanical characterization of coronary atherosclerotic lesions remains essential for the in vivo detection of vulnerable plaques. Using intravascular ultrasound strain measurements and based on the mechanical response of a circular and concentric vascular model, E. I.

Benefits of final proximal optimization technique (POT) in provisional stenting.

Aims: Initial proximal optimization technique (POT) in provisional stenting improves global malapposition, side-branch (SB) obstruction (SBO) and conservation of arterial circularity. The specific mechanical effects of a final POT sequence concluding the main provisional stenting techniques, on the other hand, are unknown.

Methods And Results: Synergy™ stents were implanted on fractal coronary bifurcation bench models using the main provisional stenting techniques (n = 5 per group): kissing-balloon inflation (KBI), snuggle, and rePOT (initial POT + SB inflation + final POT).

Benefit of a new provisional stenting strategy, the re-proximal optimisation technique: the rePOT clinical study.

Aims: A new coronary bifurcation provisional stenting technique without kissing balloon, rePOT, associating the proximal optimisation technique (POT), side branch inflation and final POT, showed excellent mechanical results in a bench test. The present study sought to use optical coherence tomography (OCT) to quantify the mechanical results of rePOT in vivo in a large patient sample with complex coronary bifurcations.

Methods And Results: A total of 106 patients with coronary bifurcations were included in a multicentre prospective registry (left main, 40.