Impact of different final optimization techniques on long-term clinical outcomes of left main cross-over stenting.

BACKGROUND: The optimal final optimization technique to be used in patients after Cross Over Left main stenting remainsdebatable. AIM: We evaluate the impact of the post-optimization technique (POT), kissing balloon (KB) and the POT-side-POT techniques on both cardiovascular mortality and event-free survival in patients receiving left main (LM) cross-over stenting for an isolated/distal bifurcation LM disease. METHODS: Clinical and instrumental records of 128 consecutive patients (102 males, mean age 73.39 ±â€¯9.54 years old) with isolated distal/bifurcation LM disease and bypass surgery contraindications or refusal enrolled to receive LM cross-over stenting between the 1st January 2012 and the 1st January 2017 at two institutions: the Rovigo General Hospital (Rovigo, Italy) and the Alexandrovka Hospital University School of Medicine (Sofia, Bulgaria). Patients has been divided into three groups (POT, KB and POT-side-POT) according the optimal final optimization technique used while the 5-year cardiovascular mortality has been evaluated using the log-rank (Mantel-Cox) analysis. RESULTS: Baseline angiographic characteristics of the LM disease were mostly equivalent among the three groups. Over a global follow-up of 61.03 ±â€¯0.92 months, the rates of target vessel revascularization, acute myocardial infarction, and stent thrombosis, were not different among groups. Patients treated with POT had a slightly better long-term survival. CONCLUSIONS: None of these optimization techniques appeared to have clearly better long-term outcomes after LM Cross-over stenting in our retrospective study. POT resulted in a slightly better survival compared to Pot-sid-POT and KB.

Usefulness of the Finet law to guide stent size selection in ostial left main stenting: Comparison with standard angiographic estimation.

BACKGROUNDS: Intravascular ultrasound has been suggested to optimize stent diameter and length in Left Main (LM) procedures, but in the real-world ostial LM stenting is often accomplished with angiography only guidance. The Finet law which regulates the fractal geometry of human bifurcation has the potential to increase the accuracy of stent-sizing. To retrospectively evaluating the impact on outcomes of the addition of Finet Law to standard quantitative coronary angiography (QCA) in guiding stent selection of ostial LM stenting compared to standard angiography estimation. METHODS: We retrospectively evaluated the clinical and instrumental records of patients with isolated ostial LM disease and bypass surgery contraindications or refusal as determined by the local Heart Team who received stenting from 1 January 2012 to 1 January 2017 at Rovigo General Hospital. Patients were discrimined on the basis of the addition to QCA angiographic evaluation of the Finet-law. RESULTS: Seventy-three patients (45 males, mean age 69.9 ±â€¯10.9 years old) ostial LM stenting, 36 patients using QCA and Finet law (QCA-Finet) and 37 using standard QCA angiographic (QCA-angio) evaluation of the vessel diameter. By QCA, vessel size, mean stent diameter at implantation and after post-dilatation were clearly bigger in the QCA+ Finet than QCA-angio (4.4 ±â€¯0.8 and 3.8 ±â€¯0.7, p < 0.001). At a mean follow-up of 5.0 ±â€¯0.4 years, cardiovascular mortality and cardiovascular events incidence were higher in QCA-angio compared to QCA+Finet group of patients. CONCLUSIONS: Our study suggested that adding the Finet law to standard angiography estimation of the LM stent size may improve long-term outcomes.