The impact of the bifurcation angle for the Nano-Crush two-stent coronary bifurcation technique on long-term outcomes in a real-world clinical population.

AIM: This study aims to assess the direct impact of bifurcation angle (BA) on immediate procedural outcomes and patient prognosis post-Nano-Crush stenting for coronary bifurcation lesions. METHODS: A retrospective analysis was conducted for all consecutive patients treated with the Nano-Crush technique across two high-volume interventional centers from January 2020 to October 2022. PRIMARY ENDPOINT: comparison of target lesion failure rate in two cohorts based on bifurcation angle (<70° vs. ≥70°), with secondary endpoints including side branch ostium coverage, rate of successful final kissing balloon inflation (FKBI), need for conversion to another technique, and procedure length. RESULTS: Baseline demographics included 71 patients in the BA<70° group and 49 in the BA≥70° group, with well-balanced characteristics. Angiographic characteristics revealed similar trends, including anatomic and morphological lesion characteristics (referencing Syntax score, Medina classification, and presence of calcifications). Both groups predominantly had complex coronary disease, with a baseline mean Syntax score of 24.18 ± 8.19 in the BA<70° group and 23.91 ± 7.29 in the BA≥70° group, respectively. A dedicated debulking device for lesion preparation was used in 25.35 % of patients in the first group and in 28.57 % of patients in the second group. The primary endpoint occurred in 5.63 % of patients in the BA<70° group and in 4.08 % of patients in the BA≥70° group (P = 0.7014) after ≥ 2 years of clinical follow-up. Angiographic success was achieved in 100 % of both groups, with procedural time averaging 74.99 ± 25.55 min in the BA≥70° and 76.94 ± 27.81 min in the BA<70° (P = 0.6922). The rate of successful final kissing balloon inflation was 98.59 % in the BA<70° group and 95.91 % in the BA≥70° group (P = 0.3566). The mean contrast volume was 189.54 ± 73.74 ml in BA<70° and 168.9 ± 62.77 ml in BA≥70° (P = 0.1126). Clinical follow-ups at 30 days and 2 years revealed similar outcomes and complications for each group, as summarized in Table 3. CONCLUSIONS: Our results demonstrate that the bifurcation angle does not significantly impact long-term clinical outcomes or procedural parameters, such as side branch ostium coverage, conversion to a modified DK Crush technique, FKBI success rate, and procedure length. These findings suggest that the Nano-Crush technique can be a viable option for bifurcation lesions, irrespective of the bifurcation angle, achieving optimal side branch ostium coverage while preventing excessive protrusion into the main vessel.

Outcomes after Percutaneous Coronary Intervention in Patients with Extremely Calcified Left Main Lesions.

Background and Objectives: Available data with regard to the outcomes of patients with severely calcified left main (LM) lesions after revascularization by percutaneous coronary intervention (PCI) when compared to non-calcified LM lesions is unclear. Materials and Methods: The present study sought to retrospectively investigate in hospital and 1 year post-intervention outcomes of patients with extremely calcified LM lesions after PCI facilitated by calcium-dedicated devices (CdD). Seventy consecutive patients with LM PCI were included. CdD requirement was based on suboptimal results after balloon angioplasty. Results: Twenty-two patients (31.4%) required at least one CdD, while nine patients (12.8%) required at least two. Intravascular lithotripsy and rotational atherectomy were the predominantly used methods(59.1% and 40.9% respectively, for in-group ratios), while ultra-high pressure and scoring balloons contributed the least to lesion preparation (9%). In 20 patients (28.5%), severe or moderate calcifications were angiographically identified, but non-compliant balloon predilation was adequate and CdD were not necessary. Total procedural time was significantly higher in CdD group (p-value 0.02). Procedural and clinical success were obtained in 100% of cases. There were no major adverse cardiac and cerebrovascular events (MACCE) recorded during hospitalization. MACCE at 1 year post-procedure were recorded in three patients (4.2% overall). All three events were documented in the control group (6.2%), and no events were recorded in CdD group (p-value 0.23). There was one cardiac death at 10 months and two target lesion revascularizations for side-branch restenosis. Conclusions: Patients with extremely calcified LM lesions treated by PCI present a favorable prognosis if angioplasty is facilitated by more aggressive lesion debulking using calcium-dedicated devices.

RailTracking: A Novel Technique to Overcome Difficult Anatomy During Transradial Approach.

OBJECTIVE: We aim to investigate the safety and efficacy of a new technique, "RailTracking," in the management of challenging transradial routes during percutaneous coronary interventions (PCI). BACKGROUND: The transradial access (TRA) currently represents the access site of choice in PCI, but complex anatomy could lead to complications and access-site crossover. The assisted-tracking techniques described in the past (such as balloon-assisted tracking and pigtail-assisted tracking) are based on the concept of a "guiding tapered tip" to improve trackability. The RailTracking technique creates a tapered catheter tip using a dedicated device. METHODS: We collected patient data from January 2021 to January 2022 in 2 high-volume centers using the RailTracking technique as a bail-out solution. A prospective analysis of the anatomical characteristics and outcomes of the study population was performed. RESULTS: Seventy-seven patients were included in the study. All patients presented with challenging anatomies; 35.1% of the patients (n = 27) had small radial arteries, 19.5% (n = 15) had significant radial tortuosity, 2.6% (n = 2) had significant brachial tortuosity, 2.6% (n = 2) had subclavian tortuosity, and 1.29% (n = 1) had a critical subclavian lesion. In addition, 38.9% presented with severe radial spasm. The procedural success rate of the RailTracking technique was 98.7% (76/77 patients). The only case of failure presented with calcifications and a critical lesion in the subclavian artery. However, no periprocedural vascular complications occurred. This new technique appears safe, with a radial artery occlusion rate of 3.89% (n = 3) at 1-month follow-up. CONCLUSION: The new RailTracking technique improves catheter crossing in challenging anatomies and seems safe and effective in cases of failure with currently available approaches.