Procedural and early clinical outcomes of patients with de novo coronary bifurcation lesions treated with the novel Nile PAX dedicated bifurcation polymer-free paclitaxel coated stents: results from the prospective, multicentre, non-randomised BIPAX clinical trial.

AIMS: To demonstrate the acute and early outcomes of the novel Nile PAX dedicated polymer-free paclitaxel-coated stents (Minvasys SAS, Gennevilliers, France) in the treatment of de novo coronary bifurcation lesions. METHODS AND RESULTS: The Nile PAX device incorporates a cobalt-chromium alloy with a side aperture in the mid-stent designed to optimise scaffold at the bifurcation carina and side branch (SB) ostium, while maintaining SB access during procedure. From December 2008 to February 2010, 101 patients were prospectively enrolled in a non-randomised, multicentre study. Lesion criteria were: vessel size 2.5-3.5 mm in the parent vessel (PV) and 2.0-3.0 mm in the SB, and lesion length <14 mm in the PV, and <5 mm in the SB. Mean age was 63 years, 29% had diabetes, LAD/Dg was involved in 80.4%, and 61.7% had significant involvement of both branches. The study stent was successfully attempted and implanted in 98%. SB received additional stent in 26% final kissing-balloon inflation was performed in 93% and lesion (angiographic) success was achieved in 98%. There was only one non-Q myocardial infarction during hospitalisation, and no additional events up to 30 days. CONCLUSIONS: Preliminary results of the prospective, non-randomised, multicentre BIPAX clinical trial demonstrated encouraging results with the novel Nile PAX bifurcation DES in the treatment of coronary bifurcation lesions, including high device and procedural success. Overall, there was only one major adverse cardiac event during hospitalisation, with no additional events up to 30 days follow-up. Long-term follow-up is warranted.

Procedural and early clinical outcomes of patients withde novo coronary bifurcation lesions treated with the novelNile PAX dedicated bifurcation polymer-free paclitaxelcoated stents: results from the prospective, multicentre,non-randomised BIPAX clinical trial

Aims: To demonstrate the acute and early outcomes of the novel Nile PAX dedicated polymer-free paclitaxelcoatedstents (Minvasys SAS, Gennevilliers, France) in the treatment of de novo coronary bifurcation lesions.Methods and results: The Nile PAX device incorporates a cobalt-chromium alloy with a side aperture inthe mid-stent designed to optimise scaffold at the bifurcation carina and side branch (SB) ostium, while maintainingSB access during procedure. From December 2008 to February 2010, 101 patients were prospectivelyenrolled in a non-randomised, multicentre study. Lesion criteria were: vessel size 2.5-3.5 mm in the parentvessel (PV) and 2.0-3.0 mm in the SB, and lesion length <14 mm in the PV, and <5 mm in the SB. Mean agewas 63 years, 29% had diabetes, LAD/Dg was involved in 80.4%, and 61.7% had significant involvement ofboth branches. The study stent was successfully attempted and implanted in 98%. SB received additionalstent in 26%; final kissing-balloon inflation was performed in 93%; and lesion (angiographic) success wasachieved in 98%. There was only one non-Q myocardial infarction during hospitalisation, and no additionalevents up to 30 days.Conclusions: Preliminary results of the prospective, non-randomised, multicentre BIPAX clinical trial demonstratedencouraging results with the novel Nile PAX bifurcation DES in the treatment of coronary bifurcationlesions, including high device and procedural success. Overall, there was only one major adverse cardiac eventduring hospitalisation, with no additional events up to 30 days follow-up. Long-term follow-up is warranted.

Integration of 3D reconstruction in the SELection criteria for Excessive Crossing Times for Magnetically Supported Percutaneous Coronary Intervention. SELECT-MP.

AIMS: To develop a clinical prediction rule based on 3D reconstruction of coronary arteries that would prospectively identify lesions that are difficult to cross and could benefit from magnetic navigation. METHODS AND RESULTS: The coronary anatomy of a cohort of 120 lesions that had undergone percutaneous coronary intervention (derivation set) was analysed using 3D reconstruction for vessel and lesion characteristics. The crossing time was the total clock time to reach a satisfactory distal position after leaving the guiding catheter. Multivariable logistic regression and linear shrinkage with bootstrapping were used to develop a clinical prediction rule that dichotomised cases into easy or difficult (prolonged crossing time). A value of 6 was the best cut-off value. This clinical prediction rule was applied to a second independent cohort of patients (validation set) where crossing time was measured. The bootstrapped c-statistic of the model was 0.82 indicating excellent discrimination. CONCLUSIONS: 3D reconstruction helped to develop a simple, accurate clinical prediction rule to identify difficult cases for conventional wires and in whom magnetic navigation may be preferable.

First direct in vivo comparison of two commercially available three-dimensional quantitative coronary angiography systems.

AIM: The in vivo comparison of the accuracy of two 3-dimensional quantitative coronary angiography (QCA) systems. METHODS: Precision-drilled plexiglass phantoms with five different luminal diameters (0.5-1.9 mm) were percutaneously inserted into the coronary arteries of four Yorkshire pigs. Twenty-one angiographic images of these stenotic phantoms were acquired for in vivo validation testing. Quantitative assessments of the minimum, maximum, and mean luminal diameters together with the minimum luminal area were determined using two 3D QCA systems, the CardiOp-B and CAAS 5. RESULTS: The CardiOp-B system significantly underestimated the minimum luminal diameter MLD whilst both systems significantly overestimated the maximum luminal diameter at the minimal luminal area (MLA) over the phantom's true value. The CAAS 5 system had a greater degree of accuracy/mm (mean difference = 0.01 vs. 0.03) and precision/mm (SD = 0.09 vs. 0.23) than the CardiOp-B in assessing the minimal LD. An increased precision/mm (SD = 0.01 vs. 0.29) and accuracy/mm (mean difference = 0.03 vs. 0.11) in the mean LD was observed with the CAAS 5. In comparing the MLA/mm(2) the CAAS 5 was more precise/mm(2) (SD = 0.14 vs. 0.55) and accurate/mm(2) (mean difference = 0.12 vs. 0.02) to the true phantom MLA compared to the CardiOp-B system. CONCLUSIONS: In a 21 phantom study, the CAAS 5 3D QCA system had a greater degree of accuracy and precision in both the luminal and area measurements than the CardiOp-B 3D QCA system.