The Cone Flare Crush Modified-T (CFCT) stenting technique for coronary artery bifurcation lesions. (October 2020)

• Record Type: Journal Article
• Authors: Peverill, William T.; Incani, Alexander; Worthley, Stephen G.; Singbal, Yash; Garrahy, Paul J.; McCann, Andrew B.; Cox, Stephen V.; Moore, Peter T.; Lim, Richard Y.Y.; Fetahovic, Taufik; Connors, Gerard W.; Hall, Cindy; Sieg, Charmaine; Camuglia, Anthony C.
• Is Part Of: IJC heart & vasculature. Volume 30(2021)
• Publication Date: 2020-10
• Subjects: Percutaneous Coronary Intervention (PCI) -- Stenting technique (STEC) -- Drug Eluting Stent (DES); ACS Acute coronary syndrome -- ACT Activated clotting time -- AHA American Heart Association -- ARC Academic Research Consortium -- BARC British Academic Research Consortium -- CABG Coronary artery bypass grafting -- CCS Canadian Cardiovascular Society -- CFCT Cone Flare Crush Modified-T -- CFI Cone Flare Inflation -- DAPT Dual antiplatelet therapy -- DES Drug Eluting Stent -- DMV Distal main vessel -- DSE Dobutamine stress echocardiography -- ESE Exercise stress echocardiography -- ISKB Intermediary simultaneous kissing balloon -- ISR In stent restenosis -- LAD Left anterior descending artery -- LCx Left circumflex artery -- LMCA Left main coronary artery -- MACCE Major adverse cardiac and cerebrovascular event -- MI Myocardial infarct -- MRA Mechanical rotational atherectomy -- MV Main Vessel -- NSTEMI Non-ST elevation Myocardial Infarction -- NYHA New York heart association -- OCT Optical coherence tomography -- PCI Percutaneous Coronary Intervention -- PMV Proximal main vessel -- POT Proximal Optimisation Technique -- PUKBI Penultimate kissing balloon inflation -- QCA Quantitative Coronary Angiography -- RBP Rated Burst Pressure -- SB Side Branch -- SEM Standard Error of the mean -- ST Stent thrombosis -- STEMI ST elevation Myocardial Infarction -- SYNTAX Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery -- TLR Target Lesion Revascularisation -- TVR Target Vessel Revascularisation -- UAP Unstable angina pectoris; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2020.100643
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Background: The present study is a prospective observational single arm clinical investigation, with parallel bench test interrogation, aimed at investigating the technical feasibility, safety and clinical outcomes with the cone flare crush modified-T (CFCT) bifurcation stenting technique. Bifurcation percutaneous coronary intervention (PCI) remains an area of ongoing procedural evolution. More widely applicable and reproducible techniques are required. Methods: From April 2018 until March 2019, 20 consecutive patients underwent bifurcation PCI using the CFCT technique with a Pt-Cr everolimus drug-eluting stent with a bioresorbable polymer. Exercise stress echocardiography was performed at 12-month follow-up. The primary outcome was a composite of cardiac related mortality, myocardial infarction, target lesion/vessel revascularization and stroke. Safety secondary endpoints included bleeding, all-cause mortality and stent thrombosis. Results: All patients underwent a successful CFCT bifurcation procedure with no complications to 30-day follow-up. One patient met the primary endpoint requiring target lesion revascularization at 9 months for stable angina. There were no other primary or secondary outcome events in the cohort. There were no strokes, deaths, stent thrombosis or myocardial infarction during the follow-up period. The mean CCS score improved from 2.25 to 0.25 (p < 0.0001). Optical coherence tomography (OCT) and bench test findings indicated optimal side branch ostial coverage and minimal redundant strut material crowding the neo-carina. Conclusions: The CFCT technique appears to be a safe, efficacious and feasible strategy for managing coronary artery bifurcation disease. Expanded and randomized datasets with longer term follow-up are required to further explore confirm this feasibility data. (ANZCTR ID: ACTRN12618001145291).