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Subintimal shift as mechanism for side-branch occlusion in percutaneous treatment of chronic total occlusions with bifurcation lesions
BACKGROUND: The aim of this study was to describe the mechanism of subintimal shift (SIS), standardise diagnostic criteria and sensitise the interventional community to this phenomenon. The treatment of chronic total occlusions (CTO) by means of percutaneous coronary intervention (PCI) is complicate...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Via Medica
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987534/ https://www.ncbi.nlm.nih.gov/pubmed/34231874 http://dx.doi.org/10.5603/CJ.a2021.0079 |
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author | Gutiérrez-Chico, Juan Luis Cortés, Carlos Ayoub, Mohamed Lauer, Bernward Otto, Sylvia Reisbeck, Bernd Reisbeck, Manuela Schulze, Christian Mashayekhi, Kambis |
author_facet | Gutiérrez-Chico, Juan Luis Cortés, Carlos Ayoub, Mohamed Lauer, Bernward Otto, Sylvia Reisbeck, Bernd Reisbeck, Manuela Schulze, Christian Mashayekhi, Kambis |
author_sort | Gutiérrez-Chico, Juan Luis |
collection | PubMed |
description | BACKGROUND: The aim of this study was to describe the mechanism of subintimal shift (SIS), standardise diagnostic criteria and sensitise the interventional community to this phenomenon. The treatment of chronic total occlusions (CTO) by means of percutaneous coronary intervention (PCI) is complicated by bifurcation lesions involved in the CTO segment or adjacent to it. Extraplaque expansion of intracoronary devices during CTO PCI may extend the dissection plane over the bifurcation with the consequential side or main branch compression by an intimo-medial flap. This phenomenon is hereby described for the first time and named subintimal shift. METHODS: Experienced CTO operators from 3 international high volume centers for CTO PCI retrospectively searched their personal records for paradigmatic cases of SIS, summarising key features and proposing diagnostic criteria. RESULTS: The series comprised 7 demonstrative cases, illustrating SIS by intravascular imaging (2 cases) or indirect angiographic signs during CTO PCI (5 cases). Five cases were triggered by stent expansion, 1 by balloon inflation and 1 case was aborted after angiographic warning signs. In 4 cases, SIS resulted in total occlusion of a branch, refractory to ballooning whenever attempted. Four cases required bailout intervention and in 2 cases the branch was left occluded, resulting in a rise of cardiac markers. CONCLUSIONS: Subintimal shift is a noteworthy complication in CTO bifurcations, potentially resulting in occlusion of the relevant side or even the main branch. Intracoronary imaging prior to stenting is recommended to understand the tissue planes. Some counterintuitive peculiarities of this phenomenon, like its refractoriness to ballooning, must be known by CTO operators for its efficient resolution. |
format | Online Article Text |
id | pubmed-9987534 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Via Medica |
record_format | MEDLINE/PubMed |
spelling | pubmed-99875342023-03-07 Subintimal shift as mechanism for side-branch occlusion in percutaneous treatment of chronic total occlusions with bifurcation lesions Gutiérrez-Chico, Juan Luis Cortés, Carlos Ayoub, Mohamed Lauer, Bernward Otto, Sylvia Reisbeck, Bernd Reisbeck, Manuela Schulze, Christian Mashayekhi, Kambis Cardiol J Interventional Cardiology BACKGROUND: The aim of this study was to describe the mechanism of subintimal shift (SIS), standardise diagnostic criteria and sensitise the interventional community to this phenomenon. The treatment of chronic total occlusions (CTO) by means of percutaneous coronary intervention (PCI) is complicated by bifurcation lesions involved in the CTO segment or adjacent to it. Extraplaque expansion of intracoronary devices during CTO PCI may extend the dissection plane over the bifurcation with the consequential side or main branch compression by an intimo-medial flap. This phenomenon is hereby described for the first time and named subintimal shift. METHODS: Experienced CTO operators from 3 international high volume centers for CTO PCI retrospectively searched their personal records for paradigmatic cases of SIS, summarising key features and proposing diagnostic criteria. RESULTS: The series comprised 7 demonstrative cases, illustrating SIS by intravascular imaging (2 cases) or indirect angiographic signs during CTO PCI (5 cases). Five cases were triggered by stent expansion, 1 by balloon inflation and 1 case was aborted after angiographic warning signs. In 4 cases, SIS resulted in total occlusion of a branch, refractory to ballooning whenever attempted. Four cases required bailout intervention and in 2 cases the branch was left occluded, resulting in a rise of cardiac markers. CONCLUSIONS: Subintimal shift is a noteworthy complication in CTO bifurcations, potentially resulting in occlusion of the relevant side or even the main branch. Intracoronary imaging prior to stenting is recommended to understand the tissue planes. Some counterintuitive peculiarities of this phenomenon, like its refractoriness to ballooning, must be known by CTO operators for its efficient resolution. Via Medica 2023-02-27 /pmc/articles/PMC9987534/ /pubmed/34231874 http://dx.doi.org/10.5603/CJ.a2021.0079 Text en Copyright © 2023 Via Medica https://creativecommons.org/licenses/by-nc-nd/4.0/This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially |
spellingShingle | Interventional Cardiology Gutiérrez-Chico, Juan Luis Cortés, Carlos Ayoub, Mohamed Lauer, Bernward Otto, Sylvia Reisbeck, Bernd Reisbeck, Manuela Schulze, Christian Mashayekhi, Kambis Subintimal shift as mechanism for side-branch occlusion in percutaneous treatment of chronic total occlusions with bifurcation lesions |
title | Subintimal shift as mechanism for side-branch occlusion in percutaneous treatment of chronic total occlusions with bifurcation lesions |
title_full | Subintimal shift as mechanism for side-branch occlusion in percutaneous treatment of chronic total occlusions with bifurcation lesions |
title_fullStr | Subintimal shift as mechanism for side-branch occlusion in percutaneous treatment of chronic total occlusions with bifurcation lesions |
title_full_unstemmed | Subintimal shift as mechanism for side-branch occlusion in percutaneous treatment of chronic total occlusions with bifurcation lesions |
title_short | Subintimal shift as mechanism for side-branch occlusion in percutaneous treatment of chronic total occlusions with bifurcation lesions |
title_sort | subintimal shift as mechanism for side-branch occlusion in percutaneous treatment of chronic total occlusions with bifurcation lesions |
topic | Interventional Cardiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987534/ https://www.ncbi.nlm.nih.gov/pubmed/34231874 http://dx.doi.org/10.5603/CJ.a2021.0079 |
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