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Official Journal of the Italian Society of Angiology and Vascular Pathology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,752
Online ISSN 1827-1618
Lucisano L., Calcagno S., Pennacchi M., Stio R. E., Mancone M., Sardella G.
Department of Cardiovascular Respiratory, Nephrologic Anesthesiologic and Geriatric Sciences Umberto I Hospital “Sapienza” University, Rome, Italy
Since the advent of coronary angioplasty the treatment of bifurcation lesions has always proved a complex issue resulting in lower angiographic success rates, increased risk of restenosis, higher rates of dissection, myocardial infarction, and acute vessel closure. The advent of coronary stenting reduced the risks, but in-stent restenosis was noted to be frequent at the ostium of the side branch; for this reasons two-stent techniques were developed to try to combat this phenomenon. Novel dedicated stents have recently been developed to provide easier access to the SB and to scaffold more effectively its ostium, matching the stent configuration more closely to the anatomy of the bifurcation. Most of bifurcation lesions that require treatment and which have a wide angle involving the left main coronary artery (LMCA). The impact of the angle and the asymmetry of bifurcation on flow dynamic are very important and may influence clinical outcome. More recently, percutaneous coronary intervention (PCI) to treat wide angle disease has increased in frequency, and is associated with improvements in interventional techniques and adjunctive drug therapy. Several studies have shown that stenting in LMCA, especially using drug-eluting stents (DES), is a safe and effective treatment strategy both at mid- and long-term follow-up. The AXXESS System is a self-expanding, conically-shaped stent from nitinol (nickel-titanium alloy) with strut thickness, specifically designed to conform to the anatomy at the level of the bifurcation carina. A special version of the AXXESS System has been designed for left main bifurcation lesions, allowing for larger diameters (up to 4.75 mm) and distinct bifurcation angles (flare-end diameters of 8, 10 and 12 mm). The AXXENT trial is the first study to evaluate the vascular response of the self-expanding biolimus-eluting AXXESS stent for the treatment of LMCA bifurcation lesions. It was designed to evaluate the safety and efficacy of the AXXESS biolimus-eluting stent for the treatment of LMCA bifurcation lesions, that showed good results in terms of stent thrombosis and TLR at 6 months follow-up. Technical modifications and stent innovations may further improve both the angiographic and clinical outcomes for patients with wide angle bifurcation disease treated by PCI. Moreover a long term follow-up is needful to demonstrate better safety and efficacy of these new dedicated bifurcation devices.