Background and Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men. Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents.We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups. Conclusions In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.

Background and Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men. Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents.We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups. Conclusions In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.

Background and Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men. Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents.We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups. Conclusions In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.

Background and Objectives: The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men. Methods: COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents.We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups. Conclusions In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.

Background: : A torn plantar plate (PP) is important pathologic anatomy related to a dislocated or subluxated metatarsophalangeal joint (MTPJ). Traditionally, a torn PP was treated with Weil osteotomy through a dorsal approach. However, because of the limited visualization of the dorsal approach, PP repair through a plantar approach has been proposed as a new technique. This study aimed to radiologically evaluate the outcome of PP repair through the plantar approach using an improved MTPJ overlap distance (MOD) on an anteroposterior view and the degree of subluxation on an oblique view. We also aimed to investigate the potential factors affecting the recurrence of MTPJ instability. Methods: In this study, we included 31 patients who had a subluxated or dislocated MTPJ of the second or third toe and underwent surgical PP repair. PP repair was performed via a plantar approach after shortening metatarsal (MT) osteotomy with a dorsal approach for longer MT bone. We assessed the severity of MTPJ subluxation by measuring the MOD and subluxation subtype on radiographs. Radiologic recurrence was defined as an increase in MOD or change from subluxation type A to subluxation type B.The relationship of recurrence with clinical and radiologic factors was evaluated by comparing the recurred group against the nonrecurred group. Results: Shortening MT osteotomy was performed in 26 of 31 cases (84%). Repeated measures analysis of variance comparing preoperation, pin removal, and the latest follow-up MOD values revealed the effectiveness of PP repair through the plantar approach (p < 0.001). The MOD did not significantly change after pin removal and the latest follow-up (p = 0.130), indicating that reduction was well maintained. None of the clinical and radiologic factors were significantly related to recurrence. However, 3 of 12 rheumatoid arthritis (RA) feet (25%) recurred and 3 of 5 recurred cases (60%) were RA feet. This result suggests that RA indicated a tendency for recurrence. Conclusions PP repair through the plantar approach has the advantage of excellent visualization of a torn PP and direct repair.We, therefore, recommend using the plantar approach for PP repair of the MTPJ.

Background: : A torn plantar plate (PP) is important pathologic anatomy related to a dislocated or subluxated metatarsophalangeal joint (MTPJ). Traditionally, a torn PP was treated with Weil osteotomy through a dorsal approach. However, because of the limited visualization of the dorsal approach, PP repair through a plantar approach has been proposed as a new technique. This study aimed to radiologically evaluate the outcome of PP repair through the plantar approach using an improved MTPJ overlap distance (MOD) on an anteroposterior view and the degree of subluxation on an oblique view. We also aimed to investigate the potential factors affecting the recurrence of MTPJ instability. Methods: In this study, we included 31 patients who had a subluxated or dislocated MTPJ of the second or third toe and underwent surgical PP repair. PP repair was performed via a plantar approach after shortening metatarsal (MT) osteotomy with a dorsal approach for longer MT bone. We assessed the severity of MTPJ subluxation by measuring the MOD and subluxation subtype on radiographs. Radiologic recurrence was defined as an increase in MOD or change from subluxation type A to subluxation type B.The relationship of recurrence with clinical and radiologic factors was evaluated by comparing the recurred group against the nonrecurred group. Results: Shortening MT osteotomy was performed in 26 of 31 cases (84%). Repeated measures analysis of variance comparing preoperation, pin removal, and the latest follow-up MOD values revealed the effectiveness of PP repair through the plantar approach (p < 0.001). The MOD did not significantly change after pin removal and the latest follow-up (p = 0.130), indicating that reduction was well maintained. None of the clinical and radiologic factors were significantly related to recurrence. However, 3 of 12 rheumatoid arthritis (RA) feet (25%) recurred and 3 of 5 recurred cases (60%) were RA feet. This result suggests that RA indicated a tendency for recurrence. Conclusions PP repair through the plantar approach has the advantage of excellent visualization of a torn PP and direct repair.We, therefore, recommend using the plantar approach for PP repair of the MTPJ.

Background: : A torn plantar plate (PP) is important pathologic anatomy related to a dislocated or subluxated metatarsophalangeal joint (MTPJ). Traditionally, a torn PP was treated with Weil osteotomy through a dorsal approach. However, because of the limited visualization of the dorsal approach, PP repair through a plantar approach has been proposed as a new technique. This study aimed to radiologically evaluate the outcome of PP repair through the plantar approach using an improved MTPJ overlap distance (MOD) on an anteroposterior view and the degree of subluxation on an oblique view. We also aimed to investigate the potential factors affecting the recurrence of MTPJ instability. Methods: In this study, we included 31 patients who had a subluxated or dislocated MTPJ of the second or third toe and underwent surgical PP repair. PP repair was performed via a plantar approach after shortening metatarsal (MT) osteotomy with a dorsal approach for longer MT bone. We assessed the severity of MTPJ subluxation by measuring the MOD and subluxation subtype on radiographs. Radiologic recurrence was defined as an increase in MOD or change from subluxation type A to subluxation type B.The relationship of recurrence with clinical and radiologic factors was evaluated by comparing the recurred group against the nonrecurred group. Results: Shortening MT osteotomy was performed in 26 of 31 cases (84%). Repeated measures analysis of variance comparing preoperation, pin removal, and the latest follow-up MOD values revealed the effectiveness of PP repair through the plantar approach (p < 0.001). The MOD did not significantly change after pin removal and the latest follow-up (p = 0.130), indicating that reduction was well maintained. None of the clinical and radiologic factors were significantly related to recurrence. However, 3 of 12 rheumatoid arthritis (RA) feet (25%) recurred and 3 of 5 recurred cases (60%) were RA feet. This result suggests that RA indicated a tendency for recurrence. Conclusions PP repair through the plantar approach has the advantage of excellent visualization of a torn PP and direct repair.We, therefore, recommend using the plantar approach for PP repair of the MTPJ.

Background: : A torn plantar plate (PP) is important pathologic anatomy related to a dislocated or subluxated metatarsophalangeal joint (MTPJ). Traditionally, a torn PP was treated with Weil osteotomy through a dorsal approach. However, because of the limited visualization of the dorsal approach, PP repair through a plantar approach has been proposed as a new technique. This study aimed to radiologically evaluate the outcome of PP repair through the plantar approach using an improved MTPJ overlap distance (MOD) on an anteroposterior view and the degree of subluxation on an oblique view. We also aimed to investigate the potential factors affecting the recurrence of MTPJ instability. Methods: In this study, we included 31 patients who had a subluxated or dislocated MTPJ of the second or third toe and underwent surgical PP repair. PP repair was performed via a plantar approach after shortening metatarsal (MT) osteotomy with a dorsal approach for longer MT bone. We assessed the severity of MTPJ subluxation by measuring the MOD and subluxation subtype on radiographs. Radiologic recurrence was defined as an increase in MOD or change from subluxation type A to subluxation type B.The relationship of recurrence with clinical and radiologic factors was evaluated by comparing the recurred group against the nonrecurred group. Results: Shortening MT osteotomy was performed in 26 of 31 cases (84%). Repeated measures analysis of variance comparing preoperation, pin removal, and the latest follow-up MOD values revealed the effectiveness of PP repair through the plantar approach (p < 0.001). The MOD did not significantly change after pin removal and the latest follow-up (p = 0.130), indicating that reduction was well maintained. None of the clinical and radiologic factors were significantly related to recurrence. However, 3 of 12 rheumatoid arthritis (RA) feet (25%) recurred and 3 of 5 recurred cases (60%) were RA feet. This result suggests that RA indicated a tendency for recurrence. Conclusions PP repair through the plantar approach has the advantage of excellent visualization of a torn PP and direct repair.We, therefore, recommend using the plantar approach for PP repair of the MTPJ.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder that frequently causes forefoot deformities. Arthrodesis of the first metatarsophalangeal joint is a common surgery for severe hallux valgus. However, joint-preserving surgery can maintain the mobility of the joint. This study aimed to investigate the clinical and radiographic outcomes of distal chevron metatarsal osteotomy (DCMO) for correcting hallux valgus deformity associated with RA. Methods: Between August 2000 and December 2018, 18 consecutive patients with rheumatoid forefoot deformities (24 feet) underwent DCMO for hallux valgus with/without lesser toe surgery. Radiological evaluations were conducted, assessing the hallux valgus angle, the intermetatarsal angle between the first and second metatarsals, and the Sharp/van der Heijde score for erosion and joint space narrowing. Clinical outcomes were quantified using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society forefoot scores to measure function and alignment. Results: The mean hallux valgus angle decreased from 38.0° (range, 25°–65°) preoperatively to 3.5° (range, 0°–17°) at the final follow-up (p < 0.05). The mean intermetatarsal angle decreased from 14.9° (range, 5°–22°) preoperatively to 4.3° (range, 2°–11°) at the final follow-up. (p < 0.05). Regarding the Sharp/van der Heijde score, the mean erosion score (0–10) showed no significant change, decreasing from 3.83 (range, 0–6) preoperatively to 3.54 (range, 0–4) at the final follow-up (p = 0.12). Recurrent hallux valgus was observed in 1 patient and postoperative hallux varus deformity was observed in 2 feet. Spontaneous fusion of the metatarsophalangeal joint developed in 1 case. Conclusions DCMO resulted in satisfactory clinical and radiographic outcomes for correcting RA-associated hallux valgus deformity.

Background: The benefits of transradial access (TRA) over transfemoral access (TFA) for bifurcation percutaneous coronary intervention (PCI) are uncertain because of the limited availability of device selection. This study aimed to compare the procedural differences and the in-hospital and long-term outcomes of TRA and TFA for bifurcation PCI using secondgeneration drug-eluting stents (DESs). Methods: Based on data from the Coronary Bifurcation Stenting Registry III, a retrospective registry of 2,648 patients undergoing bifurcation PCI with second-generation DES from 21 centers in South Korea, patients were categorized into the TRA group (n = 1,507) or the TFA group (n = 1,141). After propensity score matching (PSM), procedural differences, in-hospital outcomes, and device-oriented composite outcomes (DOCOs; a composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization) were compared between the two groups (772 matched patients each group). Results: Despite well-balanced baseline clinical and lesion characteristics after PSM, the use of the two-stent strategy (14.2% vs. 23.7%, P = 0.001) and the incidence of in-hospital adverse outcomes, primarily driven by access site complications (2.2% vs. 4.4%, P = 0.015), were significantly lower in the TRA group than in the TFA group. At the 5-year follow-up, the incidence of DOCOs was similar between the groups (6.3% vs. 7.1%, P = 0.639). Conclusion The findings suggested that TRA may be safer than TFA for bifurcation PCI using second-generation DESs. Despite differences in treatment strategy, TRA was associated with similar long-term clinical outcomes as those of TFA. Therefore, TRA might be the preferred access for bifurcation PCI using second-generation DES.