ABSTRACT
Abstract Introduction: The current standard treatment for bifurcation lesions is the provisional stent technique, by implanting only one stent in the main branch; however, in certain cases, the use of more complex techniques that require double stenting should be considered. Objective: To perform a clinical and angiographic assessment of patients with true bifurcation lesions treated with the two-stent culotte technique. Materials and methods: A prospective study was done, which included patients diagnosed with significant obstructive coronary artery disease in bifurcation areas, who were candidates for angioplasty with culotte technique. The study included 44 patients with proved diagnosis of coronary bifurcation lesions; 66% of the treated bifurcation lesions compromised the anterior descending artery and the diagonal branch and 27%, the circumflex artery with the marginal branch. It was found that 68% of the cases had Medina 1,1,1 lesions and 23% had Medina 0,1,1 lesions. Six months later, it was found that 12.5% of the patients followed up by angiography had in-stent restenosis (ISR) > 50% that involved at least one of the bifurcation areas. In 9% of these patients, the ISR was at the origin of the side branch only, and in 3%, the ISR was confined to the distal segment of the main branch stent. Conclusion: The use of the culotte technique with two new-generation stents to treat complex coronary bifurcation lesions is an effective option and does not increase the risk of complications during the procedure nor the risk of the appearance of ISR.
Resumen Introducción: El tratamiento estándar actual para las lesiones en bifurcaciones es la técnica de stent provisional, implantando solo un stent en la rama principal, sin embargo, en ciertos casos, se debería considerar el uso de técnicas más complejas que requieren de doble stent. Objetivo: Realizar una evaluación clínica y angiográfica de pacientes con verdaderas lesiones en bifurcaciones tratados con la técnica culotte de doble stent. Material y métodos: Se realizó un estudio prospectivo que incluyó pacientes diagnosticados con enfermedad obstructiva significativa de arterias coronarias en bifurcaciones, quienes eran candidatos a angioplastia con la técnica culotte. El estudio incluyó 44 pacientes con un diagnóstico comprobado de lesiones coronarias en bifurcaciones; el 66% de las lesiones en bifurcaciones tratadas comprometían la arteria descendente anterior y la rama diagonal, y el 27% la arteria circunfleja con la rama marginal. Se encontró que el 68% de los casos tenían lesiones Medina 1,1,1 y el 23% tenían lesiones Medina 0,1,1. A los seis meses, se encontró que el 12,5% de los pacientes en seguimiento con angiografía presentaban reestenosis intrastent (RIS) mayor al 50%, que comprometía al menos una de las áreas de bifurcación. En el 9% de estos pacientes, la RIS se ubicaba únicamente en el origen de la rama lateral, y en el 3%, la RIS se restringió al segmento distal del stent de la rama principal. Conclusiones: El uso de la técnica culotte empleando dos stents de nueva generación es una opción efectiva para tratar las lesiones complejas en bifurcaciones coronarias, y no aumenta el riesgo de complicaciones durante el procedimiento ni el riesgo de la aparición de reestenosis intrastent.
ABSTRACT
Objective To report our first clinical experience with a novel modified culotte technique for the treatment of true coronary bifurcation lesions. Methods The novel modified culotte technique (the mono-ring culotte) stenting was done in which the side branch (SB) stent was deployed firstly followed by ex vivo wiring of a most proximal cell of SB stent with the hard end of main branch (MB) wire. Secondly, the MB stent was deployed through the most proximal cell of SB stent. The procedure was ended with kissing balloon dilation. From June 2014 to March 2015, 15 patients with true coronary bifurcation lesion were treated with mono-ring culotte stenting in our center. Results The procedures were successful in all cases without procedural complication and in-hospital major adverse cardiovascular events. The procedural time was (34. 3 ± 9. 6) min, fluoroscopic time was (18. 1 ± 3. 8) min, and contrast volume was (112. 0 ± 24. 5) ml, respectively. Post-procedurally, the residual stenosis of the main and the side branch were (10. 0 ± 2. 5)% and (10. 2 ± 5. 3)% , respectively. Conclusions The mono-ring culotte stenting is safe and feasible for treatment of true coronary bifurcation lesions, and may be superior to the conventional culotte stenting.
ABSTRACT
Objective To investigate the differences of various two-stent techniques in vitro and virtual bench testing. Methods Stent implantation with classic crush, double kissing ( DK) crush and culotte stenting techniques were performed in the silicone simulation model of bifurcation vessels with various distal bifurcation angles. The whole processes were recorded by a micro-focus camera. Results Distal side branch (SB) re-crossing in classical crush technique left a significant gap without stent coverage near the carina in T type bifurcation model after final kissing balloon inflation (FKBI) . The gap was also noted in either classic crush with proximal SB re-crossing or DK crush with two times proximal SB re-crossing in T type bifurcation model. The size of the gap in DK crush technique was smaller than that of classic crush. In Y type bifurcation model, both DK crush and culotte stenting left no gap compared to T type bifurcation model. Two times proximal SB re-crossing in culotte stenting resulted in a new stent carina formation after FKBI. Conclusions Distal bifurcation angle was an anatomatic predictor of gap formation in two-stent technique. In T type bifurcation model, the size of gap in DK crush technique was smaller than that of classic crush. It was suggested to perform two times proximal SB re-crossing for DK crush technique and distal SB re-crossing for culotte stenting.