A high risk unstable case of left main bifurcation lesion treated with simultaneous kissing stents as salvage procedure

Bifurcation treatment with percutaneous coronary intervention is still one challenging task especially the left main bifurcation. And it becomes still more challenging when it is done in emergency situation in a very unstable patients. There are many one-stent and two-stent approaches available to treat the bifurcation lesions but no approach has proven superior to other. Here, we present a case of a 78-year-old male diagnosed with distal left main bifurcation lesion treated with simultaneous kissing stents technique presented with acute coronary syndrome, non-ST elevation myocardial infarction with pulmonary oedema in cardiogenic shock.

The Results of Self-Expandable Kissing Stents in Aortic Bifurcation

PURPOSE: Kissing stent reconstruction is a widely used technique for the management of aortoiliac occlusive disease involving the aortic bifurcation or proximal common iliac arteries. The purpose of this study was to evaluate the results of self-expandable kissing stents in the aortic bifurcation. METHODS: We reviewed medical records of the patients treated with a kissing stent retrospectively from January 2007 to December 2012. The primary and secondary patencies were determined with Kaplan-Meier analysis, and Cox regression was used to determine the factors associated with patency. RESULTS: A total of 21 patients were included, and all were male (median age 53+/-15 years, range 48-78 years). Major symptoms were claudication (n=16, 61.9%), rest pain (n=5, 23.8%) and gangrene (n=5, 23.8%). Tans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) II classification was A 2 (9.5%), B 5 (23.8%), C 7 (33.3%) and D 8 (38%). The mean follow-up was 40.7 months. Major complication occurred in only one case which consisted of distal limb ischemia by emboli. Six patients developed symptomatic restenosis or occlusion. There was no major amputation, but minor amputation occurred in 3 patients. There were 2 mortalities not associated with the procedure (lung cancer and intracranial hemorrhage). Primary patency was 89.6% at 1 year, 74.7% at 3 years and 64.0% at 5 years. Secondary patency was 94.1% at 1 year, 88.2% at 3 years and 68.6% at 5 years. No risk factors for restenosis or occlusion were identified. CONCLUSION: Self-expandable kissing stents can be used successfully with comparable patency for endovascular treatment of symptomatic atherosclerotic occlusive lesions in the aortic bifurcation area.

Management of aorto-iliac occlusive disease by kissing-stents technique / 中华普通外科杂志

Objective To evaluate the place of kissing-stents technique in the management of aorto-iliac occlusive disease. Method Clinical data of 15 patients with aorto-iliac occlusive disease treated from Apr 2007 to Apr 2009 in our hospital were retrospectively analyzed. There were 9 males, and 6 females with a mean age of 66 years ( range 45-77 years). All 15 patients had significant symptoms of extremity ischemia. Claudication was complained in 11 (73% ) patients with an average distance of 88 meters. Four (27% ) patients had rest pain, gangrene of the toes was found in 2 patients ( 13% ). There were occlusive aorto- bilateral iliac artery with stenosis at superficial artery in 2 patients, occlusion at bilateral common iliac artery in 3 patients, occlusive disease at left common iliac artery with stenosis at bilateral superficial artery in 2 patients, occlusion at right common iliac artery in 8 patients, with stenosis or occlusion at superficial artery in 4 patients. In these 15 patients ABI was from 0.0 to 0.6, with an average of 0.36 ±0.3. Result Kissing-stents technique was successfully used in all 15 patients. 40 stents was released in bilateral common iliac arteries including 15 self-expanding stents and 25 balloon expandable stents. Residual stenosis was less than 30% and mean pressure gradient was 5 mm Hg. ABI increased from 0. 5 to 1.0 averaging at 0. 8 ±0. 2. The average hospitalization time was 7 days. Primary and secondary patency was 87% and 94% respectively as shown by a follow-up of 2 years. Conclusions Endovascular management of aorto-iliac occlusive disease by Kissing- stents technique is safe and effective and can raise the endovascular operation success rate and lower the complications.