Premium
Complex coronary bifurcation treatment by a novel stenting technique: Bench test, fluid dynamic study and clinical outcomes
Author(s) -
Rigatelli Gianluca,
Zuin Marco,
Dell'Avvocata Fabio,
Vassilev Dobrin,
Daggubati Ramesh,
Nguyen Thach,
Nguyễn Minh Trí Nhân,
Foin Nicolas
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27494
Subject(s) - medicine , intravascular ultrasound , cardiology , ostium , stent , percutaneous , percutaneous coronary intervention , revascularization , radiology , surgery , myocardial infarction
Abstract Objectives We assess the mid‐term outcomes of ultrathin biodegradable polymer double stenting using a very minimal crushing (Nano‐Crush) technique in large complex coronary bifurcation. Background Complex bifurcations have been suggested to be better approached by a planned double stent technique. Methods Two hundred and five consecutive patients (107 males and 98 females) referred for large complex coronary bifurcation percutaneous coronary interventions were enrolled. The technique was also evaluated by both a bench test with a silicon tubes phantom resembling a coronary bifurcation and a computed fluid dynamic (CFD) analysis. Results Left main bifurcation accounted for 40.9% of cases (84 patients). Mean angles between main branch (MB) and side branch (SB) were 63.6 ± 21.3°. SB intravascular ultrasound‐calculated MSA was 5.6 ± 1.5 mm 2 . Clinical follow‐up was available for 100% of patients and at a mean follow‐up of 16.2 ± 6.7 months 8 deaths, all due to cardiovascular reason, (3.9%, 4 patients for stroke, two for heart failure, one after surgical aortic valve substitution, and one after acute massive pulmonary embolism) and no presumptive stent thrombosis or target vessel induced ischemia were observed. Angiographic follow‐up was available in 108 patients (52.7%) and showed a very low significant restenosis (5 patients, 4.6%). Bench study and CFD evaluation suggested a complete coverage of the SB ostium with a very high strut‐free area at the SB. Conclusions The revascularization of complex large coronary bifurcation disease using the Nano‐crush technique appeared promising thanks to the favorable fluid dynamic profile, complete coverage of the SD ostium, and very small metal amount at the carina.