Document Detail


Crush, culotte, T and protrusion: which 2-stent technique for treatment of true bifurcation lesions? - insights from in vitro experiments and micro-computed tomography.
MedLine Citation:
PMID:  23006784     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Percutaneous coronary intervention of complex true bifurcation lesions often fails to ensure continuous stent coverage and strut apposition in both the side branch and main vessel. Struts left unopposed floating in the lumen disturb blood flow and are increasingly recognized as increasing the risk of stent thrombosis.
METHODS AND RESULTS: In this study, we compared the results of different bifurcation treatment strategies: Crush (n=5); Culotte (n=3); T-/T with Protrusion (TAP) (n=4) using drug-eluting stents deployed in-vitro in representative coronary bifurcation models. After final kissing balloon post-dilatation, the rate of malapposition within the bifurcation quantified from micro-computed tomography scanning was on average 41.5 ± 8.2% with the Crush technique, reduced to respectively 31.4 ± 5.2% with Culotte and 36.7 ± 8.0% with T-/TAP approach. Overlaying layers of struts in the Crush and Culotte techniques lead to a significantly higher rate of strut malapposition in the proximal vessel than with the T-/TAP technique (Crush: 39.1 ± 10.7%, Culotte: 26.1 ± 7.7%, TAP: 4.2 ± 7.2%, P<0.01). Maximal wall-malapposed strut distance was also found on average to be higher with the Crush (1.36 ± 0.4mm) and Culotte techniques (1.32 ± 0.1mm) than with T-/TAP (1.08 ± 0.1mm, P=0.04).
CONCLUSIONS: In this model, the Crush technique resulted in a higher risk of malapposition than either the Culotte or T-/TAP technique.
Authors:
Nicolas Foin; Eduardo Alegria-Barrero; Ryo Torii; Pak H Chan; N Viceconte; Justin E Davies; Carlo Di Mario
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2012-09-25
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  77     ISSN:  1347-4820     ISO Abbreviation:  Circ. J.     Publication Date:  2013  
Date Detail:
Created Date:  2013-01-07     Completed Date:  2013-06-13     Revised Date:  2013-07-08    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  73-80     Citation Subset:  IM    
Affiliation:
International Centre for Circulatory Health, NHLI and Imperial College, London. nicolas.foin@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Drug-Eluting Stents*
Humans
Models, Cardiovascular*
Percutaneous Coronary Intervention / adverse effects,  methods*
X-Ray Microtomography*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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