Document Detail


The "crush" technique for coronary artery bifurcation stenting: insights from micro-computed tomographic imaging of bench deployments.
MedLine Citation:
PMID:  19463329     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study provides insights into "crush" coronary bifurcation stenting through imaging of bench deployments.
BACKGROUND: Although the strategy of provisional side-branch stenting is widely accepted for suitable bifurcation lesions, there is no consensus on the best option for elective stenting with 2 stents. The crush technique has the potential to scaffold and apply the drug to the side-branch ostium where restenosis is most common.
METHODS: Sequential steps of crush stent deployment and post-dilation were undertaken in silicone phantoms and recorded on cine angiography and microcomputed tomography. We assessed the effect of deployment strategies, post-dilation strategies, and cell size on side-branch ostial area.
RESULTS: Side-branch ostial coverage by metal struts was 53% (95% confidence interval [CI]: 46 to 59) after 1-step kissing post-dilation and was reduced by 2-step kissing post-dilation to 33% (95% CI: 28 to 37; p < 0.0001). Although the residual stenosis after the classical crush strategy was 47% (95% CI: 39 to 53), it was 36% (95% CI: 31 to 40; p = 0.002) after mini-crush deployment. Stents with larger cell size (>3.5 mm diameter) had a residual stenosis of 37% (95% CI: 32 to 42) after crush deployment that was less than the residual stenosis for stents with smaller cell size (52%; 95% CI: 44 to 60; p < 0.0001).
CONCLUSIONS: Side-branch ostial stenosis after crush stenting was minimized by mini-crush deployment, 2-step kissing post-dilation, and the use of stents with larger cell size. It is unknown if optimizing stent deployment at bifurcation lesions will reduce clinical stent thrombosis and restenosis.
Authors:
John A Ormiston; Mark W I Webster; Bruce Webber; James T Stewart; Peter N Ruygrok; Robert I Hatrick
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  1     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2009-05-25     Completed Date:  2009-06-11     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  351-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon, Coronary / instrumentation*,  methods*
Cineangiography
Coronary Angiography / instrumentation,  methods*
Coronary Vessels / pathology*
Materials Testing
Phantoms, Imaging
Prosthesis Design
Reproducibility of Results
Silicones
Stents*
X-Ray Microtomography* / instrumentation
Chemical
Reg. No./Substance:
0/Silicones

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


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