The use of self-expanding stents in coronary bifurcations and beyond: a paradigm revisited

Conventional tubular balloon expandable (BE) stent designs are poorly suited to coronary bifurcations, yielding highly variable results. For this reason, intense interest remains and industry development continues for dedicated bifurcation coronary stents to make treatment of such lesions more straightforward. Innovative designs have emerged, some balloon expandable, but also self-expandable, based on the premise that nitinol based designs may conform more favourably than other metals to non-tubular vascular structures such as bifurcations. Through discussion of one of the early implantations of the first of these new age self-expanding designs, the Devax coronary bifurcation system, we outline the state-of-the-art use of self-expanding designs in percutaneous intervention to coronary bifurcations, and revisit an old paradigm with contemporary applications. The Devax system was the first of a new generation of self-expanding coronary stents after a more than 15 year lull in their development and was also the first dedicated drug eluting stent (DES) for bifurcations. It was first used in man in 2003. Other self-expanding designs have followed and shown promise in this setting, including Stentys and the Capella Sideguard. New indications have also emerged, including small vessels, addressed by the Cardiomind Sparrow and soft, unstable lesions, treated by the vProtect luminal shield. Of note, all the novel devices presented have a relative paucity of clinical data with no randomised clinical trials to date, but--if the contemporary results continue to be favourable--their indications may become more widespread in the future of coronary intervention.