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Modified culotte stenting for treatment of complex coronary bifurcation lesions: immediate and 9-month outcomes in a
Liang-long Chen1, Lin Fan, Zhao-yang Chen
1Department of Cardiology, Union Hospital, Fujian Medical University, Fujian Institute of Coronary Artery Disease, Fuzhou, Fujian 350001, China. lianglongchen@126.com
Insights
Modified culotte stenting (MCS) offers a safe and effective approach for treating coronary bifurcation lesions (CBLs). This drug-eluting stent strategy demonstrated high success rates and favorable 9-month outcomes in a recent study.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Optimal stenting strategies for coronary bifurcation lesions (CBLs) remain an area of active investigation.
- The modified culotte stenting (MCS) technique is a potential approach for complex CBL interventions.
Purpose of the Study:
- To evaluate the technical feasibility, reliability, and 9-month clinical and angiographic outcomes of modified culotte stenting (MCS) for coronary bifurcation lesions (CBLs) using drug-eluting stents.
Main Methods:
- A prospective study included 34 consecutive patients with CBLs requiring stenting of the parent vessel (PV), main branch (MB), and side branch (SB).
- All patients initially underwent MCS, with the option to switch to double-kissing-crush stenting (DKS) if acute branch occlusion occurred.
Main Results:
- Immediate procedural success was high (97% for MCS, 100% per protocol) with 100% successful final balloon kissing.
- Nine-month clinical success was 94%, with only two patients experiencing angina recurrence without needing target lesion revascularization.
- Angiographic follow-up showed infrequent in-stent or in-segment binary stenosis and acceptable late lumen loss.
Conclusions:
- Modified culotte stenting (MCS) is technically feasible, safe, and effective for treating complex coronary bifurcation lesions (CBLs) requiring dual-stent implantation.
- The technique facilitates final balloon kissing and is associated with high immediate success and favorable 9-month clinical and angiographic outcomes.
Background:
The optimal stenting strategy for the treatment of coronary bifurcation lesions (CBLs) remains uncertain. The present study observed technical feasibility and reliability, 9-month clinical and angiographic outcomes of the modified culotte stenting (MCS) in the treatment of CBLs with drug-eluting stents.
Methods:
A total of 34 consecutive patients with CBLs that required stenting the parent vessel (PV), the main branch (MB) and the side branch (SB) were included. All patients were first assigned to receive MCS for CBL interventions (per MCS), and might be switched to receive the double-kissing-crush stenting (DKS) in case of temporally acute branch occlusion (per protocol).
Results:
The immediate angiographic or procedural success was achieved in 33/34 (97%) lesions (patients) per MCS, 34/34 (100%) lesions (patients) per protocol with 100% successful final balloon kissing. The long-term clinical success at 9 months was 94% per MCS and 94% per protocol, only 2 patients had reoccurrence of angina but none of them needed target lesion revascularization. There were no procedure-related biomarker elevation, no in-stent thrombosis peri-procedurally and at 9-month follow-up. Quantitative coronary angiography data at 9 months showed that in-stent (6%) or in-segment (6%) binary stenosis was infrequent, and minimal lumen diameter was significantly reduced but late lumen loss was acceptable with only (0.10 ± 0.14) mm for PV, (0.21 ± 0.23) mm for MB and (0.27 ± 0.32) mm for SB.
Conclusions:
MCS for treatment of CBLs that required dual-stent implantation was technically easier and safer, readily to complete final balloon kissing, and was associated with high immediate success and optimal 9-month outcomes.
