The utility of stent enhancement to guide percutaneous coronary intervention for bifurcation lesions
Joana D Silva1, Xavier Carrillo, Neus Salvatella
1Cardiovascular Intervention Unit, Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
Insights
StentBoost (StB) enhances fluoroscopic imaging for complex bifurcation percutaneous coronary intervention (PCI). This technique improves stent visualization, aiding in optimal deployment and side branch access during PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous coronary intervention (PCI) of bifurcation lesions presents significant technical challenges.
- Coronary angiography, the current standard, has limitations in guiding complex PCI.
- Novel imaging techniques are needed to improve outcomes in bifurcation PCI.
Purpose of the Study:
- To evaluate the utility of StentBoost (StB), a fluoroscopic imaging technique, for guiding bifurcation PCI.
- To assess the role of StB in visualizing stent deployment and facilitating complex PCI procedures.
Main Methods:
- A prospective study involving 97 patients undergoing bifurcation PCI (98 bifurcations) utilizing StentBoost.
- Classification of bifurcation lesions using the modified Medina classification.
- Assessment of StB image quality categorized as optimal, suboptimal, or poor visualization.
Main Results:
- StentBoost provided good image quality in 79.6% of cases, enabling clear visualization of stents and guidewires.
- Suboptimal and poor image quality were observed in 19.4% and 1% of cases, respectively.
- StB identified guidewire and balloon malposition outside stent borders in three instances during side branch rewiring.
Conclusions:
- StentBoost is a valuable imaging tool for bifurcation PCI, offering improved stent visualization.
- The technique aids in accurate side branch rewiring and assessment of stent expansion and apposition.
- StentBoost simplifies complex bifurcation PCI, potentially leading to better procedural outcomes.
Aims:
Percutaneous coronary intervention (PCI) of bifurcation lesions is complex and is technically very demanding. Coronary angiography is considered the gold standard method to guide PCI but has several limitations. The purpose of this study was to determine the utility of stent enhancement with StentBoost® (StB), a novel fluoroscopic imaging technique, and its potential role during bifurcation PCI.
Methods And Results:
This prospective study included 97 patients who underwent bifurcation PCI (98 bifurcations), using StB. Bifurcation lesions were classified according to the modified Medina classification. StB was performed in all patients to obtain improved stent visualisation and to detect optimal release and deployment. Therefore, three groups were formed, according to the quality of image: optimal visualisation, suboptimal visualisation and poor visualisation. Most of the bifurcation disease involved the main vessel (99%) and in 80 patients (81.6%) there was side branch involvement. Most bifurcations had both main vessel and side branch lesions (Medina 1,1,1) (70 patients, 71.4%). StB image quality was good in 79.6% of the cases (optimal visualisation of the stent and guidewire), was suboptimal in 19.4%, and poor in 1% (overlapping of structures or devices). In three cases, StB enabled the identification of the guidewire and angioplasty balloon passing outside stent borders during rewiring of the side branch.
Conclusions:
Imaging techniques have a primary role during bifurcation PCI. StentBoost is a simple and quick method that offers several advantages, enabling improved stent visualisation, appropriate rewiring of the side branch, adequate stent expansion and optimal apposition of the struts to the wall.
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