Reversed single string technique for coronary bifurcation stenting-First report of case demonstrations in vitro

This work reports the concept and the practical feasibility of Reversed Single String bifurcation stenting technique by demonstrating three in vitro cases.

Provisional T stenting is the most used interventional technique to treat coronary bifurcation lesions. However, after main branch (MB) stenting, treatment of the side branch (SB) may become indicated to provide a good final result. Currently applied methods all have their structural limitations with respect to wall coverage, multiple strut layers, poor apposition rate. We reasoned that reversing the Single String technique principle could be used as a bail out after inadequate provisional T stenting.

We simulated in three silicone bifurcation phantoms a scenario whereby stenting the SB becomes indicated after provisional T stenting. Thereafter, as first step of Reversed Single String, a stent was deployed into the SB ostium with one single protruding stent-cell into the MB. After wiring that stent-cell and positioning MB balloon across it, final kissing balloon dilation was performed. Results of the in vitro Reversed Single String cases were evaluated by X-ray angiography, optical frequency domain imaging, and 3-Dimensional (3D) reconstruction (OFDI). Each case was successfully performed and completed. In the bifurcation area, perfect apposition was documented in over 81% of the struts. Malapposition remained below 4% of struts in each case. 3D OFDI reconstruction did not reveal any strut fracture.

This report suggests that Reversed Single String technique might offer a potential bail out solution for provisional T-stenting cases, when treatment of the SB becomes indicated. © 2017 Wiley Periodicals, Inc.