Double-Kissing Nanocrush for Bifurcation Lesions: Development, Bioengineering, Fluid Dynamics, and Initial Clinical
Paul D Morris1, Rebecca Gosling1, Alex Rothman2
1Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom; Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, United Kingdom; Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, United Kingdom.
The Canadian Journal of Cardiology
|February 24, 2020
Summary
The novel double-kissing (DK) nanocrush technique simplifies coronary bifurcation stenting, offering complete lesion coverage with minimal metal. This refined approach shows excellent short-term clinical outcomes and favorable hemodynamics.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Coronary bifurcation lesions often require complex stenting techniques.
- Existing two-stent methods, like crush and minicrush, have limitations.
- Refinement of the minicrush technique is needed to improve outcomes.
Purpose of the Study:
- To develop and evaluate a simplified DK nanocrush technique for coronary bifurcation stenting.
- To assess the feasibility, safety, and efficacy of the DK nanocrush method.
- To compare the DK nanocrush technique with existing bifurcation stenting strategies.
Main Methods:
- The DK nanocrush technique involves precise stent positioning, kissing balloon inflations, and specific recrossing strategies.
- Evaluation included benchtop studies, micro-CT reconstruction, computational fluid dynamics (CFD) modeling, and clinical application.
- The technique was applied to 9 patients with bifurcation lesions.
Main Results:
- The DK nanocrush technique achieved complete ostial coverage of bifurcation lesions.
- CFD analysis indicated minimal disturbance to blood flow patterns.
- Clinical application in 9 patients resulted in excellent angiographic outcomes and no adverse events at 12 months.
Conclusions:
- The DK nanocrush technique represents a significant refinement of the crush technique for coronary bifurcation stenting.
- It offers practical advantages and potentially improved theoretical benefits.
- Further validation in prospective trials against other techniques is warranted.
