A Novel guide extension assisted stenting technique for coronary bifurcation lesions

A challenging technical scenario frequently encountered in a percutaneous coronary intervention of a coronary bifurcation lesion (CBL) is stent implantation of only the stenosed segment without compromising the other two normal segments in non-true bifurcation lesions. Another is precise stent implantation covering the side branch ostium without leaving excessive stent metal at the other two segments of a bifurcation lesion in complex true bifurcation lesions. The aim of this study was to describe a novel stenting technique for both non-true and true CBLs by using a guide extension catheter (GuideLiner). With the assistance of a guide extension catheter mounted on both the main and the side-branch guidewires and with its intubation down to the bifurcation carina, a stent can be implanted in the side branch segment or distal main segment of the bifurcation lesion appropriately without compromising the other two segments of the coronary bifurcation. Stent implantation is described in three bifurcation lesions in three cases and shown in detail with illustrative figures. The technique facilitates side-branch only stenting in side-branch mono-ostial (medina 0, 0, 1) CBL or only the distal main segment in distal mono-ostial (medina 0, 1, 0) CBL without compromising the other two remaining segments when using the one-stent technique in non-true CBLs without leaving unnecessary excessive stent metal at the bifurcation site and when using a two-stent technique in complex true bifurcation lesions (tri-ostial or medina 1, 1, 1). Consequently, through optimizing stent deployment, the technique may have the potential to reduce the risk of subacute stent thrombosis and future in-stent restenosis. The most appropriate lesions suitable for the technique, and some other practical tips are also described.