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A Novel Coronary Bifurcation Stenting Technique: Double Kissing Nano-Culotte Stenting
Serkan Kahraman1, Ahmet Yaşar Çizgici1, Mehmet Ertürk1
1Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, İstanbul, Türkiye.
Insights
This study introduces a new minimal protruded double kissing (DK) nanoculotte stenting technique for complex coronary bifurcation lesions (CBL). This approach aims to improve outcomes by minimizing stent protrusion and layers at critical points.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- Coronary bifurcation lesions (CBL) present complex anatomical challenges for percutaneous coronary intervention (PCI).
- Optimal stenting strategies for CBL remain debated despite advanced techniques.
- Current PCI aims to minimize stent protrusion, neocarina layers, and malapposition.
Observation:
- Traditional two-stent strategies have evolved, emphasizing minimal main vessel protrusion and double kissing (DK) balloon dilatation.
- While DK crush stenting is common, DK culotte stenting shows potential advantages in reducing malapposition and neocarina metal layers.
- A novel minimal protruded DK nanoculotte stenting technique was applied to treat a true CBL case.
Findings:
- The presented technique successfully treated a true coronary bifurcation lesion.
- The novel approach focuses on minimizing stent protrusion into the main vessel.
- It aims to optimize stent deployment at the side branch ostium and proximal main vessel.
Implications:
- This technique may offer an alternative strategy for complex coronary bifurcation interventions.
- Further research could validate the efficacy and safety of the minimal protruded DK nanoculotte technique.
- Improved stenting strategies can lead to better patient outcomes in PCI for CBL.
Abstract:
Percutaneous coronary intervention (PCI) of coronary bifurcation lesion (CBL) is challenging due to its complex anatomy resulting in difficulty in deciding on treatment procedure. Although there are advanced techniques and well-experienced operators, the optimal stenting strategy is still debated. The contemporary PCI techniques of CBL aim to achieve minimal stent protrusion to the main vessel and to minimize stent layers at the neocarina as well as the side branch (SB) ostium and proximal main vessel (PMV). In addition, it is necessary to avoid incomplete stent coverage at the SB ostium and stent malapposition. Traditional 2-stent strategies have been improved using minimal stent protrusion to the main vessel (MV) and double kissing (DK) balloon dilatation to reach optimal results. Although the DK crush has been the prominent treatment modality,1 there are studies showing that the DK culotte stenting may have better results especially in terms of stent malapposition and metal layers at the neocarina.2 In our case report, we demonstrate a novel minimal protruded DK nanoculotte stenting technique for the treatment of true CBL.
