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Published on: February 18, 2020
Placement of coronary stents in bifurcation lesions by the "culotte" technique
B Chevalier1, B Glatt, T Royer
1Centre Cardiologique du Nord, Saint-Denis, France.
Insights
The novel culotte technique for coronary artery bifurcation stenting shows high feasibility and excellent short-term results. Further studies are needed to assess its midterm benefits in complex coronary interventions.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary angioplasty of bifurcation lesions presents significant technical challenges.
- Traditional balloon angioplasty can lead to recoil, the "snow-plow" effect, and side branch occlusion, resulting in high reintervention rates.
Purpose of the Study:
- To introduce and evaluate the feasibility and efficacy of the "culotte" technique for intracoronary stent placement in coronary artery bifurcation lesions.
Main Methods:
- The "culotte" technique involves a two-step stent implantation in the main and side branches, with overlapping stents in the main branch before the bifurcation.
- The technique was applied to 50 patients with various coronary artery bifurcations.
Main Results:
- A clinical success rate of 94% was achieved, with 3 cases of non-Q-wave myocardial infarction.
- The initial target lesion revascularization rate was 24%, which decreased with the use of true kissing balloon inflation for final stent deployment.
Conclusions:
- The culotte technique is a feasible approach for stenting coronary artery bifurcations, demonstrating promising short-term outcomes.
- Long-term efficacy and benefits require further investigation, particularly regarding midterm outcomes.
Abstract:
Coronary angioplasty of bifurcation lesions remains a technical challenge. Balloon angioplasty induces recoil and the "snow-plow" effect with a risk of side branch occlusion. The late result is associated with a high rate of reintervention. Randomized studies in nonbifurcated lesions have demonstrated better short- and midterm results after stent placement. We propose the "culotte" technique as a new technique to place intracoronary stents in bifurcation lesions: implantation of 2 similar stents in 2 steps in the main branch and in the side branch with overlapping of the 2 stents in the main branch before bifurcation. We performed this technique in 50 patients (in the left anterior diagonal branch in 33, in the left circumflex obtuse marginal branch in 12, in the right coronary artery in 4, and in the left main coronary artery in 1). The clinical success rate was 94% with 3 non-Q-wave myocardial infarctions. Late results indicated a 24% target lesion revascularization rate, which improved when a true kissing balloon inflation was used to achieve final deployment of both stents. This culotte technique is highly feasible and provides excellent short-term results. Assessment of its midterm benefit requires further study.
