Análisis de Pruebas de Banco de la Gestión de Perforaciones en el Contexto de la Intervención Coronaria de...

Management of coronary perforation in bifurcation lesions with covered stents remains challenging.

We aimed to describe a proper practice and toolbox for "jailed-branch" management after covered stent deployment.

Using a bench model, we tested various wires with a 120° angulated microcatheter for their ability to penetrate covered stents to access jailed side branches (SB). Next, four PCI techniques were assessed: Test #1 (main branch [MB] rupture simulation): MB covered stent, graft penetration, and kissing balloon inflation (KBI) (n = 7). Test #2: Test #1 completed with Culotte using a drug-eluting stent (DES) (n = 3). Test #3: Culotte with two covered stents simulating MB and SB rupture (n = 3). Test #4: Test #3 plus final DES in MB (n = 3).

High tip-load wires ( > 12 g) successfully penetrated covered stents within 14 s. All procedures were completed successfully. Test #1 showed lumen area reductions of -8% (MB) and -25% (SB), with graft overhang at the SB. Conversion to Culotte with DES (Test #2) improved SB lumen reduction to -8%. Test #3 showed reductions of -7% (MB) and -15% (SB), with graft overhang at MB, corrected in Test #4 by DES implantation, resulting in +9% lumen gain (MB) and improved SB lumen reduction (-11%).

In this bifurcation perforation in-bench model, high tip-load wires effectively penetrated covered stents toward excluded branches after crossover covered stent implantation. Conversion to Culotte, using either a DES or a second covered stent, was feasible. Overhanging graft material following SB fenestration could be addressed by overstenting with a DES.