Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Cardiovascular Intervention
Crush, Culotte, T and Protrusion: Which 2-Stent Technique for Treatment of True Bifurcation Lesions?
– Insights From In Vitro Experiments and Micro-Computed Tomography –
Nicolas FoinEduardo Alegria-BarreroRyo ToriiPak H. ChanN. ViceconteJustin E. DaviesCarlo Di Mario
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2013 Volume 77 Issue 1 Pages 73-80

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Abstract

Background: Percutaneous coronary intervention of complex true bifurcation lesions often fails to ensure continuous stent coverage and strut apposition in both the side branch and main vessel. Struts left unopposed floating in the lumen disturb blood flow and are increasingly recognized as increasing the risk of stent thrombosis. Methods and Results: In this study, we compared the results of different bifurcation treatment strategies: Crush (n=5); Culotte (n=3); T-/T with Protrusion (TAP) (n=4) using drug-eluting stents deployed in-vitro in representative coronary bifurcation models. After final kissing balloon post-dilatation, the rate of malapposition within the bifurcation quantified from micro-computed tomography scanning was on average 41.5±8.2% with the Crush technique, reduced to respectively 31.4±5.2% with Culotte and 36.7±8.0% with T-/TAP approach. Overlaying layers of struts in the Crush and Culotte techniques lead to a significantly higher rate of strut malapposition in the proximal vessel than with the T-/TAP technique (Crush: 39.1±10.7%, Culotte: 26.1±7.7%, TAP: 4.2±7.2%, P<0.01). Maximal wall-malapposed strut distance was also found on average to be higher with the Crush (1.36±0.4mm) and Culotte techniques (1.32±0.1mm) than with T-/TAP (1.08±0.1mm, P=0.04). Conclusions: In this model, the Crush technique resulted in a higher risk of malapposition than either the Culotte or T-/TAP technique.  (Circ J 2013; 77: 73–80)

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© 2013 THE JAPANESE CIRCULATION SOCIETY
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