Clinical and angiographic assessment of the culotte technique for the treatment of complex coronary bifurcation lesions

Abstract

Introduction:The current standard treatment for bifurcation lesions is the provisional stent technique, by implanting only one stent in the main branch; however, in certain cases, the use of more complex techniques that require double stenting should be considered. Objective: To perform a clinical and angiographic assessment of patients with true bifurcation lesions treated with the two-stent culotte technique. Materials and methods: A prospective study was done, which included patients diagnosed with significant obstructive coronary artery disease in bifurcation areas, who were candidates for angioplasty with culotte technique. The study included 44 patients with proved diagnosis of coronary bifurcation lesions; 66% of the treated bifurcation lesions compromised the anterior descending artery and the diagonal branch and 27%, the circumflex artery with the marginal branch. It was found that 68% of the cases had Medina 1,1,1 lesions and 23% had Medina 0,1,1 lesions. Six months later, it was found that 12.5% of the patients followed up by angiography had in-stent restenosis (ISR) > 50% that involved at least one of the bifurcation areas. In 9% of these patients, the ISR was at the origin of the side branch only, and in 3%, the ISR was confined to the distal segment of the main branch stent. Conclusion: The use of the culotte technique with two new-generation stents to treat complex coronary bifurcation lesions is an effective option and does not increase the risk of complications during the procedure nor the risk of the appearance of ISR.