Complex coronary bifurcation treatment by a novel stenting technique: Bench test, fluid dynamic study and clinical outcomes

Abstract

The revascularization of complex large coronary bifurcation disease using the Nano-crush technique appeared promising thanks to the favorable fluid dynamic profile, complete coverage of the SD ostium, and very small metal amount at the carina.

Left main bifurcation stenting assessed by computational fluid dynamic: The impact on wall shear stress forces depends on both specific techniques and bifurcation angles

“…Our data showed that angles have a mutual impact on specific technique performance in terms of WSS, as the different impact of each technique on increasing the lower WSS area should probably be explained by not only the grade of struts coverage but also by the strut's apposition to the wall. The Nano crush technique has been developed with the aim of being applicable at any bifurcation angle and that is confirmed by our data: results of averaged WSS were higher in MB and SB at any angle compared to the other two techniques, confirming indirectly the complete coverage and good stent apposition observed in the bench and clinical study [28]. At the carina the WSS are slightly lower at 45°, and highest at 60° and 85° degrees, probably reflecting the larger flow disturbance induced by the short segment of the crushed SB stent at an acute angle.…”

Fundamentals of percutaneous coronary bifurcation interventions

“…The “nano-crush” technique was first presented by Ray et al [ 101 , 102 ] at the 12th EBC meeting in 2016. Later, in 2017, Rigatelli et al [ 103 ] published a bench test and clinical outcome study of a technique with the same name. Although both procedures use a tiny SB stent part for crushing, the techniques are somewhat different from each other.…”

“…While the MV balloon is inflated, the SB stent is pulled back until a small part protrudes into the MV and is deployed. However, in the nano-crush technique described by Rigatelli et al [ 103 , 104 ], 0.5-1 mm protrusion of the proximal part of the SB stent for crushing is adjusted visually by angiography. Moreover, the KBI numbers and techniques are also different.…”

“…Moreover, the KBI numbers and techniques are also different. Where Ray et al [ 102 ] perform double “classical” KBI at high pressures without a final POT, Rigatelli et al [ 103 - 105 ] perform only one “snuggle” KBI, then a final POT. The other steps are similar to the DK-crush stenting technique described before.…”

Thin and crush: The new mantra in left main stenting?

“…Even more recently, the Nano-Crush technique[ 12 - 13 ] has become part of the repertoire of double stenting techniques, providing evidence that the use of ultrathin strut stents and very minimal crush is beneficial for both the physiological and rheological properties of the complex bifurcations, leading to a lower rate of thrombosis and restenosis at both side branch (SB) and true carina[ 14 ].…”