Crush versus Culotte stenting techniques for coronary bifurcation lesions

Chen, En; Cai, Wei; Chen, Lianglong

doi:10.1097/md.0000000000014865

Cited by 14 publications

(10 citation statements)

References 37 publications

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“…Several meta-analyses, as summarized in Table 2 , compare crush and culotte stenting techniques. Meta-analytic findings observed by Chen et al in 2019 [ 21 ] remain consistent with the most recent RCTs comparing crush and culotte stenting techniques. In this study, 3 RCTs and 4 observational studies with long-term follow-up, for a total of 2211 patients (1281 treated with crush, 930 treated with culotte), were evaluated for TLR, MACE, stent thrombosis, cardiac death, and MI.…”

Section: A Comparison Of Stenting Techniquessupporting

confidence: 81%

Coronary Bifurcation Stenting: Review of Current Techniques and Evidence

Aedma

Naik

Kanmanthareddy

2023

CCR

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Background: Coronary bifurcation stenting constitutes 20% of all PCI performed. Given the extensive prevalence of bifurcation lesions, various techniques have sought to optimally stent the bifurcation to improve revascularization while also decreasing rates of stent thrombosis and lesion recurrence. Advanced techniques, such as planned two-stent approaches, have been shown to have improved outcomes, but also require fluoroscopy and procedure time, posing an economical argument as well as a patient-outcome one. Objective: Because of the many strategies posited in the literature, it becomes essential to objectively evaluate evidence from randomized controlled trials and meta-analyses to help determine the optimal stenting strategy. Methods: We perform a review of the clinical evidence on the efficacy of coronary bifurcation stenting. Results: In this review, we review the most recent randomized controlled trials and meta-analyses on the efficacy of various stenting techniques and advances in stenting technologies published to gauge the current state of understanding, and chart where the field is heading. Conclusion: Bifurcation stenting is a maturing problem in the field of interventional cardiology that is adapting to the needs of the patients and advances in technology.

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Section: A Comparison Of Stenting Techniquessupporting

confidence: 81%

Coronary Bifurcation Stenting: Review of Current Techniques and Evidence

Aedma

Naik

Kanmanthareddy

2023

CCR

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“…For this reason, a two-stent technique is frequently necessary for complex true bifurcation lesions. The DK-crush technique has been shown to be superior to the provisional side-branch stenting as well as to culotte techniques in terms of efficacy and safety[ 1 , 3 ]. Nonetheless, it must be recognized that the DK-crush technique is technically demanding and time consuming.…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous coronary intervention (PCI) of a coronary bifurcation lesion (CBL) is a challenging procedure for interventionists[ 1 ]. The short- and long-term outcomes are closely related to the procedural success and optimization of the bifurcation stenting technique[ 2 , 3 ]. Several one- or two-stent techniques for PCI of CBLs have been described, depending on the type and location of the bifurcation lesions[ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

A Novel guide extension assisted stenting technique for coronary bifurcation lesions

Y‐Hassan

Palma

2021

WJC

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A challenging technical scenario frequently encountered in a percutaneous coronary intervention of a coronary bifurcation lesion (CBL) is stent implantation of only the stenosed segment without compromising the other two normal segments in non-true bifurcation lesions. Another is precise stent implantation covering the side branch ostium without leaving excessive stent metal at the other two segments of a bifurcation lesion in complex true bifurcation lesions. The aim of this study was to describe a novel stenting technique for both non-true and true CBLs by using a guide extension catheter (GuideLiner). With the assistance of a guide extension catheter mounted on both the main and the side-branch guidewires and with its intubation down to the bifurcation carina, a stent can be implanted in the side branch segment or distal main segment of the bifurcation lesion appropriately without compromising the other two segments of the coronary bifurcation. Stent implantation is described in three bifurcation lesions in three cases and shown in detail with illustrative figures. The technique facilitates side-branch only stenting in side-branch mono-ostial (medina 0, 0, 1) CBL or only the distal main segment in distal mono-ostial (medina 0, 1, 0) CBL without compromising the other two remaining segments when using the one-stent technique in non-true CBLs without leaving unnecessary excessive stent metal at the bifurcation site and when using a two-stent technique in complex true bifurcation lesions (tri-ostial or medina 1, 1, 1). Consequently, through optimizing stent deployment, the technique may have the potential to reduce the risk of subacute stent thrombosis and future in-stent restenosis. The most appropriate lesions suitable for the technique, and some other practical tips are also described.

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“…Lip-like strut area (LSA): LSA was calculated as follows: LSA = (BOA -OEA), where the redundant lip-like struts originated from the MB struts crossing over the SB ostium, which were overturned by FKBD but incompletely apposed to the upper side of the SB ostium, occupying the partial SB ostium. The area of stenosis of the ostium was calculated as LSA/BOA (Figure 4B) 10,11 .…”

Section: Openness Index Of Branch Ostiummentioning

confidence: 99%

“…OCT was used to examine scaffold malapposition in each defaulted segment, which was calculated as described previously 10,11 a and graded as: 1) full apposition (no malapposition), 2) incomplete apposition (malapposition >160um), 3) marked malapposition (malapposition >200um), and 4) oating struts (malapposition >500um).…”

Section: Stent Deformation Indexmentioning

confidence: 99%

Improving Bifurcated Scaffold Morphologies: The Feasibility of Culotte Techniques with Bioresorbable Vascular Scaffolds

Tu,

Zhang,

Tian

et al. 2024

Preprint

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Objectives: This study aimed to assess the bioresorbable vascular scaffold (BVS) performance with culotte stenting techniques and evaluate bifurcated scaffold morphologies. Methods: Conventional culotte stenting (CCS), double kissing mini-culotte stenting (DKMCS), and double kissing single-ring culotte stenting (DKSRCS) were executed in silicone bifurcated models. Procedures concluded with final kissing balloon inflation and proximal optimization technique. Microcomputed tomography assessed morphological parameters like side branch (SB) residual ostial stenosis and neocarina length (LNC) quantitatively. Optical coherence tomography (OCT) measured strut malapposition rates (SMR). Results: Quantitative assessments showed that BVS, in comparison with CCS, had significantly enhanced scaffold expansion at the SB ostium (6.29 ± 0.36 mm2 vs 6.71 ± 0.37 mm2, P = 0.05; 6.29 ± 0.36 mm2 vs 6.78 ± 0.26 mm2, P = 0.05, respectively), and decreased SB ostial stenosis(0.14% ± 0.04% vs 0.08% ± 0.04%, P < 0.05; 0.14% ± 0.04% vs 0.08 ± 0.03%, P < 0.05, respectively), LNC (0.49 ± 0.10 mm vs 0.30 ± 0.08 mm, P < 0.05; 0.49 ± 0.10 mm vs 0. 28 ± 0.06 mm, P < 0.05, respectively) and gap width(1.48 ± 0.06 mm vs 1.21 ± 0.06 mm, P < 0.05; 1.48 ± 0.06 mm vs 1.10 ± 0.04 mm, P < 0.05, respectively) in both DKMCS and DKSRCS. Notably, DKMCS and DKSRCS demonstrated reduced SMR, especially in scaffold overlap areas, as revealed by OCT. Conclusions: DKMCS and DKSRCS offer superior morphological outcomes for BVS models than CCS, suggesting BVS as a viable and effective technique for culotte stenting.

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Crush versus Culotte stenting techniques for coronary bifurcation lesions

Abstract: Supplemental Digital Content is available in the text

Cited by 14 publications

References 37 publications

Coronary Bifurcation Stenting: Review of Current Techniques and Evidence

Coronary Bifurcation Stenting: Review of Current Techniques and Evidence

A Novel guide extension assisted stenting technique for coronary bifurcation lesions

Improving Bifurcated Scaffold Morphologies: The Feasibility of Culotte Techniques with Bioresorbable Vascular Scaffolds

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