Nano-Culotte Stenting for Coronary Bifurcation Lesions: Pros and Cons of a Novel Strategy

Single-Stent Double-Kissing Nano-Crush Technique for the Management of Side Branch Ostial Lesions: A Game Changer? Or Just Another Player in the Game?

“…The technique introduced by Acar et al 1 may be regarded as a variant of the 2-stent nano-crush technique primarily used for the management of true bifurcation lesions. 4 , 5 Both techniques are primarily based on initial SB stent pull-back toward the inflated balloon in the MV followed by SB stent implantation and double-kissing balloon inflation in the later stages. 1 , 5 However, this novel strategy does not necessitate stent implantation in the MV (due to the absence of a critical MV lesion) and exclusively harnesses MV balloon inflation to crush the protruded SB stent struts.…”

“… 6 Importantly, this technique might work well in the presence of very narrow bifurcation angles. 4 Alternatively, a potential variant of this technique without MV stenting, yet, with a single-kissing balloon inflation along with a final DCB inflation (which I may term ‘1-stent single-kissing nano-culotte), may also be quite feasible in this patient 1 and in similar cases with narrow bifurcation angles. Furthermore, MV dissection may be less likely compared with “osdokina crush” due to the single-kissing balloon inflation in this technique.…”

“…However, SB ostial geographic miss may also be likely in the “1-stent, single-kissing nano-culotte” technique in the presence of a large distal MV. 4 …”

Reply to Letter to the Editor: “Single-Stent Double-Kissing Nano-Crush Technique for the Management of Side Branch Ostial Lesions: A Game Changer? Or Just Another Player in the Game?”

“…We reviewed the study and the double-kissing nano-culotte technique pointed out by the esteemed authors. 7 It is especially advantageous that it is used in narrow-angle coronary bifurcation lesion. 7 Of course, an isolated ostial SB lesion may have an important place among revascularization techniques.…”

“… 7 It is especially advantageous that it is used in narrow-angle coronary bifurcation lesion. 7 Of course, an isolated ostial SB lesion may have an important place among revascularization techniques. However, in Medina 0.0.1 lesions, placing a stent on the main branch without disease would mean trying to solve a problem in a way that is likely to open the door to another problem in the future.…”