The "Crush" Technique for Coronary Artery Bifurcation Stenting: Insights From Micro-Computed Tomographic Imaging of Bench Deployments
John A. Ormiston, MBChB, FRACP, FRACR, FRCP*,
Mark W.I. Webster, MBChB, FRACP,
Bruce Webber, MHSc,
James T. Stewart, MD, FRACP, FACC, FSCAI,
Peter N. Ruygrok, MD, FRACP,
Robert I. Hatrick, MBBS, MRCP
Mercy Angiography, Mercy Hospital, Auckland, New Zealand.
* Reprint requests and correspondence: Dr. John A. Ormiston, Mercy Angiography, P.O. Box 9911, Newmarket, Auckland, New Zealand. (Email: johno{at}mercyangiography.co.nz).
Objectives: This study provides insights into "crush" coronary bifurcation stenting through imaging of bench deployments.
Background: Although the strategy of provisional side-branch stenting is widely accepted for suitable bifurcation lesions, there is no consensus on the best option for elective stenting with 2 stents. The crush technique has the potential to scaffold and apply the drug to the side-branch ostium where restenosis is most common.
Methods: Sequential steps of crush stent deployment and post-dilation were undertaken in silicone phantoms and recorded on cine angiography and microcomputed tomography. We assessed the effect of deployment strategies, post-dilation strategies, and cell size on side-branch ostial area.
Results: Side-branch ostial coverage by metal struts was 53% (95% confidence interval [CI]: 46 to 59) after 1-step kissing post-dilation and was reduced by 2-step kissing post-dilation to 33% (95% CI: 28 to 37; p < 0.0001). Although the residual stenosis after the classical crush strategy was 47% (95% CI: 39 to 53), it was 36% (95% CI: 31 to 40; p = 0.002) after mini-crush deployment. Stents with larger cell size (>3.5 mm diameter) had a residual stenosis of 37% (95% CI: 32 to 42) after crush deployment that was less than the residual stenosis for stents with smaller cell size (52%; 95% CI: 44 to 60; p < 0.0001).
Conclusions: Side-branch ostial stenosis after crush stenting was minimized by mini-crush deployment, 2-step kissing post-dilation, and the use of stents with larger cell size. It is unknown if optimizing stent deployment at bifurcation lesions will reduce clinical stent thrombosis and restenosis.
Key Words: coronary bifurcations • stents • crush stenting • bench testing • bifurcation stenting
|
Abbreviations and Acronyms
| | CT = computed tomography | | DES = drug-eluting stent(s) | | MB = main branch | | SB = side branch |
|
|
