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First Clinical Experience of "Flower Petal Stenting"

A Novel Technique for the Treatment of Coronary Bifurcation Lesions

Yoshihisa Kinoshita, MD^_*,_*, Osamu Katoh, MD^_*, Tetsuo Matsubara, MD, Mariko Ehara, MD^_*, Kenya Nasu, MD^_*, Maoto Habara, MD^_*, Takahiko Suzuki, MD^_*

^_* Division of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan
Division of Cardiology, Nagoya Heart Center, Nagoya, Aichi, Japan

^_* Reprint requests and correspondence: Dr. Yoshihisa Kinoshita, Division of Cardiology, Toyohashi Heart Center, 21-1, Gobudori, Oyama, Toyohashi, Aichi 441-8530, Japan (Email: Ykinoshita{at}heart-center.or.jp).

Objectives: We sought to report the results of both bench-testing and our first clinical experience with this novel technique.

Background: The optimal stenting technique for bifurcation lesions has yet to be defined.

Methods: This technique works by flaring the proximal side of the stent in side branch out like a flower petal. We tested it in vitro and the resultant stent structure and stent polymer damage was observed in both main branch and side branch with an optical microscopy, multislice computer tomography, intravascular ultrasound, endoscopy, and by electron microscopy. We also applied this technique in 33 patients and assessed patient outcomes up to 9 months prospectively. Drug-eluting stents were used for the bench tests and for all patients.

Results: Bench-testing showed complete coverage of the bifurcation with minimal stent-layer overlapping. There was little polymer damage by electron microscopy. Procedural success was achieved in all cases and restenosis occurred in 2 cases. In both restenosis cases, "petal" stenting technique was done reluctantly after another stent had already been deployed in the main branch before any stenting of the side branch. There were no incidences of restenosis when this technique was used electively.

Conclusions: In terms of damage to the polymer and ostial strut coverage, this new "flower petal stenting" technique is effective for treatment of bifurcation lesion and it may well be superior to other available techniques.

Key Words: flower petal stenting • bifurcation lesions • drug-eluting stent

Abbreviations and Acronyms   DES = drug-eluting stents   IVUS = intravascular ultrasound   MACE = major adverse cardiac events   MB = main branch   MI = myocardial infarction   PCI = percutaneous coronary intervention   SB = side branch   TLR = target lesion revascularization   w = wire

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