Author + information
- Raúl Valdesuso II1,
- Juan Ramon Gimeno2,
- Francisco Javier Lacunza2,
- Julio Antonio Rodriguez3,
- Raul Cecilio Rodriguez4,
- Hector Alberto Fleites5 and
- Albert Toruncha6
Stenting ostial and/or bifurcated lesions (L) constitute always a challenge. Szabo Technique (SzT) is a simple way to deal with these problems, but Stent can be damaged during the process increasing nonfatal complication (NFC).
From Jan'08 to May'13. SzT was attempted in 266 patients (pts) (65 ± 5 years; 68% male). Different brand of stents were used. Before pre-dilating the target L, an “Anchor Guide Wire” (AGW) is placed into “non-stenotic” side branch, and Its proximal stiff tip is attempted crossing through the proximal Stent's cell, by 2 Types of approaches (Tyapps): (Type I) inflating Stent's balloon to lifting up its proximal crown (rest of stent is keeping inside its protective sheath); (Type II) by bending the Stent (looking for “fish flake effect”) attempting to separate its proximal cell from balloon.
A total of 283 L (82% by transradial approach) were attempt with SzT. Guide Catheter (GC) Fr used (%) were: 6F: 17; Sheathless GC, 6.5 Fr: 26; 7Fr GC: 28 and Sheathless 7.5 GC: 29. Total Stent used 291. Total Stent Implanted by SzTc: 268 (92%) Mean stent length and diameter was 13.47 ± 5.2 mm and 2.77 ± 1.14 mm. Tyapps used were (%): 43 Type I and 57 Type II. Failure of Stent delivery was due to: puncture of Stent's balloon: 3 (13%) (all in Tyapps II), stent dislodgment 7 (30%) (6 in Tyapps I); Stent non eligible due to deformation by any Tyapps: 5 (22%); others causes (guide wire twisting, failure of reaching the L, etc: 8 (33%). In all SzT failure, procedure was successfully ended with any other stenting technique without NFC.
SzT is highly successful technique, but both Tyapps for Stent threading involves risk of Stent damage (5% in our series), that cause decreasing its rate of success delivery and increasing NFC.
SzT is highly successful technique, but both Tyapps for Stent threading involves risk of Stent damage (5% in our series), that cause decreasing of its delivery success rate and increasing of NFC. Due to these results, we designed with Hexacath (Paris France) one Stent with a dedicated cell (coming from factory), to simplify the threading of AGW, avoiding balloon puncture or Stent deformation. Our Stent called Titan V, has been successfully implanted in test benches and animal models and currently is under evaluation for CE mark.