Author + information
- Received October 10, 2013
- Accepted October 24, 2013
- Published online July 1, 2014.
- Stephan Achenbach, MD∗ ( and )
- Christian Schlundt, MD
- ↵∗Reprint requests and correspondence:
Dr. Stephan Achenbach, Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany.
Various techniques for stent deployment in bifurcation lesions have been developed. In general, a single-stent approach is preferable, but balloon dilation of the side branch can lead to deformation of the main branch stent, which is incompletely resolved by “final kissing balloon dilation” (1,2). In vivo imaging of stent expansion and deformation by fluoroscopy is challenging, given the poor x-ray absorption of modern thin-strut stents. Software tools have become available that permit improved visualization of coronary stents in cine fluoroscopy. They improve contrast-to-noise ratio (and, hence, resolution) by averaging consecutive cine fluoroscopic frames. Balloon markers are used as reference points in order to eliminate motion. We present cine fluoroscopic images obtained using a commercially available stent enhancement tool (ClearStent, Siemens Healthcare, Forchheim, Germany) on a single-plane x-ray angiographic flat-panel system (Artis Zee, Siemens Healthcare). The patient was a 78-year-old woman with typical chest pain and left anterior descending coronary artery stenoses, with a fractional flow reserve of 0.76. A bioresorbable scaffold (Absorb 2.5/18 mm, Abbott Vascular, Abbott Park, Illinois) was used to treat the mid-left anterior descending coronary artery. A high-grade bifurcation lesion of the left anterior descending/1st diagonal branch remained (Medina 0/1/0). Treatment of this lesion is demonstrated here. A drug-eluting stent (Xience Prime 3.0/15 mm, Abbott Vascular) was implanted in the left anterior descending coronary artery, followed by rewiring and balloon angioplasty of the diagonal branch and final kissing balloon inflation. Figures 1, 2, 3, 4, 5, 6, 7, and 8⇓⇓⇓⇓⇓⇓⇓ illustrate the various steps of the procedure and resulting changes in stent geometry.
Dr. Achenbach is a consultant to Siemens Healthcare and Abbott; has received speaker honoraria from Siemens Healthcare and Abbott; and his institution has received research grants from Siemens Healthcare and Abbott. Dr. Schlundt has received speaker honoraria from Abbott.
- Received October 10, 2013.
- Accepted October 24, 2013.
- American College of Cardiology Foundation