Author + information
- Received September 29, 2014
- Revision received January 20, 2015
- Accepted January 29, 2015
- Published online June 1, 2015.
- Gabor G. Toth, MD∗,†,
- Stylianos Pyxaras, MD∗,
- Peter Mortier, MS, PhD‡,§,
- Frederic De Vroey, MD∗,
- Giuseppe Di Gioia, MD∗,‖,
- Julien Adjedj, MD∗,
- Mariano Pellicano, MD∗,
- Angela Ferrara, MD∗,
- Thomas De Schryver, MS¶,
- Luc Van Hoorebeke, MS¶,
- Benedict Verhegghe, MS, PhD‡,§,
- Emanuele Barbato, MD, PhD∗,‖,
- Bernard De Bruyne, MD, PhD∗,
- Matthieu De Beule, MS, PhD‡,§ and
- William Wijns, MD, PhD∗∗ ()
- ∗Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium
- †University Heart Centre Graz, Medical University of Graz, Graz, Austria
- ‡FEops Besloten Vennootschap met Beperkte Aansprakelijkheid, Ghent, Belgium
- §IBiTech-bioMMeda, IMinds Medical IT, Ghent University, Ghent, Belgium
- ‖Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- ¶UGCT, Ghent University, Ghent, Belgium
- ↵∗Correspondence and reprint requests:
Dr. William Wijns, Cardiovascular Research Centre Aalst, OLV-Ziekenhuis, Moorselbaan 164, Aalst, B9300, Belgium.
Objectives The study aimed to evaluate the adequacy and feasibility of the single string bifurcation stenting technique.
Background Double-stent techniques may be required for complex bifurcations. Currently applied methods all have their morphological or structural limitations with respect to wall coverage, multiple strut layers, and apposition rate.
Methods Single string is a novel method in which, first, the side branch (SB) stent is deployed with a single stent cell protruding into the main branch (MB). Second, the MB stent is deployed across this protruding stent cell. The procedure is completed by final kissing balloon dilation. The single string technique was first tested in vitro (n = 20) and next applied in patients (n = 11) with complex bifurcation stenoses.
Results All procedures were performed successfully, crossing a single stent cell in 100%. Procedure duration was 23.0 ± 7.9 min, and the fluoroscopy time was 9.4 ± 3.5 min. The results were evaluated by optical coherence tomography, showing fully apposed struts in 83.0 ± 9.2% in the bifurcation area. Residual area obstruction in the MB was 6.4 ± 5.6% and 25.0 ± 16.9% in the SB, as evaluated by micro computed tomography. All the human cases were performed successfully with excellent angiographic results: the residual area stenosis was 27 ± 8% and 29 ± 10% in the MB and in the SB, respectively, by 3-dimensional quantitative coronary angiography. No relevant periprocedural enzyme increase was observed. During follow-up (6 ± 4 months), no adverse clinical events (death, myocardial infarction, target vessel revascularization) were noted.
Conclusions The single string technique for complex bifurcation dilation was shown to be adequate in vitro and feasible in humans, with favorable results in terms of stent overlap, malapposition rate, and low residual obstruction in both the MB and SB.
Testing equipment, including guidewires, stents, and balloon catheters were provided by Abbott Laboratories Inc. (Abbott Park, Illinois), Biosensors Interventional Technologies Ltd. (Singapore), Biotronik SE & Co. (Berlin, Germany), Boston Scientific Inc. (Natick, Massachusetts), and Medtronic Inc. (Minneapolis, Minnesota) without financial involvement or intellectual restriction. Drs. Verhegghe and Mortier are cofounders of FEops. Dr. Adjedj is supported by a grant from Federation Française de Cardiologie. Dr. De Bruyne has received institutional grant support and consulting fees from St. Jude Medical. Dr. De Beule is a shareholder in FEops. Dr. Wijns has received institutional grants from Abbott Vascular, Biosensors Interventional Technology, Biotronik, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 29, 2014.
- Revision received January 20, 2015.
- Accepted January 29, 2015.
- American College of Cardiology Foundation