Author + information
- Received October 19, 2018
- Accepted October 30, 2018
- Published online March 18, 2019.
- Ruka Yoshida, MDa,b,
- Kensuke Takagi, MDa,
- Yasuhiro Morita, MD, PhDa and
- Itsuro Morishima, MD, PhDa,∗ ()
- aDepartment of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
- bDepartment of Cardiology, Nagoya University, Nagoya, Japan
- ↵∗Address for correspondence:
Dr. Itsuro Morishima, Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan.
A 59-year-old man presented with cardiac arrest. Coronary angiography revealed severe stenosis at the left main bifurcation (Figure 1A). Intending for culotte stenting, the first stent was deployed to the left main–circumflex across the left anterior descending coronary artery, followed by recrossing to the left anterior descending coronary artery. However, a 1.25-mm balloon could not pass the stent strut (SS) even using an anchoring balloon, proximal optimization, and rewiring (1). The Corsair microcatheter (ASAHI Intecc, Nagoya, Japan) could pass the SS by rotation. Thus, the kissing-Corsair technique (KCT) was performed (Figure 1B). Subsequently, a 2.5-mm balloon passed the SS, and culotte stenting was accomplished (Figure 1C). Successful revascularization (Figure 1D) resulted in an uneventful hospital course.
We performed bench testing of the KCT (main branch, 3.5 mm; side branch [SB], 2.5 mm). A 3.5-mm stent (Xience Sierra, Abbott Vascular, Santa Clara, California) was deployed from the proximal main branch–SB, followed by recrossing the second wire to the distal main branch (Figure 2A). After passing the Corsair microcatheter through the SS (Figure 2B), the KCT was performed using a 3.5-mm balloon (Figure 2C). This resulted in a widely opened SS and good SB scaffolding (Figure 2D). The difference in the SS before and after the KCT was apparent (Figures 2A and 2D).
The jailed balloon or jailed Corsair technique is widely used to protect the SB prior to stenting (1,2). However, there is limited evidence on treatment of the SB after stenting in patients in whom small balloons cannot pass the SS even after using the contemporary technique (1). The 1-mm Corsair shaft serves as a small balloon, providing the quasi-effect of the kissing balloon technique. In conclusion, the KCT is an excellent option for the treatment of patients in whom small balloons cannot pass the SS.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 19, 2018.
- Accepted October 30, 2018.
- 2019 American College of Cardiology Foundation
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