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Percutaneous intervention of Coronary Bifurcation stenosis still remains an enigma. The provisional stenting technique with a single stent crossover considered optimum in many of such cases. In bifurcation lesions supplying a large amount of myocardium, particularly where side branch is having long lesions from the ostium, a two-stent technique is sometimes necessary. All two-stent techniques have limitations, some are not fit for certain anatomies, some have more metal loads and some does not ensure optimum side branch opening.
We have introduced a new technique which can be performed in almost all anatomies, ensures minimum metal load and proper side branch opening.
In our technique in Medina 1:1:1 situations, after proper balloon dilatation of both the branches the SB stent is placed with one size smaller NC balloon in MB. The MB balloon is inflated and SB stent is pulled to it snugly and deployed. The MB balloon is inflated next to crush the minimal protrusion of SB stent and ultimately the SB balloon is pulled into MB for a kissing balloon inflation, done at moderate pressure. SB wire and balloon is then removed along with MB balloon and MB stent is deployed followed by final kissing balloon inflation after crossing the MB strurts into the SB with appropriate sized NC Balloons.
Since last 8 years, we have followed the patients treated with our technique as an all-comer situation (N= 42, M 98%, F 2%, Mean Age 62.78 ± 8. LMCA-35%, Non LMCA-65%). Patient demographics are given below.
No significant difference in occurrence of MACE with respect to sex, age (≤60 vs. >60 years), diabetes, hypertension, calcified lesion. Significant occurrence of MACE is found in a case of LMCA (P value 0.0205<0.05), in a case of CRF (P value 0.0003<0.01) and also in a case of CRF among LMCA patients (P value 0.0006<0.01). To analysis time-dependent occurrence of MACE Kaplan-Meier’s curve with the log-rank comparison is computed. Cox regression analysis is used to find Hazard ratio and identify predictors for the occurrence of MACE. All tests are two-sided and a P-value less than 0.05 is considered statistically significant.
All 2 stent strategy for coronary bifurcation has some limitation. Some techniques are better when the angel is <90 and some more fitted with 90 angels. Again some bifurcation stenting like Culotte and Crush technique are technically difficult. Moreover, proper ostial coverage sometimes may be missed in some other techniques like T Stenting and proper opening of the SB may be a problem in TAP-stenting.
Our technique is simple, easy, ensures proper ostial coverage with minimal metal load and can be performed in all anatomies with good long term result.