Simplified highway technique for the treatment of bifurcation lesions – initial experiences in our center
█ Original article
Katona András, Ungi Imre, Sasi Viktor, Thury Attila1
1Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szeged
Dr. Katona András, e-mail: firstname.lastname@example.org
Introduction: Bifurcations often involved in percutan coronary interventions (PCI). According to current guidelines, one stent technique is the gold standard, thus it means suboptimal result in the side branch. Numerous techniques are suggested to protect the side branch however none of them is perfect. A new method is described below, with our first experiences and early data.
Methods: Data of the patients who are treated with this “Simplified Highway Technique” (SHW) are collected prospectively. Inclusion criteria is at least 2 mm diameter of the side branch with a minimum of 20% ostial diameter stenosis. Angiographic features and procedural complications analysed retrospectively.
Results: Between 2014 October and 2017 November 181 bifurcation were treated with SHW in 180 patients, 36 were cut coronary syndrome (ACS) and 145 elective case. Distribution of these bifurcations: 6.6% left main coronary artery (LMCA), 59.2% left anterior descending-diagonal (LAD – diagonal), 27.6% ramus circumflex – obtuse marginal (CX – OM), 6.6% distal right coronary (RCA). Most of the cases the planned one stent strategy provided satisfactory result, but in 19 cases a second stent implantation in the side branch were needed. It means “crush” in 4 cases”, “T and protrusion” in 8 cases, “culotte” in 7 cases. “bail-out” crush is a unique advantage of this method, as a “service channel” remains outside of the main branch stent, which gives the possibility to deploy a stent “under” the main branch stent before proximal optimalisation (POT). This was not possible only in 1 case, where this channel collapsed and impossible to redilatate it.
Discussion: Advantage of this SHW technique is the simplicity and fully controlled side branch availability in 6 Fr guiding catheters. In spite of this primary one stent technique, delivery of a second stent is easy. Of course the need of a second stent due to a dissection draws the attention on imperfection of current side branch protection techniques.