Culotte versus the novel nano-crush technique for unprotected complex bifurcation left main stenting: difference in procedural time, contrast volume and X-ray exposure and 3-years outcomes

Rigatelli, Gianluca; Zuin, Marco; Vassilev, Dobrin; Dinh, Huy; Giatti, Sara; Carraro, Mauro; Zanon, Francesco; Dung, Ho Thuong

doi:10.1007/s10554-018-1497-8

Cited by 14 publications

(11 citation statements)

References 24 publications

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“…New problems then arose, such as overlap, multiple metal layers, stent malapposition and under-expansion of stent strut at the ostial SB, which increased restenosis and stent thrombosis [24]. Mini-crush, mini-culotte, double kissing-crush, and nano-crush techniques evolved to minimize overlap and metal burden and to improve clinical outcomes [1,2,[13][14][15]. Nonetheless, a significant risk of geographic miss or excessive overlap is inevitably associated with these techniques, which are guided by fluoroscopic placement of the SB stent.…”

Section: Discussionmentioning

confidence: 99%

“…The ideal technique should provide full coverage with no metal gaps and minimal overlap between the MV and SB stents [11,12]. Imaging and clinical outcomes have been improved with the development of 2-stent techniques, such as mini-crush, T and protrusion stenting, among others [12][13][14][15]. However, technical evolution approached but did not meet the ideal criteria of "full coverage, minimal overlap, and minimal distortion.…”

Section: Introductionmentioning

confidence: 99%

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Szabo 2-stent technique for coronary bifurcation lesions: procedural and short-term outcomes

Yang

Qian

Huang

2020

BMC Cardiovasc Disord

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Background: Provisional 1-stent technique is currently regarded as the default approach for the majority of bifurcation lesions. Nonetheless, 2-stent techniques may be required for complex bifurcations with high compromise risk or fatal consequences of side branch (SB) occlusion. Limitations exist in current approaches, as stents gap, multiple metal layers and stent malapposition caused by imprecise placement with fluoroscopic guide and intrinsic technical defects. This study was designed to investigate the effectiveness of the novel Szabo 2-stent technique for coronary bifurcation lesions. Methods: In the Szabo 2-stent technique, one stent is precisely implanted at the SB ostium with Szabo technique resulting in a single strut protruding into the main vessel (MV). After MV rewiring and SB guidewire withdrawal, another stent is implanted in MV followed by proximal optimization technique, SB rewiring, and final kissing inflation (FKI). Results: The technique tested successfully in silicone tubes (n = 9) with: procedure duration, 31.2 ± 6.8 min; MV and SB rewiring time, 26.8 ± 11.2 s and 33.3 ± 15 s; easy FKI; and 2.3 ± 0.5 balloons/procedure. Bifurcation lesions (n = 22) were treated with angiographic success in MV and SB, respectively: increased minimal lumen diameter (0.63 ± 0.32 mm to 3.20 ± 0.35 mm; 0.49 ± 0.37 mm to 2.67 ± 0.25 mm); low residual stenosis (12.4 ± 2.4%; 12.4 ± 2.3%); and intravascular ultrasound confirmed (n = 19) full coverage; minimal overlap and malapposition; minimal lumen area (2.4 ± 1.2 mm 2 ; 2.1 ± 1.0 mm 2); plaque burden (78.1 ± 11.3%; 71.6 ± 15.5%); and minimal stent area (9.1 ± 1.6 mm 2 ; 6.1 ± 1.3 mm 2). Periprocedural cardiac troponin increased in 1 asymptomatic patient without electrocardiographic change. There was no target lesion failure (cardiac death, myocardial infarction, target lesion revascularization) at 6month follow-up. Conclusions: The Szabo 2-stent technique for bifurcation lesions provided acceptable safety and efficacy at shortterm follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Szabo 2-stent technique for coronary bifurcation lesions: procedural and short-term outcomes

Yang

Qian

Huang

2020

BMC Cardiovasc Disord

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“…A total of 149 citations were screened and eight studies [15,[26][27][28][29][30][31][32] were eventually included in the study. The process of study selection was shown in Figure 1.…”

Section: Screening Studies and Characteristic And Quality Assessment mentioning

confidence: 99%

“…volume, and more dose area product [29,30,32]. The FKBD and the proximal optimization technique are needed to acquire a better immediate imaging effect and to decrease short-and long-term cardiovascular events.…”

Section: Figure 3: Forest Plots Of CD Mi and St Between Crush And Cumentioning

confidence: 99%

Crush is superior to Culotte in two-stent strategy for treatment of left main coronary artery bifurcations: A systematic review and meta-analysis

Chen

Cui

Chen

et al. 2020

CIM

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Purpose: Crush and Culotte techniques have been used increasingly to treat patients with complex unprotected left main coronary artery bifurcation lesions. This article compares published data on these two techniques. Methods: Databases, including PubMed, Embase, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure, were searched for articles published before Aug 21, 2019 to identify all relevant studies on left main coronary artery bifurcation lesions treated by Crush versus Culotte techniques. The pooled data were analyzed using either fixed- or random-effects model depending on heterogeneity (assessed via the I2 index). The endpoints were major adverse cardiac events, target lesion revascularization, cardiac death, stent thrombosis, myocardial infarction and target vessel revascularization. Results: Eight articles with a total of 1,283 patients were included, and 710 patients were treated with Crush, and 573 ones with Culotte. Crush group was trend to decreased major adverse cardiac event compared with Culotte group [Relative ratio (RR) 0.63,95% confidence interval(CI) 0.39-1.04, I2 =72.7%], mainly driven by decreased cardiac death [RR 0.49, 95% CI(0.25-0.99), I2 =0%], decreased myocardial infarction [RR 0.40, 95% CI(0.21-0.76), I2 =21.6%],and lower stent thrombosis [RR 0.39, 95% CI(0.16-0.98), I2 =39.4%]. There was no significant difference in target lesion revascularization and target vessel revascularization between Crush and Culotte [RR 0.77, 95% CI 0.46-1.28, I2=61.1%; RR 0.78, 95% CI (0.30-2.02), I2 =73.1%, respectively]. Conclusion: Crush was superior to Culotte for treatment of left main coronary artery bifurcation lesions with a trend of lower incidence of long-term major adverse cardiac events, mainly derived from decreased myocardial infarction, stent thrombosis and cardiac death.

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“…Rigatelli and colleagues assessed the performance and 3-years outcome od unprotected left main (LM) stenting using either the Culotte or a novel nano-crush technique in a population of 65 patients (32 nano-crush and 33 Culotte) in this single-center study [2]. The nano-crush patients showed lower contrast medium volume and X-ray exposure, shorter fluoroscopy and procedures time compared to the Culotte technique.…”

Section: X-ray Imagingmentioning

confidence: 99%

Cardiovascular imaging 2019 in the International Journal of Cardiovascular Imaging

Reiber

Pereira

Dallan

et al. 2020

Int J Cardiovasc Imaging

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Culotte versus the novel nano-crush technique for unprotected complex bifurcation left main stenting: difference in procedural time, contrast volume and X-ray exposure and 3-years outcomes

Cited by 14 publications

References 24 publications

Szabo 2-stent technique for coronary bifurcation lesions: procedural and short-term outcomes

Szabo 2-stent technique for coronary bifurcation lesions: procedural and short-term outcomes

Crush is superior to Culotte in two-stent strategy for treatment of left main coronary artery bifurcations: A systematic review and meta-analysis

Cardiovascular imaging 2019 in the International Journal of Cardiovascular Imaging

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