In vitro flow and optical coherence tomography comparison of two bailout techniques after failed provisional stenting for bifurcation percutaneous coronary interventions

Abstract

Objectives To evaluate, in vitro, SB stenting techniques after failed provisional stenting. We aimed to compare flows and stent strut apposition of T and protrusion (TAP) versus Reversed String (RS) techniques using a flow simulator, optical coherence tomography (OCT) using silicon bifurcation phantoms with different bifurcation angulations. Background While bifurcation coronary artery stenoses are preferably treated with provisional T‐stenting strategy, the preferred bailout two stents technique to treat the side branch remains unclear. Methods and results Eleven 30°‐angle and ten 60°‐angle bifurcation phantoms were used. After performing provisional stenting, TAP and RS techniques were compared in six phantoms with 30° and five with 60° angles. Flow measurement was performed using absolute coronary flow and particle image velocimetry techniques. Strut apposition was evaluated using OCT. Flow analyses showed that disturbed flow regions were observed in the vicinity of floating struts protruded into the lumen both regardless of TAP and RS techniques. OCT analysis showed a higher proportion of floating struts protruding into the main branch with TAP compared to RS, respectively (13% vs. 1%; P <0.001) in both angles. Conclusions RS reduces the proportion of floating struts protruding into the main branch compared to TAP, at comparable flow rates. Clinical studies are needed to evaluate feasibility and potential clinical benefit of this technique.

A Novel Strategy to Simplify the Procedures in Treating Complicated Coronary Bifurcation Lesions: From a Bench Test to Clinical Application

“…One concern about this simplified protocol is that retrieval of the jailed balloon might leave a "gap" (malapposition) between the struts and vessel wall. A previous study showed that OCT could conveniently be acquired from silicon bifurcation phantoms, and OCT had quite strong resolution power to recognize malapposition (27). Therefore, this silicon bifurcation phantom is suitable for testing the reliability of the simplified protocol.…”

Bioresorbable zinc stent with ultra-thin center struts attenuates stent jail in porcine femoral artery bifurcations

“…Although peripheral arterial diseases (PAD) are developing into an expanding field for endovascular interventions using bioresorbable stents [12], bifurcation stenting in PAD is rare. More clinical experience with bifurcation stenting exists in coronary artery lesions, e.g., in vessels of diameters of 2-4 mm [13][14][15][16][17]. Stenting of the main arterial branch and balloon dilatation only of the side branch (so-called Table 1.…”