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

Abstract

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.

Coronary Bifurcation Stenting: Review of Current Techniques and Evidence

“…The Szabo Technique Trial (NCT03714802) compares modified T-stenting with the Szabo technique to conventional T-stenting. The Szabo 1-stent and 2-stent techniques have both been validated previously for short-term outcomes in cohort studies [ 66 ]. The insProvisional Trial (NCT03780192) evaluates the performance of the INSPIRON Sirolimus-eluting stent, a third-generation stent designed with a cobalt-chromium alloy and thin struts [ 67 ], placed with the provisional strategy.…”

Analyzing coronary bifurcation structures: Towards personalized balloon angioplasty and stent deployment

“…Additional methods of direct stent placement in the proximal vessel have been proposed (e.g., Szabo technique, reverse Szabo technique) [11][12][13][14]. We have proposed a "reverse balloon" concept, using two guide wires placed in each branch, so called "mother" (main) and "daughter" (side) branches [11].…”