The Cone Flare Crush Modified-T (CFCT) stenting technique for coronary artery bifurcation lesions

Abstract

Background The present study is a prospective observational single arm clinical investigation, with parallel bench test interrogation, aimed at investigating the technical feasibility, safety and clinical outcomes with the cone flare crush modified-T (CFCT) bifurcation stenting technique. Bifurcation percutaneous coronary intervention (PCI) remains an area of ongoing procedural evolution. More widely applicable and reproducible techniques are required. Methods From April 2018 until March 2019, 20 consecutive patients underwent bifurcation PCI using the CFCT technique with a Pt-Cr everolimus drug-eluting stent with a bioresorbable polymer. Exercise stress echocardiography was performed at 12-month follow-up. The primary outcome was a composite of cardiac related mortality, myocardial infarction, target lesion/vessel revascularization and stroke. Safety secondary endpoints included bleeding, all-cause mortality and stent thrombosis. Results All patients underwent a successful CFCT bifurcation procedure with no complications to 30-day follow-up. One patient met the primary endpoint requiring target lesion revascularization at 9 months for stable angina. There were no other primary or secondary outcome events in the cohort. There were no strokes, deaths, stent thrombosis or myocardial infarction during the follow-up period. The mean CCS score improved from 2.25 to 0.25 (p < 0.0001). Optical coherence tomography (OCT) and bench test findings indicated optimal side branch ostial coverage and minimal redundant strut material crowding the neo-carina. Conclusions The CFCT technique appears to be a safe, efficacious and feasible strategy for managing coronary artery bifurcation disease. Expanded and randomized datasets with longer term follow-up are required to further explore confirm this feasibility data. (ANZCTR ID: ACTRN12618001145291).

Six-months clinical and intracoronary imaging follow-up after reverse T and protrusion or double-kissing and crush stenting for the treatment of complex left main bifurcation lesions

“…In a recently published paper, we reported the outcomes of a randomized trial comparing DKC with a simplified variant involving a shorter stent crush length and only one rewiring. We reported that this variation, which we called reverse-T-and-protrusion (rTAP) and which resembles a previously reported technique named “cone flare DKC”( 7 ), was non-inferior to DKC in terms of side branch (SB) ostial expansion and was associated with shortened procedural times ( 8 ). In the present study, we compare the intermediate-term outcomes assessed by optical coherence tomography (OCT) of patients with LM bifurcation disease, randomized to either the DKC technique or rTAP.…”

Ostial lesion of the anterior descending coronary artery treated via Szabo technique supported by stent boost imaging: a case report

“…An ostial lesion of the coronary artery lies within 3 mm of the opening of the coronary artery [ 1 ]. The lesion is not easy to expand, as it is rich in elastic fiber tissue and easily retracts, and the rate of restenosis and calcification is high.…”