The Use of Bumper Wire Technique and Intravascular Ultrasound for Precise Aorto-Ostial Stenting

Abstract

BackgroundAorto-ostial interventions are challenging due to the limitations of contemporary equipment, imprecise ostial demarcation, and problematic ostial lesion characteristics. Suboptimal stent placement is common and portends worse clinical outcomes. Procedural and long-term outcomes of the bumper wire technique with intravascular ultrasound (IVUS) assessment have not been investigated.MethodsA single-center retrospective study was conducted. Patients who underwent ostial lesion percutaneous coronary intervention (PCI) with the bumper wire technique between January 2019 and September 2020 were identified. The primary endpoint was to determine the geographic miss rate defined by inadequate ostial coverage or excess stent protrusion of > 2 mm by IVUS or angiography. The secondary endpoint was target lesion failure (TLF) at 6 months after PCI, defined as the composite of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularization.ResultsIn total, 45 patients were identified. The average age was 71.7 years old, and 85.4% were men. Indication for PCI was acute coronary syndrome in about a third of patients. Twenty-six patients had left main ostial lesions and 19 patients had right coronary artery ostial lesions. Geographic miss was detected in two patients (4.4%): one patient (2.2%) had excess proximal stent protrusion and one patient (2.2%) had an ostial miss. Six patients were lost to follow-up. TLF, stroke, or major bleeding were not observed in any of the patients.ConclusionThe bumper wire technique is safe and efficient with low rates of geographic miss or adverse clinical outcomes. This is the first study to confirm precise aorto-ostial stent implantation with the bumper wire technique using IVUS confirmation.

Consequences and Management of Excessive Ostial Stent Protrusion: A Case Report

“…Concomitantly, anatomic variations of coronary origin, irregular ostial shape, and the limitation of 2D angiography can lead to imprecisions in ostial demarcation. [ 1 – 3 ]…”

“…Reddy et al demonstrated that the bumper wire or double wire technique is a secure and efficient approach for aorto-ostial interventions, with reduced geographic miss on IVUS and favourable clinical outcomes. [ 3 ] Kerim et al documented a case of acute stent thrombosis involving restenosis of a protruding ostial stent of the right coronary artery (RCA), with significant overhanging into the aorta, managed employing a double wire technique. [ 1 , 2 , 6 ] When the protrusion is short, the proximal stent struts can be expanded outward against the aortic wall using a flash ostial balloon.…”

“…The use of intracoronary imaging has been linked to improved clinical outcomes in ostial lesion stenting. [ 2 , 3 ]…”

“…Additionally, ostial anatomic variations, the coronary ostium irregular shape and limitations of 2D angiography can lead to imprecisions in aorto-ostial stenting. [1][2][3] Incomplete coverage of the ostial lesion or an excessive proximal stent protrusion is frequently encountered in aorto-ostial interventions. These occurrences are closely linked to adverse cardiovascular events, such as increased neo-intimal hyperplasia, incomplete neo-endothelisation, as well as early and late stent malapposition.…”

Contemporary Left Main Percutaneous Coronary Intervention: A State-of-the-art Review

“…The bumper wire technique – often referred to as the floating or sepal wire method – uses a second guidewire inserted into the aortic root to mark the ostium and prevent the guide catheter from prolapsing past the target ostial lesion. 41 …”