Configuration of two-stent coronary bifurcation techniques in explanted beating hearts: the MOBBEM study

DOI: 10.4244/EIJ-D-23-00063

Stefano Cangemi
Stefano Cangemi1, MD; Francesco Burzotta1,2, MD, PhD; Francesco Bianchini1, MD; Amanda DeVos3, BS; Thomas Valenzuela3, PhD; Carlo Trani1,2, MD; Cristina Aurigemma2, MD, PhD; Enrico Romagnoli2, MD, PhD; Jens Flested Lassen4, MD, PhD; Goran Stankovic5, MD, PhD; Paul Anthony Iaizzo3, PhD
1. Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; 2. Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 3. Visible Heart Laboratories, Department of Surgery, University of Minnesota, Minneapolis, MN, USA; 4. Department of Cardiology B, Odense University Hospital & University of Southern Denmark, Odense C, Denmark; 5. Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Background: In patients with complex coronary bifurcation lesions undergoing percutaneous coronary intervention (PCI), various 2-stent techniques might be utilised. The Visible Heart Laboratories (VHL) offer an experimental environment where PCI results can be assessed by multimodality imaging.

Aims: We aimed to assess the post-PCI stent configuration achieved by 2-stent techniques in the VHL and to evaluate the procedural factors associated with suboptimal results.

Methods: Bifurcation PCI with 2-stent techniques, performed by expert operators in the VHL on explanted beating swine hearts, was studied. The adopted bifurcation PCI strategy and the specific procedural steps applied in each procedure were classified according to Main, Across, Distal, Side (MADS)-2 and to their adherence to the European Bifurcation Club (EBC) recommendations. Microcomputed tomography (micro-CT) was used to assess the post-PCI stent configuration. The primary endpoint was “suboptimal stent implantation”, defined as a composite of stent underexpansion (<90%), side branch ostial area stenosis >50% and the gap between stents.

Results: A total of 82 PCI with bifurcation stenting were assessed, comprised of 29 crush, 25 culotte, 28 T/T and small protrusion (TAP) techniques. Suboptimal stent implantation was observed in as many as 53.7% of the cases, regardless of baseline anatomy or the stenting strategy. However, less frequent use of the proximal optimisation technique (POT; p=0.015) and kissing balloon inflations (KBI; p=0.027) and no adherence to EBC recommendations (p=0.004, p multivariate=0.006) were significantly associated with the primary endpoint.

Conclusions: Commonly practised bifurcation 2-stent techniques may result in imperfect stent configurations. More frequent use of POT/KBI and adherence to expert recommendations might reduce the occurrence of post-PCI suboptimal stent configurations.

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bifurcationcoronary artery diseasecoronary bifurcation lesionculotteDK-crushdrug-eluting stentkissing balloon inflationPOTTAP
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