The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Double-Kissing Culotte Technique for Coronary Bifurcation Stenting - Technical evaluation and comparison with conventional double stenting techniques

DOI: 10.4244/EIJ-D-20-00130

1. University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, Austria, Austria
2. 2nd Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
3. Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
4. Gottfried Schatz Research Center: Biophysics, Medical University of Graz, Graz, Austria
5. National Heart Research Institute of Singapore, National Heart Centre Singapore, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore
6. The Lambe Institute for Translational Medicine and Curam, Saolta University Healthcare Group, Galway, Ireland
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Aims:To assess, whether Culotte technique could be improved by an additional kissing dilation prior main branch (MB) stenting.

Methods and results:Double-kissing (DK) Culotte was compared to Culotte and DK-Crush techniques in bench model (n=24). Results were evaluated for stent apposition, for luminal opening and for flow dynamics.Total procedure duration of DK-Culotte was 18.3±3.4min, significantly lower than for DK-Crush (24.3±5.7min; p=0.015), however similar to Culotte (21.6±5.9min, p=0.104).In DK-Culotte overall rate of moderate (200-500mm) and significant (>500mm) malapposition was 2.1±1.9% and 0.4±0.2%; similar as compared to Culotte (3.7±3.8%, p=0.459 and 1.0±1.0%, p=0.517; respectively), and lower as compared to DK-Crush (8.1±2.5%, p<0.001 and 3.7±5.3%, p=0.002; respectively). Lower malapposition rate of DK-Culotte as compared to DK-Crush was due to less moderate and significant malapposition in proximal MB (0.0±0.0% vs. 14.0±7.6%, p<0.001 and 0.0±0.0% vs. 4.2±9.1%, p=0.026, respectively). Micro computed tomography did not show difference in luminal opening at proximal MB, distal MB or SB. There was no difference either in maximum shear rate or in areas of high shear or recirculation.

Conclusions:Bench tests data suggest that DK approach facilitates Culotte technique. Clinical validity and relevance remains to be confirmed in larger in vivo population.

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