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

Coronary interventions - Mini focus on bifurcation lesions

Double-kissing culotte technique for coronary bifurcation stenting

EuroIntervention 2020;16:e724-e733. DOI: 10.4244/EIJ-D-20-00130

1. University Heart Center Graz, Department of Cardiology, Medical University of Graz, Graz, 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; 6. Department of Biomedical Engineering, National University of Singapore, Singapore; 7. The Lambe Institute for Translational Medicine and Curam, Saolta University Healthcare Group, Galway, Ireland

Aims: The aim of this study was to assess whether the culotte technique could be improved by an additional kissing dilation prior to main branch (MB) stenting.

Methods and results: Double-kissing (DK) culotte was compared to the culotte and DK-crush techniques in a bench model (n=24). Results were evaluated for stent apposition, luminal opening and flow dynamics. The total procedure duration of DK-culotte was 18.3±3.4 minutes, significantly lower than for DK-crush (24.3±5.7 min; p=0.015), but similar to culotte (21.6±5.9 min, p=0.104). In DK-culotte the overall rate of moderate (200-500 µm) and significant (>500 µm) 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). The lower malapposition rate of DK-culotte as compared to DK-crush was due to less moderate and significant malapposition in the 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 a difference in luminal opening at the proximal MB, distal MB or SB. There was no difference either in the maximum shear rate or in areas of high shear or recirculation.

Conclusions: Bench test data suggest that the DK approach facilitates the culotte technique. The clinical validity and relevance remain to be confirmed in a larger in vivo population.

Sign in to read and download the full article

Forgot your password?
No account yet? Sign up for free!
Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Read next article
Stepwise visualisation of a provisional bifurcation stenting procedure – multimodal visualisation within a reanimated human heart utilising Visible Heart methodologies