Key result
In a bifurcation phantom model, simultaneous kissing balloon inflation fully expanded the stent in the side-branch ostium and eliminated main-branch distortion during the crush technique.
Why the study?
How do different deployment strategies affect drug-eluting stent performance using the crush technique in a bifurcation phantom?
How do different deployment strategies affect drug-eluting stent performance using the crush technique in a bifurcation phantom?
In an in vitro bifurcation phantom model, simultaneous kissing balloon inflation during the crush technique optimizes stent expansion and minimizes distortion.
Should not yet change bifurcation stenting practice; leaves open need for in vivo validation of optimized crush technique.
Sirolimus-eluting stents appear to reduce substantially restenosis following percutaneous coronary bifurcation intervention. The crush technique was devised to reduce restenosis further by improving stent and drug application to the side-branch ostium. We aimed to investigate the performance of drug-eluting stent (DES) platforms with the crush technique, to identify deployment pitfalls, and to clarify the best deployment strategies. Each stage of the crush technique was photographed in a bifurcation phantom. Simultaneous side- and main-branch dilatation (kissing balloons) fully expanded the stent in the side-branch ostium, widened the gaps between stent struts covering the side branch, and eliminated main-branch distortion. With side branches angled at > 70 degrees , sequential (side- then main-branch) inflations may be needed to achieve best results. Postdilatation of the main branch with a balloon of narrower diameter than the deploying balloon caused main-branch stent distortion. These principles applied to all the bifurcation strategies and stent designs tested.
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Ormiston et al. (2004) studied Coronary bifurcations. Crush technique with drug-eluting stents was evaluated on Stent expansion and distortion in a bifurcation phantom. In a bifurcation phantom model, simultaneous kissing balloon inflation fully expanded the stent in the side-branch ostium and eliminated main-branch distortion during the crush technique.
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