Incorporation of a Balloon-Cushion Stenting Technique into the Culotte Stenting Technique in Left Main Coronary Artery Bifurcation Interventions

Background: Percutaneous coronary intervention (PCI) for a left main coronary artery (LMCA) with its distal bifurcation lesions remains a challenge. Acute sidebranch occlusion after main branch stenting can potentially lead to catastrophic events. Here we describe a novel balloon-cushion stenting technique to be incorporated into the culotte stenting technique for true LMCA bifurcation lesions to prevent acute sidebranch occlusion. Methods and Results: 1) Predilatation with 2 balloons with kissing for better sidebranch preparation. 2) Balloonstent simultaneous kissing inflation, with a stent in the dominant artery and a 1.5/20 mm balloon from LMCA to the sidebranch. 3) After the stent deployment, a Crusade microcatheter was introduced via wire in the dominant vessel for wire re-crossing of the stent strut. The standard culotte technique and final kissing balloon inflation were then performed. Twelve patients were treated with this balloon-cushion stenting technique (Group A) and 18 patients with the conventional double-stent techniques (Group B). One case of acute sidebranch occlusion occurred in Group B. The amount of contrast medium and procedural time did not differ statistically between the 2 groups. Conclusions: The present study suggests that incorporation of the balloon-cushion stenting technique into the culotte stenting technique for LMCA bifurcation intervention is feasible and effective in avoiding acute sidebranch occlusion.