The "Y" stent: a technique using nitinol stents to treat bifurcations.
OBJECTIVE
To investigate a new method of stent deployment using commercially available self-expanding stents to treat bifurcation lesions, providing complete lesion coverage without obstructing branches.


METHODS
After preliminary in vitro and clinical testing with biliary obstructions, 11 vascular obstructive lesions in 10 patients (7 men; mean age 63 years, range 32-81) were treated by percutaneous Y-shaped stenting. Five patients had iliac arterial stenoses involving the iliac bifurcation; the other 5 patients had 6 central venous obstructions involving branch points. Bifurcated stents were constructed in situ by deploying a nitinol stent extending into one branch and selective balloon fracturing of struts to create a fenestration. A second stent was deployed through the hole, followed by symmetrical fracturing of struts in the second stent to form a Y-shaped configuration.


RESULTS
All deployments were technically successful and resulted in complete coverage of the bifurcation lesions. Protrusion of fractured stent material into flow lumens was minor as determined by angiography, intravascular ultrasound, and passage of balloons, but it required the stents to be oversized. The lengths and luminal diameters were tailored for each arm of the Y-shaped stents.


CONCLUSIONS
In situ creation of a Y-shaped stent using 2 self-expanding nitinol stents is a feasible option with potential advantages in the treatment of obstructive lesions involving a bifurcation.
Sze
Daniel Y
DY
Division of Cardiovascular and Interventional Radiology, Stanford University Medical Center, Stanford, California 94305-5642, USA. dansze@stanford.edu
Razavi
Mahmood K
MK
Mitri
Ragheed K
RK
Regala
Alan C
AC
Dake
Michael D
MD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome
D000497:Alloys; C013616:nitinol