Drug-eluting stents for coronary bifurcations: insights into the 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.
Ormiston
John A
JA
Mercy Hospital, Auckland, New Zealand. johno@mercyangiography.co.nz
Currie
Erin
E
Webster
Mark W I
MW
Kay
Patrick
P
Ruygrok
Peter N
PN
Stewart
James T
JT
Padgett
Richard C
RC
Panther
Monique J
MJ
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D023903:Coronary Restenosis / Q000517:prevention & control*; D006801:Humans; D011474:Prosthesis Design; D015607:Stents