title: Stenting of unprotected distal left main coronary artery bifurcation stenoses using modified crush technique with double kissing balloon inflation (sleeve technique): immediate procedure result and early clinical outcome.
abstract: BACKGROUND
  Sleeve technique is a modified version of the crush technique. It is specifically designed to increase the success rate of final kissing balloon inflation, which used to be a major limitation of the latter.
  
  
  OBJECTIVE
  This study sought to look at the feasibility, safety, and early clinical outcome of sleeve technique in stenting of unprotected distal left main coronary artery (LMCA) bifurcation stenoses.
  
  
  METHODS
  From August 2005 to April 2006, 12 consecutive patients with symptomatic distal LMCA bifurcation stenoses of diameter narrowing > or =50%, who refused coronary artery bypass graft surgery, were treated with two-stent strategy using the sleeve technique.
  
  
  RESULTS
  Eleven patients (91.7%) were male, with a mean age of 64.4 +/- 9.3 years. Intravenous abciximab was given to 10 patients (83.3%). The baseline reference vessel diameters of the main vessel and side branch were 3.32 +/- 0.44 and 3.00 +/- 0.58 mm, respectively. After intervention, the minimal luminal diameter was increased from 0.99 +/- 0.46 to 3.26 +/- 0.28 mm and 1.43 +/- 0.71 to 2.93 +/- 0.45 mm in the main vessel and side branch, respectively. The intervention procedure was successful in all patients with 100% final kissing balloon inflation rate. The average procedure time was 58.6 +/- 20.5 minutes. Two patients had a small non-Q myocardial infarction postprocedure. The resultant major adverse cardiac event rate was 16.7% at 30 days after the procedure.
  
  
  CONCLUSIONS
  Sleeve technique is a safe and feasible approach in the stenting of distal LMCA bifurcation stenoses.
authors.affiliation: Cardiac Medical Unit, Grantham Hospital, Hong Kong. jimmanh2002@yahoo.com
authors.forename: Man-Hong
authors.initials: MH
authors.lastname: Jim
authors.forename: Wing-Hing
authors.initials: WH
authors.lastname: Chow
authors.forename: Hee-Hwa
authors.initials: HH
authors.lastname: Ho
mesh_terms: D000800:Angioplasty, Balloon / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D023903:Coronary Restenosis; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome