Szabo technique versus conventional angiographic placement in bifurcations 010-001 of Medina and in aorto-ostial stenting: angiographic and procedural results.
OBJECTIVE
The best strategy for stenting in bifurcations remains unclear. Szabo et al described a technique for accurate stent placement in bifurcations 010-001 or in aorto-ostial lesions. Its feasibility has been validated in animal models and small clinical series, but its safety and procedural results have never been compared to conventional positioning.


RESULTS
In a retrospective search, 257 out of 2,596 intervened lesions corresponded to Medina 010 (108, 42.0%)/001 (66, 25.7%) bifurcations or aorto-ostial lesions (83, 32.3%). Szabo was the initial choice in 78. Crude analysis showed significant differences between groups in several control variables, that disappeared after propensity score matching. Cross-over occurred in nine (11.7%) Szabo cases vs. no case in the conventional group. Two independent blinded investigators evaluated the angiographic result immediately after stent deployment. Szabo reduced the incidence of stent malpositioning (6.4% vs. 41.0%, p=0.000001), protrusion in the non-stented vessel/aorta (6.4% vs. 34.6%, p=0.00003) and incomplete scaffolding of the plaque (0.0% vs. 7.7%, p=NA). No significant differences regarding complications, procedural success or procedural complexity were observed after 30 days follow-up.


CONCLUSIONS
The Szabo technique reduces the incidence of angiographic malpositioning in Medina 010/001 bifurcations and aorto-ostial lesions, without increasing procedural complications.
Gutiérrez-Chico
Juan Luis
JL
Complejo Hospitalario Universitario de Vigo, Hospital de Meixoeiro, Vigo, Spain. jlgutierrez@medynet.com
Villanueva-Benito
Iñaki
I
Villanueva-Montoto
Lorena
L
Vázquez-Fernández
Sofía
S
Kleinecke
Caroline
C
Gielen
Stephan
S
Iñiguez-Romo
Andrés
A
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D015607:Stents; D016896:Treatment Outcome