First clinical experience of "flower petal stenting": a novel technique for the treatment of coronary bifurcation lesions.
OBJECTIVE
We sought to report the results of both bench-testing and our first clinical experience with this novel technique.


BACKGROUND
The optimal stenting technique for bifurcation lesions has yet to be defined.


METHODS
This technique works by flaring the proximal side of the stent in side branch out like a flower petal. We tested it in vitro and the resultant stent structure and stent polymer damage was observed in both main branch and side branch with an optical microscopy, multislice computer tomography, intravascular ultrasound, endoscopy, and by electron microscopy. We also applied this technique in 33 patients and assessed patient outcomes up to 9 months prospectively. Drug-eluting stents were used for the bench tests and for all patients.


RESULTS
Bench-testing showed complete coverage of the bifurcation with minimal stent-layer overlapping. There was little polymer damage by electron microscopy. Procedural success was achieved in all cases and restenosis occurred in 2 cases. In both restenosis cases, "petal" stenting technique was done reluctantly after another stent had already been deployed in the main branch before any stenting of the side branch. There were no incidences of restenosis when this technique was used electively.


CONCLUSIONS
In terms of damage to the polymer and ostial strut coverage, this new "flower petal stenting" technique is effective for treatment of bifurcation lesion and it may well be superior to other available techniques.
Division of Cardiology, Toyohashi Heart Center, Toyohashi, Aichi, Japan. Ykinoshita@heart-center.or.jp
Yoshihisa
Y
Kinoshita
Osamu
O
Katoh
Tetsuo
T
Matsubara
Mariko
M
Ehara
Kenya
K
Nasu
Maoto
M
Habara
Takahiko
T
Suzuki
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology / Q000517:prevention & control; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D011446:Prospective Studies; D011474:Prosthesis Design; D012720:Severity of Illness Index; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D002317:Cardiovascular Agents; D017239:Paclitaxel; D020123:Sirolimus