title: Bench top evaluation and clinical experience with the Szabo technique: new questions for a complex lesion.
abstract: BACKGROUND
  The Szabo technique has been described as a method to ensure accurate ostial stent placement. We sought to investigate this novel technique in detail both in vitro and in vivo.
  
  
  RESULTS
  The technique was subjected to bench testing and also undertaken in 26 patients. Each step was recorded with cine angiography and the stents imaged by microcomputed tomography. The ostial LAD was treated in 81% and a DES was implanted in 92%. Angiographic success was 88.5% (one case of stent dislodgement). Repeat angiography was performed in 78% and restenosis observed in two patients. MACE rate at 15.5 ± 5.1 months was 13% (1 TLR, 1 MI, 1 cardiac death). Despite a seemingly excellent immediate angiographic result, we report one case of restenosis at follow up and one case of IVUS examination (performed in four patients) in which significant stent protrusion, into the proximal main vessel, was observed. In vitro bench testing confirmed a significant and asymmetric (carina side) stent protrusion into the main branch, with the last cell of the stent undergoing significant deformation.
  
  
  CONCLUSIONS
  The Szabo technique is not a precise technique to implant a stent at the level of the ostium. The proximal end of the stent undergoes significant and asymmetric deformation, protruding into main branch. Additional concerns with this complex technique include the potential for stent damage or contamination before implantation and the risk of stent dislodgement. We conclude that there are more disadvantages than benefits to this technique which only partially addresses the difficulties encountered in the treating ostial lesions.
authors.affiliation: Interventional Cardiology Unit, Del Mar Hospital, Barcelona, Spain. beavaquerizo@yahoo.es
authors.forename: Beatriz
authors.initials: B
authors.lastname: Vaquerizo
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.forename: John
authors.initials: J
authors.lastname: Ormiston
authors.forename: Faustino
authors.initials: F
authors.lastname: Miranda-Guardiola
authors.forename: Bruce
authors.initials: B
authors.lastname: Webber
authors.forename: Andres
authors.initials: A
authors.lastname: Fantuzzi
authors.forename: Guillermo
authors.initials: G
authors.lastname: Delgado
authors.forename: Jordi
authors.initials: J
authors.lastname: Brugera
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D002932:Cineangiography / Q000295:instrumentation; D017023:Coronary Angiography / Q000295:instrumentation; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D019047:Phantoms, Imaging; D011474:Prosthesis Design; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055114:X-Ray Microtomography / Q000295:instrumentation