title: Modified culotte stenting for treatment of complex coronary bifurcation lesions: immediate and 9-month outcomes in a pilot study.
abstract: BACKGROUND
  The optimal stenting strategy for the treatment of coronary bifurcation lesions (CBLs) remains uncertain. The present study observed technical feasibility and reliability, 9-month clinical and angiographic outcomes of the modified culotte stenting (MCS) in the treatment of CBLs with drug-eluting stents.
  
  
  METHODS
  A total of 34 consecutive patients with CBLs that required stenting the parent vessel (PV), the main branch (MB) and the side branch (SB) were included. All patients were first assigned to receive MCS for CBL interventions (per MCS), and might be switched to receive the double-kissing-crush stenting (DKS) in case of temporally acute branch occlusion (per protocol).
  
  
  RESULTS
  The immediate angiographic or procedural success was achieved in 33/34 (97%) lesions (patients) per MCS, 34/34 (100%) lesions (patients) per protocol with 100% successful final balloon kissing. The long-term clinical success at 9 months was 94% per MCS and 94% per protocol, only 2 patients had reoccurrence of angina but none of them needed target lesion revascularization. There were no procedure-related biomarker elevation, no in-stent thrombosis peri-procedurally and at 9-month follow-up. Quantitative coronary angiography data at 9 months showed that in-stent (6%) or in-segment (6%) binary stenosis was infrequent, and minimal lumen diameter was significantly reduced but late lumen loss was acceptable with only (0.10 ± 0.14) mm for PV, (0.21 ± 0.23) mm for MB and (0.27 ± 0.32) mm for SB.
  
  
  CONCLUSIONS
  MCS for treatment of CBLs that required dual-stent implantation was technically easier and safer, readily to complete final balloon kissing, and was associated with high immediate success and optimal 9-month outcomes.
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, Fujian Institute of Coronary Artery Disease, Fuzhou, Fujian 350001, China. lianglongchen@126.com
authors.forename: Liang-long
authors.initials: LL
authors.lastname: Chen
authors.forename: Lin
authors.initials: L
authors.lastname: Fan
authors.forename: Zhao-yang
authors.initials: ZY
authors.lastname: Chen
authors.forename: Xing-chun
authors.initials: XC
authors.lastname: Zhen
authors.forename: Yu-kun
authors.initials: YK
authors.lastname: Luo
authors.forename: Chao-gui
authors.initials: CG
authors.lastname: Lin
authors.forename: Ya-fei
authors.initials: YF
authors.lastname: Peng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies