title: Single String Technique for Coronary Bifurcation Stenting: Detailed Technical Evaluation and Feasibility Analysis.
abstract: OBJECTIVE
  The study aimed to evaluate the adequacy and feasibility of the single string bifurcation stenting technique.
  
  
  BACKGROUND
  Double-stent techniques may be required for complex bifurcations. Currently applied methods all have their morphological or structural limitations with respect to wall coverage, multiple strut layers, and apposition rate.
  
  
  METHODS
  Single string is a novel method in which, first, the side branch (SB) stent is deployed with a single stent cell protruding into the main branch (MB). Second, the MB stent is deployed across this protruding stent cell. The procedure is completed by final kissing balloon dilation. The single string technique was first tested in vitro (n = 20) and next applied in patients (n = 11) with complex bifurcation stenoses.
  
  
  RESULTS
  All procedures were performed successfully, crossing a single stent cell in 100%. Procedure duration was 23.0 ± 7.9 min, and the fluoroscopy time was 9.4 ± 3.5 min. The results were evaluated by optical coherence tomography, showing fully apposed struts in 83.0 ± 9.2% in the bifurcation area. Residual area obstruction in the MB was 6.4 ± 5.6% and 25.0 ± 16.9% in the SB, as evaluated by micro computed tomography. All the human cases were performed successfully with excellent angiographic results: the residual area stenosis was 27 ± 8% and 29 ± 10% in the MB and in the SB, respectively, by 3-dimensional quantitative coronary angiography. No relevant periprocedural enzyme increase was observed. During follow-up (6 ± 4 months), no adverse clinical events (death, myocardial infarction, target vessel revascularization) were noted.
  
  
  CONCLUSIONS
  The single string technique for complex bifurcation dilation was shown to be adequate in vitro and feasible in humans, with favorable results in terms of stent overlap, malapposition rate, and low residual obstruction in both the MB and SB.
authors.affiliation: Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium; University Heart Centre Graz, Medical University of Graz, Graz, Austria.
authors.forename: Gabor
authors.initials: G
authors.lastname: G Toth
authors.affiliation: Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Pyxaras
authors.affiliation: FEops Besloten Vennootschap met Beperkte Aansprakelijkheid, Ghent, Belgium; IBiTech-bioMMeda, IMinds Medical IT, Ghent University, Ghent, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Mortier
authors.affiliation: Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium.
authors.forename: Frederic
authors.initials: F
authors.lastname: De Vroey
authors.affiliation: Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Gioia
authors.affiliation: Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Adjedj
authors.affiliation: Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium.
authors.forename: Mariano
authors.initials: M
authors.lastname: Pellicano
authors.affiliation: Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium.
authors.forename: Angela
authors.initials: A
authors.lastname: Ferrara
authors.affiliation: UGCT, Ghent University, Ghent, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: De Schryver
authors.affiliation: UGCT, Ghent University, Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Van Hoorebeke
authors.affiliation: FEops Besloten Vennootschap met Beperkte Aansprakelijkheid, Ghent, Belgium; IBiTech-bioMMeda, IMinds Medical IT, Ghent University, Ghent, Belgium.
authors.forename: Benedict
authors.initials: B
authors.lastname: Verhegghe
authors.affiliation: Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
authors.affiliation: Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: FEops Besloten Vennootschap met Beperkte Aansprakelijkheid, Ghent, Belgium; IBiTech-bioMMeda, IMinds Medical IT, Ghent University, Ghent, Belgium.
authors.forename: Matthieu
authors.initials: M
authors.lastname: De Beule
authors.affiliation: Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium. Electronic address: william.wijns@olvz-aalst.be.
authors.forename: William
authors.initials: W
authors.lastname: Wijns
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000175:diagnosis / Q000628:therapy*; D005240:Feasibility Studies; D006801:Humans; D010865:Pilot Projects; D011446:Prospective Studies; D015641:Radiography, Interventional; D012042:Registries; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D055114:X-Ray Microtomography
keywords: coronary bifurcation; double-stent technique; first-in-human; in vitro; percutaneous intervention