title: Ex vivo mono-ring technique simplifies culotte stenting for treatment of true bifurcation lesions: Insights from bench testing and clinical application.
abstract: BACKGROUND
  Despite various culotte-based stenting techniques available clinically, the optimal one remains undetermined. The study aimed to test whether ex vivo mono-ring culotte stenting (MRC) was technically feasible and superior to mini culotte stenting (MCS) in treatment of coronary bifurcation lesions.
  
  
  METHODS
  Mono-ring culotte stenting was characterized by ex vivo wiring of the most proximal cell of the side branch (SB) stent to ensure a mono-ring result of the culotte stenting. Comparison of MRC vs. MCS in treatment of true bifurcation lesions was performed in vitro (n = 15 for each group) and in clinical case-controlled study with propensity matching at a ratio of 1:2 (n = 21 for MRC group; n = 42 for MCS group).
  
  
  RESULTS
  Compared to MCS, MRC had lower incidence of stent under-expansion band (0% vs. 53.3%, p = 0.002) and less residual ostial area stenosis of SB (9.2 ± 9.0% vs. 20.0 ± 14.8%, p = 0.023), as assessed in vitro by micro-computed tomography. In a case-controlled study, no adverse cardiac events were observed in the MRC group. The procedural success was similar between MRC and MCS (100% vs. 95.2%, p = 0.548), but MRC had less residual ostial stenosis of the SB (8.7% ± 11.0% vs. 16.8% ± 11.2%, p = 0.008), lower procedural (33.3 ± 9.5 min vs. 46.7 ± 15.6 min, p = 0.001) and fluoroscopic (19.7 ± 4.9 min vs. 26.2 ± 7.1 min, p < 0.001) time, and less contrast use (114.3 ± 28.9 mL vs. 156.5 ± 56.4 mL, p = 0.002).
  
  
  CONCLUSIONS
  Mono-ring culotte stenting as compared to MCS is associated with better bifurcation stent morphology, less procedural complexity and residual ostial SB stenosis.
authors: Lianglong
authors: L
authors: Chen
authors: Department of Cardiology, Fujian Medical University Union Hospital. fanlin1975@126.com.
authors: Lin
authors: L
authors: Fan
authors: Yukun
authors: Y
authors: Luo
authors: Wenliang
authors: W
authors: Zhong
authors: Linlin
authors: L
authors: Zhang
authors: Zhaoyang
authors: Z
authors: Chen
authors: Chaogui
authors: C
authors: Lin
authors: Yafei
authors: Y
authors: Peng
authors: Xingchun
authors: X
authors: Zheng
authors: Xianfeng
authors: X
authors: Dong
authors: Wei
authors: W
authors: Cai
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D004867:Equipment Design; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation*; D055114:X-Ray Microtomography
keywords: coronary bifurcation lesions; culotte stenting; percutaneous coronary intervention