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Long-term outcomes following mini-crush versus culotte stenting for the treatment of unprotected left main disease: insights from the Milan and New-Tokyo (MITO) registry Intravascular ultrasound predictors of angiographic restenosis after sirolimus-eluting stent implantation Impact of myocardial fibrosis on left ventricular remodelling, recovery, and outcome after transcatheter aortic valve implantation in different haemodynamic subtypes of severe aortic stenosis Comparison of 1-Year Pre- And Post-Transcatheter Aortic Valve Replacement Hospitalization Rates: A Population-Based Cohort Study Coronary calcium as a predictor of coronary events in four racial or ethnic groups Long-term results after PCI of unprotected distal left main coronary artery stenosis: the Bifurcations Bad Krozingen (BBK)-Left Main Registry Ticagrelor versus clopidogrel in patients with acute coronary syndromes Defining a new standard for IVUS optimized drug eluting stent implantation: the PRAVIO study A Controlled Trial of Rivaroxaban After Transcatheter Aortic-Valve Replacement The role of integrated backscatter intravascular ultrasound in characterizing bare metal and drug-eluting stent restenotic neointima as compared to optical coherence tomography
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Original Research2020 Apr 28.

JOURNAL：Eurointervention. Article Link

Double-Kissing Culotte Technique for Coronary Bifurcation Stenting - Technical evaluation and comparison with conventional double stenting techniques

GG Toth, V Sasi; D Franco et al. Keywords: technique improvement; culotte technique

ABSTRACT

AIMS - To assess, whether Culotte technique could be improved by an additional kissing dilation prior main branch (MB) stenting.

 

METHODS AND RESULTS - Double-kissing (DK) Culotte was compared to Culotte and DK-Crush techniques in bench model (n=24). Results were evaluated for stent apposition, for luminal opening and for flow dynamics.Total procedure duration of DK-Culotte was 18.3±3.4min, significantly lower than for DK-Crush (24.3±5.7min; p=0.015), however similar to Culotte (21.6±5.9min, p=0.104).In DK-Culotte overall rate of moderate (200-500mm) and significant (>500mm) malapposition was 2.1±1.9% and 0.4±0.2%; similar as compared to Culotte (3.7±3.8%, p=0.459 and 1.0±1.0%, p=0.517; respectively), and lower as compared to DK-Crush (8.1±2.5%, p<0.001 and 3.7±5.3%, p=0.002; respectively). Lower malapposition rate of DK-Culotte as compared to DK-Crush was due to less moderate and significant malapposition in proximal MB (0.0±0.0% vs. 14.0±7.6%, p<0.001 and 0.0±0.0% vs. 4.2±9.1%, p=0.026, respectively). Micro computed tomography did not show difference in luminal opening at proximal MB, distal MB or SB. There was no difference either in maximum shear rate or in areas of high shear or recirculation.

 

CONCLUSIONS - Bench tests data suggest that DK approach facilitates Culotte technique. Clinical validity and relevance remains to be confirmed in larger in vivo population.




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