Modified kissing balloon inflation associated with better results after Culotte stenting for bifurcation lesions: A bench test.

BACKGROUND: Main vessel (MV) stent deformation and overstretch caused by classical kissing balloon inflation (C-KBI) using two balloons with a longer overlapping in the MV for bifurcation lesions has caused a widespread concern. PURPOSE: This bench study tested our hypothesis that mini-KBI (M-KBI) with a shorter protrusion of side branch (SB) balloon would ascertain a better result after Culotte stenting. METHODS: Twenty-four coronary stents were deployed using Culotte approach in twelve bifurcation models with a bifurcation angle of 45°, 3.5 mm in MV diameter, and 3.0 mm in SB diameter. After stent implantation, the final KBI were assigned to C-KBI (two kissing balloons juxtaposed within the MV stent, at least overlap for 3 mm; n = 6) and M-KBI (the proximal marker of SB balloon just sited at the level of upper edge of SB ostium; n = 6). Proximal optimization technique (POT) was performed after KBI. Stent geometry was visually evaluated based on bench photos, microscopy, videoscopy, micro-CT, and scanning electron microscopy. Stent deformation index, minimal lumen diameter, and cross-sectional area at either carina level of MV and ostium of SB were measured from optical coherence tomography (OCT). RESULTS: In Culotte technique, C-KBI was associated with visually significant stent deformation, overexpansion and the "bottleneck" effect of the MV stent, which could not be effectively rectified by POT, while M-KBI could keep the circle shape of MV stent with good stent apposition in both MV and SB stent. By quantitative measurements, deformation index of MV was 0.06 ± 0.01 after M-KBI, significantly lower than 0.25 ± 0.02 if C-KBI was performed. In the line in carina, compared to C-KBI, M-KBI has smaller CSA-stent/CSA-reference, which indicated a less overstretch of MV stent. However, minimal lumen diameter and cross-sectional area of SB ostium was not different in the mini-KBI group (3.0958 ± 0.0285 mm and 7.9667 ± 0.1741 mm), when compared those after C-KBI (3.1217 ± 0.0772 mm and 7.9083 ± 0.3115 mm, p > .05). CONCLUSIONS: Followed by POT, M-KBI is preferable than C-KBI in preventing stent deformation, overexpansion in MV stent and could get well apposed of MV stent and well-opened SB stent as expected in a Culotte technique.

Renal artery intervention for a patient with flash pulmonary edema accompanied by elevation of troponin levels due to bilateral renal artery stenosis and multivessel coronary disease: a case report.

An 84-year-old woman complaining of acute-onset chest distress for 2 hours was referred to the Department of Cardiology, Guangzhou Red Cross Hospital, China. A physical examination showed signs of acute pulmonary edema with considerably elevated blood pressure of 186/120 mmHg. An electrocardiogram showed ST segment depression in leads I, II, and III, and from V4 to V6. A laboratory test showed markedly elevated creatine, high-sensitivity cardiac troponin T, and N-terminal pro-brain natriuretic peptide levels. Echocardiography showed a mildly enlarged left ventricle with an ejection fraction of 43%. The patient was diagnosed with acute coronary syndrome, non-ST segment elevation myocardial infarction, and Killip 3 grade heart function. The non-ST segment elevation myocardial infarction Global Registry of Acute Coronary Events score was 156. Emergency coronary angiography showed severe three-vessel disease with a global ejection fraction of 50% based on left ventricular angiography. Selective renal artery angiography was performed and major stenosis at the ostia in both renal arteries was found. We did not touch the coronary artery, but performed intervention of the renal artery by implanting two bare metal stents in both ostia of bilateral renal arteries. An unexpected clinical benefit was obtained.