A novel 3-d reconstruction system for the assessment of bifurcation lesions treated by the mini-crush technique.

BACKGROUND: Conventional two-dimensional angiography lacks the ability to properly image the true bifurcation geometry, and its percutaneous coronary intervention-induced changes in the clinical setting. METHODS AND RESULTS: A novel three-dimensional reconstruction system was investigated by retrospectively analyzing 39 lesions in 35 consecutive patients with coronary bifurcation disease treated with the mini-crush technique. At baseline, significant correlations were proved between two- and three-dimensional systems in terms of either reference vessel diameter (R(2)= 0.68 and 0.29 for main and side branches, respectively), minimum lumen diameter (R(2)= 0.73 and 0.36), stenosis diameter (R(2)= 0.69 and 0.29), and lesion length (R(2)= 0.48 and 0.58). These results were consistent with those observed after the procedure and at 8-month follow-up. Lesion length was significantly longer with the three-dimensional compared to the two-dimensional system for both main and side branches (P < 0.001, and P = 0.007, respectively). CONCLUSIONS: The three-dimensional quantitative reconstruction system may provide accurate evaluation of the complex curvilinear structure of bifurcation lesions when using a double stent technique.

The "mini-crush technique" for the treatment of coronary trifurcation lesions.

AIMS: Recent evidence suggest that coronary bifurcation lesions might be treated by DES using "the mini-crush technique" with low rate of MACE and restenosis both at main and side branches. However, the treatment of a coronary trifurcation lesion is more problematic. Here we assess the feasibility of the "mini-crush technique" for treating trifurcation lesions. METHODS AND RESULTS: We report on the treatment of trifurcation lesions using DES in all branches by the mini-crush technique in five consecutive patients (65+/-11.5 years) from December 2004 till March 2006. Independently, from the anatomical type of trifurcation, the mini-crush procedure was performed in all cases. After predilatation of all branches, positioning of stents in both side branches at a distance of 1-2 mm proximally to the carina of the trifurcation was performed. Side-branch stents were then deployed sequentially and crushed at the same time by a balloon positioned in the main branch. Afterwards, the main branch stent was advanced to cover the ostium of both side branches and deployed. The jailed wire technique was employed in all cases, and if possible in both branches. Final triple kissing balloon was employed in all cases. The "mini-crush technique" was performed safely in all the five patients obtaining an excellent angiographic result at 8.0+/-1.0 months follow-up angiography. CONCLUSIONS: The "mini-crush technique" with DES can be safely performed giving complete coverage of the ostium of side branches and optimising side branch access.