Classic Culotte Stenting

Dr. Onur Akgün

Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

The section on “Classic Culotte Stenting” discusses the complexities of treating coronary bifurcation lesions, which pose unique challenges in interventional cardiology. These lesions require careful consideration of var- ious factors, including the anatomy of the arteries and the approach to stenting. The DEFINITION study is highlighted as a significant research effort aimed at establishing criteria for complex bifurcation lesions, demonstrating that while both provisional and two-stent strategies yield similar outcomes in terms of major clinical events after one year, the two-stent approach shows fewer cardiac deaths in complex cases. The cu- lotte stenting technique, introduced in 1998, involves placing two stents in a fashion that resembles pant legs, offering effective solutions for specific lesion types, such as those with calcification or large side branches. The procedure requires meticulous pre-procedural preparation, including selecting appropriate catheters and imaging methods to assess plaque characteristics. The steps of the culotte stenting procedure are detailed, from guide wire placement to stent implantation and optimization techniques. Key considerations include choosing the right stent sizes, ensuring proper stent apposition, and performing proximal optimization to min- imize complications. Overall, the culotte technique is a valuable approach for managing complex bifurcation lesions, but it requires careful planning and execution.

Keywords: Coronary artery disease; Percutaneous coronary intervention; Classic Culotte

Referanslar

  1. Chen S-L, Sheiban I, Xu B, Jepson N, Paiboon C, Zhang J-J, Ye F, Sansoto T, Kwan TW and Lee M. Impact of the com- plexity of bifurcation lesions treated with drug-eluting stents: the DEFINITION study (Definitions and impact of complEx biFurcation lesIons on clinical outcomes after percutaNeous coronary IntervenTIOn using drug-eluting steNts). JACC: Cardiovascular Interventions. 2014;7:1266-1276. [Crossref]  [PubMed]
  2. Burzotta F, Lassen J, Lefèvre T, Banning AP, Chatzizisis Y, Johnson TW, Ferenc M, Rathore S, Albiero R and Pan M. Percutaneous coronary intervention for bifurcation coro- nary lesions: the 15th consensus document from the Euro- pean Bifurcation Club: 15th EBC consensus on bifurcation. EuroIntervention. 2021;16:1307. [Crossref]  [PubMed]  [PMC]
  3. Chevalier B, Glatt B, Royer T and Guyon P. Placement of coronary stents in bifurcation lesions by the "culotte" tech- nique. The American journal of cardiology. 1998;82:943- 949. [Crossref]  [PubMed]
  4. Banning AP, Lassen JF, Burzotta F, Lefevre T, Darremont O, Hildick-Smith D, Louvard Y and Stankovic G. Percuta- neous coronary intervention for obstructive bifurcation le- sions: the 14th consensus document from the European Bi- furcation Club. EuroIntervention. 2019;15:90-98. [Crossref]  [PubMed]
  5. Thuijs DJ, Kappetein AP, Serruys PW, Mohr F-W, Morice M-C, Mack MJ, Holmes DR, Curzen N, Davierwala P and Noack T. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. The Lancet. 2019;394:1325-1334. [Link]
  6. Adriaenssens T, Byrne RA, Dibra A, Iijima R, Mehilli J, Bruskina O, Schömig A and Kastrati A. Culotte stenting technique in coronary bifurcation disease: angiographic fol- low-up using dedicated quantitative coronary angiographic analysis and 12-month clinical outcomes. European heart journal. 2008;29:2868-2876. [Crossref]  [PubMed]
  7. Morice M-C. Bifurcation lesions: a never-ending challenge. 2008;29:2831-2832. [Crossref]  [PubMed]
  8. Lassen JF, Albiero R, Johnson TW, Burzotta F, Lefèvre T, Iles TL, Pan M, Banning AP, Chatzizisis YS and Ferenc M. Treatment of coronary bifurcation lesions, part II: implant- ing two stents. The 16th expert consensus document of the European Bifurcation Club. EuroIntervention. 2022;18:457. [Crossref]  [PubMed]  [PMC]
  9. Kervinen K, Niemelä M, Romppanen H, Erglis A, Kumsars I, Maeng M, Holm NR, Lassen JF, Gunnes P and Stavnes S. Clinical outcome after crush versus culotte stenting of coro- nary artery bifurcation lesions: the Nordic Stent Technique Study 36-month follow-up results. JACC: Cardiovascular Interventions. 2013;6:1160-1165. [Crossref]  [PubMed]