Szabo technique versus conventional angiographic placement in bifurcations 010-001 of Medina and in aorto-ostial stenting: angiographic and procedural results

Abstract

Aims: The best strategy for stenting in bifurcations remains unclear. Szabo et al described a technique for accurate stent placement in bifurcations 010-001 or in aorto-ostial lesions. Its feasibility has been validated in animal models and small clinical series, but its safety and procedural results have never been compared to conventional positioning.

Methods and results: In a retrospective search, 257 out of 2,596 intervened lesions corresponded to Medina 010 (108, 42.0%)/001 (66, 25.7%) bifurcations or aorto-ostial lesions (83, 32.3%). Szabo was the initial choice in 78. Crude analysis showed significant differences between groups in several control variables, that disappeared after propensity score matching. Cross-over occurred in nine (11.7%) Szabo cases vs. no case in the conventional group. Two independent blinded investigators evaluated the angiographic result immediately after stent deployment. Szabo reduced the incidence of stent malpositioning (6.4% vs. 41.0%, p=0.000001), protrusion in the non-stented vessel/aorta (6.4% vs. 34.6%, p=0.00003) and incomplete scaffolding of the plaque (0.0% vs. 7.7%, p=NA). No significant differences regarding complications, procedural success or procedural complexity were observed after 30 days follow-up.

Conclusions: The Szabo technique reduces the incidence of angiographic malpositioning in Medina 010/001 bifurcations and aorto-ostial lesions, without increasing procedural complications.