The utility of stent enhancement to guide percutaneous coronary intervention for bifurcation lesions

Abstract

Aims: Percutaneous coronary intervention (PCI) of bifurcation lesions is complex and is technically very demanding. Coronary angiography is considered the gold standard method to guide PCI but has several limitations. The purpose of this study was to determine the utility of stent enhancement with StentBoost® (StB), a novel fluoroscopic imaging technique, and its potential role during bifurcation PCI.

Methods and results: This prospective study included 97 patients who underwent bifurcation PCI (98 bifurcations), using StB. Bifurcation lesions were classified according to the modified Medina classification. StB was performed in all patients to obtain improved stent visualisation and to detect optimal release and deployment. Therefore, three groups were formed, according to the quality of image: optimal visualisation, suboptimal visualisation and poor visualisation. Most of the bifurcation disease involved the main vessel (99%) and in 80 patients (81.6%) there was side branch involvement. Most bifurcations had both main vessel and side branch lesions (Medina 1,1,1) (70 patients, 71.4%). StB image quality was good in 79.6% of the cases (optimal visualisation of the stent and guidewire), was suboptimal in 19.4%, and poor in 1% (overlapping of structures or devices). In three cases, StB enabled the identification of the guidewire and angioplasty balloon passing outside stent borders during rewiring of the side branch.

Conclusions: Imaging techniques have a primary role during bifurcation PCI. StentBoost is a simple and quick method that offers several advantages, enabling improved stent visualisation, appropriate rewiring of the side branch, adequate stent expansion and optimal apposition of the struts to the wall.