Field of Vision
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jun 26, 2021; 13(6): 155-162
Published online Jun 26, 2021. doi: 10.4330/wjc.v13.i6.155
A Novel guide extension assisted stenting technique for coronary bifurcation lesions
Shams Y-Hassan, Rodney de Palma
Shams Y-Hassan, Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, Stockholm S-141 86, Sweden
Rodney de Palma, Buckinghamshire Healthcare NHS Trust, Buckinghamshire HP11 2TT, United Kingdom
Author contributions: Y-Hassan S contributed to the study conception, interpretation of the results, and manuscript write up; De Palma R contributed to interpretation of the results, critical review and manuscript write up; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors have no competing interests to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shams Y-Hassan, MBChB, MD, Doctor, Research Scientist, Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, SE-171 76, Stockholm S-141 86, Sweden. shams.younis-hassan@sll.se
Received: January 20, 2021
Peer-review started: January 20, 2021
First decision: February 28, 2021
Revised: March 18, 2021
Accepted: May 17, 2021
Article in press: May 17, 2021
Published online: June 26, 2021
Processing time: 153 Days and 3.7 Hours
Abstract

A challenging technical scenario frequently encountered in a percutaneous coronary intervention of a coronary bifurcation lesion (CBL) is stent implantation of only the stenosed segment without compromising the other two normal segments in non-true bifurcation lesions. Another is precise stent implantation covering the side branch ostium without leaving excessive stent metal at the other two segments of a bifurcation lesion in complex true bifurcation lesions. The aim of this study was to describe a novel stenting technique for both non-true and true CBLs by using a guide extension catheter (GuideLiner). With the assistance of a guide extension catheter mounted on both the main and the side-branch guidewires and with its intubation down to the bifurcation carina, a stent can be implanted in the side branch segment or distal main segment of the bifurcation lesion appropriately without compromising the other two segments of the coronary bifurcation. Stent implantation is described in three bifurcation lesions in three cases and shown in detail with illustrative figures. The technique facilitates side-branch only stenting in side-branch mono-ostial (medina 0, 0, 1) CBL or only the distal main segment in distal mono-ostial (medina 0, 1, 0) CBL without compromising the other two remaining segments when using the one-stent technique in non-true CBLs without leaving unnecessary excessive stent metal at the bifurcation site and when using a two-stent technique in complex true bifurcation lesions (tri-ostial or medina 1, 1, 1). Consequently, through optimizing stent deployment, the technique may have the potential to reduce the risk of subacute stent thrombosis and future in-stent restenosis. The most appropriate lesions suitable for the technique, and some other practical tips are also described.

Keywords: Coronary bifurcation lesion; GuideLiner stenting; Percutaneous coronary intervention; One- or two-stenting technique; Novel descriptive, intelligible and ordered classification; Medina classification

Core Tip: A novel stenting technique for coronary bifurcation lesions (CBLs) is presented. With the help of a guide extension-assisted technique using a GuideLiner mounted on both guidewires in the branches of the bifurcation lesion and advanced to the carina of the bifurcation, a stent can be implanted at the most possible appropriate site of the side branch in side-branch mono-ostial (medina 0, 0, 1) or in the distal mono-ostial (medina 0, 1, 0) in non-true CBLs. The technique can also be used to stent the side branch in two-stent techniques for complex true CBLs (tri-ostial or medina 1, 1, 1).