Three-dimensional optical coherence tomography reconstruction of bifurcation stenting using the Szabo anchor-wire technique

Abstract

Ostial lesions present unique challenges for percutaneous coronary intervention (PCI). These lesions are often more calcified, fibrotic, rigid, and more prone to elastic recoil. Intervention on these lesions is associated with higher procedural complications and higher rates of restenosis. Ostial lesions require precise stent placement in the ostium with the absence of side branch compromise. Accurate stent placement in the ostium without side branch compromise is difficult to accomplish with angiography alone. The Szabo technique uses two coronary guidewires for the correct placement in the aorto-ostial or bifurcation lesion. One guidewire is passed through the final cell of the stent strut and acts as the anchor wire. It helps to prevent migration of the stent beyond the ostium and facilitates the precise stenting at the ostium. This technique has several advantages including less reliance on angiography, lower rates of stent malposition and lower rates of incomplete stent coverage. Potential disadvantages include stent distortion and dislodgement from stent manipulation. We describe two cases of successful PCI to bifurcation lesions using the Szabo technique and confirmation of correct placement in the ostium with optical coherence tomography.

Keywords: Cardiac catheterization; Bifurcation lesion; Percutaneous coronary intervention; Optical coherence tomography; Ostial stenosis

Core tip: Percutaneous intervention of ostial and bifurcation lesions is associated with higher rates of restenosis and procedural complications. Vessel anatomy, histology, and the variable angle of takeoff of ostial lesions contribute to the challenging nature of intervention. Lesion histology demonstrates greater calcification, rigidity, eccentricity as well as thicker muscular and elastic tissue, which contribute to greater elastic recoil. The Szabo two-wire technique provides accurate and complete stent positioning within the ostium, with less dependence on angiography. Intravascular imaging such as with intravascular ultrasound and optical coherence tomography (OCT) can confirm proper stent positioning. We describe two cases of successful percutaneous coronary intervention to bifurcation lesions using the Szabo technique and confirmation of correct placement in the ostium with OCT.