Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:118 - Vol. 70 Num.02 DOI: 10.1016/j.rec.2016.04.053

Hybrid Culotte for Bifurcations With Side Branch Lesion

Manuel Pan a, Soledad Ojeda a, Jorge Chavarría a,

a Departamento de Cardiología, Hospital Reina Sofía, Universidad de Córdoba (IMIBIC), Córdoba, Spain

Article

A diabetic 78-year-old man with unstable angina was admitted to the hospital. Multivessel disease with preserved left ventricular function was observed. The left anterior descending artery (LAD) showed a {1,1,1} bifurcation lesion with diffuse stenosis at the diagonal branch (D1) (Figure 1). After predilation of D1, a long dissection occurred (Figure 1). A culotte technique was performed by the implantation of a 2.5 x 28 mm bioresorbable vascular scaffold (BVS) at D1-LAD (Figure 1), and a metallic drug eluting stent (DES) at LAD. After BVS implantation, postdilation with a noncompliant balloon 2.75 x 15 mm through the struts of the BVS (Figure 1) was performed and a 3.0 x 18 mm DES was implanted at LAD (Figure 1). The procedure was finished with kissing balloon inflation (3 + 2.5 mm noncompliant balloon diameters) (Figure 1). The final result is shown in Figure 1. The final optical coherence tomography with excellent result is shown in Figure 2. When using this technique, the fragility of the BVS is an advantage. The device does not offer any resistance to dilation through the struts. Another advantage of this strategy is the possibility of using conventional kissing balloon inflation. Although it induces BVS proximal strut fracture, the overlapped metallic stent preserves the scaffolding in the proximal part of the bifurcation. To minimize the potential risk of scaffold thrombosis, dual antiplatelet therapy for at least 12 months seems an advisable option. Finally, studies are needed to determine the value of this technique in comparison with other therapeutic strategies in complex bifurcation lesions.

Figure 1.

Figure 2.

CONFLICTS OF INTEREST

M. Pan has received minor lecture fees from Abbott and S. Ojeda has received minor lecture fees from Abbott.

Corresponding author: jorgechv@yahoo.com

1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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