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Percutaneous treatment of coronary bifurcation lesions: a novel “extended Y” technique with complete lesion stent coverage
  1. S Helqvist1,
  2. E Jørgensen1,
  3. H Kelbæk1,
  4. S Aljabbari1,
  5. L Thuesen2,
  6. J Flensted Lassen2,
  7. K Saunamäki1
  1. 1Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
  2. 2Department of Cardiology, Skejby Sygehus, Aarhus, Denmark
  1. Correspondence to:
    Dr Steffen Helqvist
    2014 Cardiac Catheterisation Laboratory, Department of Cardiology, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark; helqvist{at}rh.dk

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Bifurcation lesions are one of the major unsolved problems of percutaneous coronary intervention (PCI). Large metal burden in the artery, stent deformation, and stent overlap are problems associated with proposed techniques that use conventional stents.1–5 Several specially designed bifurcation devices have been proposed. However, none of these has been shown to be effective. We invented the “extended Y” technique, which uses conventional stent systems. In this technique, stenting of the main branch proximally and close to the origin of the side branch is followed by deployment of two kissing stents in a Y fashion in the distal branches, creating a short protrusion of a double stent barrel into the proximal stent. We studied this extended Y technique in bifurcations with disease of both the main branch and the two ostia of the distal branches.

PATIENTS AND METHODS

Thirty patients (22 men, mean (SD) age 64.6 (8.9) years) were treated. Bifurcations were left anterior descending/diagonal (50%), left anterior descending/septal (3%), circumflex/obtuse marginal (23%), or right coronary artery/posterior descending artery/posterolateral artery (23%). In four bifurcations the proximal part of the main branch was not diseased. Fifty per cent of patients had non-ST elevation acute coronary syndrome and 50% had stable angina. Side branch diameters were 2 mm or more. Paclitaxel (18 patients) or sirolimus eluting stents were used. Eight patients received a glycoprotein IIb/IIIa receptor blocker. …

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