Placement of coronary stents in bifurcation lesions by the “culotte” technique

• Published in: The American journal of cardiology Vol. 82; no. 8; pp. 943 - 949
• Main Authors: Chevalier, Bernard, Glatt, Bernard, Royer, Thierry, Guyon, Philippe
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.10.1998; Elsevier; Elsevier Limited
• Subjects: Angioplasty; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Blood vessels; Coronary Angiography; Coronary Disease - diagnostic imaging; Coronary Disease - pathology; Coronary Disease - therapy; Diseases of the cardiovascular system; Female; Follow-Up Studies; Heart attacks; Humans; Male; Medical procedures; Medical sciences; Middle Aged; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Stents; Treatment Outcome; Human; Treatment; Coronary artery; Instrumentation therapy; Bifurcation; Instrumental dilatation; Technique
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(98)00510-4

Coronary angioplasty of bifurcation lesions remains a technical challenge. Balloon angioplasty induces recoil and the “snow-plow” effect with a risk of side branch occlusion. The late result is associated with a high rate of reintervention. Randomized studies in nonbifurcated lesions have demonstrated better short- and midterm results after stent placement. We propose the “culotte” ∗technique as a new technique to place intracoronary stents in bifurcation lesions: implantation of 2 similar stents in 2 steps in the main branch and in the side branch with overlapping of the 2 stents in the main branch before bifurcation. We performed this technique in 50 patients (in the left anterior diagonal branch in 33, in the left circumflex obtuse marginal branch in 12, in the right coronary artery in 4, and in the left main coronary artery in 1). The clinical success rate was 94% with 3 non–Q-wave myocardial infarctions. Late results indicated a 24% target lesion revascularization rate, which improved when a true kissing balloon inflation was used to achieve final deployment of both stents. This culotte technique is highly feasible and provides excellent short-term results. Assessment of its midterm benefit requires further study.