Turkiye Klinikleri Cardiovascular Sciences

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A Practical Technique to Advance Stent Through Uncrossable Coronary Lesions: A Prospective Cohort Study
Geçilemeyen Koroner Lezyonlarda Stenti İlerletmenin Pratik Tekniği: Prospektif Kohort Çalışması
Ömer ALYANa, Mutlu Çağan SÜMERKANb , Kudret KESKİNb , Hilal ACAR DEMİRc
aDepartment of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Türkiye
bDepartment of Cardiology, University of Health Sciences Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
cDepartment of Radiation Oncology, Bağcılar Medipol Mega University Hospital, İstanbul, Türkiye
Turkiye Klinikleri J Cardiovasc Sci. 2023;35(2):58-68
doi: 10.5336/cardiosci.2023-98476
Article Language: EN
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ABSTRACT
 Objective: Uncrossable coronary lesions are still challenging to treat. Several devices and techniques are introduced, including rotational atherectomy, or anchor balloon. However, these methods are expensive, not always available, and associated with lower procedural success and higher major adverse cardiac events. Our study describes a simple, effective method [patience technique (PT)] to advance a stent through uncrossable lesions that has not been described in the literature. Material and Methods: In a prospective study with 24 patients undergoing uncrossable lesion percutaneous coronary intervention with stent advancement failures, we identify PT and describe our experience with PT. The PT is the process of pushing the uncrossed same stent for a prolonged time under an optimum constant force to overcome the intraluminal friction. Results: Twenty-three (95.8%) patients had modified American College of Cardiology/ American Heart Association classification Type C, 22 (91.70%) diffuse [median length: 38 mm (quartiles 31.25-52.25)], 22 (91.70%) eccentric and 20 (83.30%) moderate-extensive calcified lesions. Respectively, 8 (27.59%) of 29 stenosis was in left anterior descending, and right coronary artery, 6 (20.69%) left circumflex coronary artery, 3 (10.35%) D1, 2 (6.90%) left main coronary artery-Cx, 1 (3.45%) LCxOM2 and saphenous vein graft-LCxOM2. The median stent advancement time was 134.00 seconds (quartiles 95.25-178.50). All procedures progressed after using the PT and finally resulted successfully without complications. Conclusion: The PT is feasible, and safe for facilitating the passage of stents through uncrossable lesions. Before advancing percutaneous cardiac intervention techniques, this method could be used advantageously in calcified, diffuse, and eccentric lesions.

Keywords: Coronary artery disease; percutaneous coronary intervention
ÖZET
 Amaç: Geçilemeyen koroner lezyonların tedavisi hâlen zorlayıcıdır. Bunun için rotasyonel aterektomi veya çapa balonu gibi çeşitli cihaz ve teknikler tanımlanmıştır. Ancak bu ve benzeri cihaz ve yöntemler pahalıdır, her zaman mevcut değildir, başarı oranları düşüktür, komplikasyon oranları yüksektir ve belirli koşullar altında uygulanabilmektedirler. Çalışmamızda, karmaşık yöntemlerden önce zorlayıcı geçilemeyen lezyonlarda stenti ilerletmek için basit, etkili, maliyetsiz, güvenli ve literatürde daha önce tanımlanmamış bir tekniği [sabır tekniği (ST)] açıklıyoruz. Gereç ve Yöntemler: Geçilmesi zor koroner lezyonların girişimi esnasında stent ilerletme işlemi başarısızlığa uğrayan 24 hasta üzerinde ileriye dönük çalışma ile yeni bir teknik tanımladık. ST, koroner arter ile stent arasındaki lümen içi sürtünme kuvvetinin üstesinden gelmek için optimum sabit bir kuvvet altında, periyodu uzatarak, uzun süre stenti itme işlemidir. Bulgular: Hastaların 23'ünde (%95,8) modifiye Amerikan Kardiyoloji Koleji/Amerikan Kalp Birliği sınıflandırması Tip C, 22'sinde (%91,70) yaygın [medyan lezyon uzunluğu: 38 mm (çeyrekler 31,25-52,25)], 22'sinde (%91,70) eksantrik ve 20'sinde (%83,30) orta-ileri düzeyde kalsifiye lezyonlar mevcuttu. Yirmi dokuz lezyonun 8'inde (%27,59) sağ koroner arter ve sol ön inen koroner arter, 6'sında (%20,69) sol sirkumfleks koroner arter, 3'ünde (%10,35) D1, 2'sinde (%6,90) sol ana koroner arter-Cx, 1'inde (%3,45) LCxOM2 ve safen ven greft lezyonları izlendi. Ortanca stent ilerletme süresi 134,00 sn (çeyrekler 95,25-178,50) saptandı. ST kullandıktan sonra tüm koroner girişimsel işlemleri komplikasyonsuz olarak başarıyla sonuçlandırıldı. Sonuç: Stentin geçirilmesi zor, eksantrik, diffüz ve ileri kalsifik koroner lezyonlarda, stent geçişini kolaylaştırmak için karmaşık yöntemlere geçmeden önce başarılı ve güvenilir bir yöntem olan ST kullanılabilir.

Anahtar Kelimeler: Koroner arter hastalığı; perkütan koroner girişim
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