Canadian Journal of Cardiology
Images in Cardiology| Volume 34, ISSUE 12, P1689.e1-1689.e2, December 2018

Efficacy of Simultaneous Kissing Stent Technique Using Two Polytetrafluoroethylene-Covered Stents for Severe Coronary Perforation Involving Bifurcation

Published:August 16, 2018DOI:
      A 75-year-old man presented with unstable angina. Coronary angiography (CAG) revealed severe stenosis at the mid-left circumflex artery (LCx), involving the bifurcation of the obtuse marginal (OM) branch. Following excimer laser-angioplasty, angiography revealed grade III coronary perforation (CP) (Fig. 1A; Video 1 , view video online). Despite performing prolonged balloon inflation, angiography revealed persistent minor bleeding and formation of pseudoaneurysm (Fig. 1B; Video 2 , view video online). Intravascular ultrasound (IVUS) revealed media dissolution at the carina side of the OM (Fig. 1, C-F). After switching to an 8-Fr guiding catheter, a polytetrafluoroethylene (PTFE)-covered stent (Graftmaster; Abbott Vascular, Tokyo, Japan) was implanted into the distal-LCx; the pseudoaneurysm was still found on angiogram (Video 3 , view video online). Therefore, other 2 PTFE-covered stents were implanted using the simultaneous kissing stent (SKS) technique into both the main branch and the OM, bridging to the distal-covered stent (Video 4 , view video online). IVUS revealed a semicircular stent expansion (Fig. 1, H-K). Final angiography revealed complete hemostasis (Fig. 1G; Video 5 , view video online). Computed tomography revealed good expansion of both stents (Fig. 1, L-N), and CAG after 1 year revealed good flow of both branches (Video 6 , view video online).
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      Figure 1Kissing stent using 2 covered stents to bailout coronary perforation. (A) Following excimer laser-angioplasty, perforation occurred. (B) After balloon hemostasis, formation of pseudoaneurysm and sustained minor bleeding were detected. (C-F) Intravascular ultrasound (IVUS) revealed a hematoma without an external elastic membrane (EEM; large arrows) and pseudoaneurysm at the same side of the obtuse marginal (OM) branch. (G) Angiography after 2 covered stents implantation using simultaneous kissing stent technique. (H-K) IVUS image; distal main branch (MB, [H]), distal OM (I), mid-portion of the covered stents ([J] OM; [K] MB). (L-N) Computed tomography imaging of the implanted covered stent after 6 months.
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