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Efficacy of Simultaneous Kissing Stent Technique Using Two Polytetrafluoroethylene-Covered Stents for Severe Coronary Perforation Involving Bifurcation
Corresponding author: Dr Itsuro Morishima, Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki 503-0864, Japan. Tel.: +81584813341; fax: +81584755715.
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).
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.
, view video online). Despite performing prolonged balloon inflation, angiography
revealed persistent minor bleeding and formation of pseudoaneurysm (Fig. 1B; Video 2 
