Clinical Images

The Reverse T-Stenting and Small Protrusion Technique: A Novel Technique for Coronary Bifurcation Lesions

Ioannis Tsiafoutis, MD, PhD1;  Theodoros Zografos, MD, PhD1;  Athanasios Antonakopoulos, MD, MSc1;  Michael Koutouzis, MD, PhD1;  Grigorios Tsigkas, MD, PhD2;  Nikolaos Bourboulis, MD, PhD1;  Apostolos Katsivas, MD, PhD1

Ioannis Tsiafoutis, MD, PhD1;  Theodoros Zografos, MD, PhD1;  Athanasios Antonakopoulos, MD, MSc1;  Michael Koutouzis, MD, PhD1;  Grigorios Tsigkas, MD, PhD2;  Nikolaos Bourboulis, MD, PhD1;  Apostolos Katsivas, MD, PhD1

J INVASIVE CARDIOL 2017;29(12):E195-E196.

Key words: new technique, bifurcation lesions, cardiac imaging


Bifurcation lesions may be encountered in approximately 15%-20% of percutaneous coronary interventions (PCIs).1 Current consensus suggests provisional stenting of the side branch (SB) as the preferred strategy;2 nevertheless, a two-stent approach is required in up to 30% of procedures. Among several bifurcation techniques, the T-stenting and small protrusion (TAP) technique has been shown to provide complete stent coverage of the SB ostium and minimal stent overlap, with favorable long-term clinical outcomes.3 

We describe a novel technique based on a modification of TAP stenting, suitable for procedures where a two-stent strategy is predetermined (Figure 1). In the reverse TAP technique, SB stenting is performed first with a similar, small protrusion of the SB stent. Kissing-balloon inflation modifies the proximal part of the stent around the SB ostium, the SB wire is retrieved, and the main vessel (MV) stent is subsequently delivered. Following rewiring of the SB through the MV stent struts, the procedure is finalized by kissing-balloon inflation (Figure 2). 

The reverse TAP technique allows for reduced guide catheter sizes, and provides complete coverage of the SB ostium with no stent protrusion into the MV and minimal stent overlap, while offering two important advantages compared with the traditional TAP technique. There is no need to jail the SB wire and no need to pass a stent through stent struts. Therefore, the reverse TAP technique allows for a safer and less complex procedure. An obvious disadvantage is that this technique does not allow for a provisional approach, thereby limiting its use in true bifurcation lesions where a two-stent procedure is deemed appropriate.

References

1.    Latib A, Colombo A. Bifurcation disease: what do we know, what should we do? JACC Cardiovasc Interv. 2008;1:218-226.

2.    Lassen JF, Holm NR, Banning A, et al. Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. EuroIntervention. 2016;12:38-46.

3.    Naganuma T, Latib A, Basavarajaiah S, et al. The long-term clinical outcome of T-stenting and small protrusion technique for coronary bifurcation lesions. JACC Cardiovasc Interv. 2013;6:554-561.


From 1the Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece; and 2the Department of Cardiology, University of Patras, Patras, Greece. 

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

Manuscript accepted May 10, 2017. 

Address for correspondence: Dr Theodoros Zografos, Department of Cardiology, Hellenic Red Cross Hospital, 1 Athanasaki Street, 11521, Athens, Greece. Email: theodoroszografos@gmail.com

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