The impact of the bifurcation angle for the Nano-Crush two-stent coronary bifurcation technique on long-term outcomes in a real-world clinical population

Claudiu Ungureanu; Alexandre Natalis; Mihai Cocoi; Silviu Dumitrascu; Tim Noterdaeme; Olivier Gach; Adrien Jossart; Raphael Soetens; Giuseppe Colletti

doi:10.1016/j.carrev.2024.02.017

The impact of the bifurcation angle for the Nano-Crush two-stent coronary bifurcation technique on long-term outcomes in a real-world clinical population

Cardiovasc Revasc Med. 2024 Mar 12:S1553-8389(24)00070-8. doi: 10.1016/j.carrev.2024.02.017. Online ahead of print.

Authors

Claudiu Ungureanu¹, Alexandre Natalis², Mihai Cocoi³, Silviu Dumitrascu⁴, Tim Noterdaeme⁵, Olivier Gach⁵, Adrien Jossart⁴, Raphael Soetens⁴, Giuseppe Colletti²

Affiliations

¹ Cardiovascular Jolimont Hospital, La Louvière, Belgium. Electronic address: claudiu.ungureanu@jolimont.be.
² Cardiovascular Department, Clinique Saint Joseph, Vivalia, Arlon, Belgium.
³ Cardiovascular Department, Institutul Inimii, Cluj, Romania.
⁴ Cardiovascular Jolimont Hospital, La Louvière, Belgium.
⁵ Cardiovascular Departement, MontLégia, Liège, Belgium.

PMID: 38494371
DOI: 10.1016/j.carrev.2024.02.017

Abstract

Aim: This study aims to assess the direct impact of bifurcation angle (BA) on immediate procedural outcomes and patient prognosis post-Nano-Crush stenting for coronary bifurcation lesions.

Methods: A retrospective analysis was conducted for all consecutive patients treated with the Nano-Crush technique across two high-volume interventional centers from January 2020 to October 2022.

Primary endpoint: comparison of target lesion failure rate in two cohorts based on bifurcation angle (<70° vs. ≥70°), with secondary endpoints including side branch ostium coverage, rate of successful final kissing balloon inflation (FKBI), need for conversion to another technique, and procedure length.

Results: Baseline demographics included 71 patients in the BA<70° group and 49 in the BA≥70° group, with well-balanced characteristics. Angiographic characteristics revealed similar trends, including anatomic and morphological lesion characteristics (referencing Syntax score, Medina classification, and presence of calcifications). Both groups predominantly had complex coronary disease, with a baseline mean Syntax score of 24.18 ± 8.19 in the BA<70° group and 23.91 ± 7.29 in the BA≥70° group, respectively. A dedicated debulking device for lesion preparation was used in 25.35 % of patients in the first group and in 28.57 % of patients in the second group. The primary endpoint occurred in 5.63 % of patients in the BA<70° group and in 4.08 % of patients in the BA≥70° group (P = 0.7014) after ≥ 2 years of clinical follow-up. Angiographic success was achieved in 100 % of both groups, with procedural time averaging 74.99 ± 25.55 min in the BA≥70° and 76.94 ± 27.81 min in the BA<70° (P = 0.6922). The rate of successful final kissing balloon inflation was 98.59 % in the BA<70° group and 95.91 % in the BA≥70° group (P = 0.3566). The mean contrast volume was 189.54 ± 73.74 ml in BA<70° and 168.9 ± 62.77 ml in BA≥70° (P = 0.1126). Clinical follow-ups at 30 days and 2 years revealed similar outcomes and complications for each group, as summarized in Table 3.

Conclusions: Our results demonstrate that the bifurcation angle does not significantly impact long-term clinical outcomes or procedural parameters, such as side branch ostium coverage, conversion to a modified DK Crush technique, FKBI success rate, and procedure length. These findings suggest that the Nano-Crush technique can be a viable option for bifurcation lesions, irrespective of the bifurcation angle, achieving optimal side branch ostium coverage while preventing excessive protrusion into the main vessel.

Keywords: Complex coronary percutaneous intervention; Coronary bifurcation; Nano-Crush technique; Personalized coronary 3D bench test modelling; Two stents techniques.