Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2017; 9(4): 384-390
Published online Apr 26, 2017. doi: 10.4330/wjc.v9.i4.384
Three-dimensional optical coherence tomography reconstruction of bifurcation stenting using the Szabo anchor-wire technique
Katherine Yu, Harkawal Hundal, Todd Zynda, Arnold Seto
Katherine Yu, Harkawal Hundal, Todd Zynda, Department of Cardiology, University of California Irvine, Orange, CA 92868, United States
Arnold Seto, Department of Cardiology, Long Beach Veterans Affairs Medical Center, Long Beach, CA 90822, United States
Author contributions: Yu K, Hundal H, Zynda T and Seto A contributed equally to this work.
Institutional review board statement: None.
Informed consent statement: None.
Conflict-of-interest statement: The authors have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Arnold Seto, MD, MPA, Chief of Cardiology, Department of Cardiology, Long Beach Veterans Affairs Medical Center, 5901 E 7th Street, 111C, Long Beach, CA 90822, United States. arnoldseto@yahoo.com
Telephone: +1-714-4566699 Fax: +1-714-4568895
Received: October 11, 2016
Peer-review started: October 13, 2016
First decision: November 30, 2016
Revised: February 4, 2017
Accepted: February 28, 2017
Article in press: March 2, 2017
Published online: April 26, 2017
Processing time: 199 Days and 9 Hours
Abstract

Ostial lesions present unique challenges for percutaneous coronary intervention (PCI). These lesions are often more calcified, fibrotic, rigid, and more prone to elastic recoil. Intervention on these lesions is associated with higher procedural complications and higher rates of restenosis. Ostial lesions require precise stent placement in the ostium with the absence of side branch compromise. Accurate stent placement in the ostium without side branch compromise is difficult to accomplish with angiography alone. The Szabo technique uses two coronary guidewires for the correct placement in the aorto-ostial or bifurcation lesion. One guidewire is passed through the final cell of the stent strut and acts as the anchor wire. It helps to prevent migration of the stent beyond the ostium and facilitates the precise stenting at the ostium. This technique has several advantages including less reliance on angiography, lower rates of stent malposition and lower rates of incomplete stent coverage. Potential disadvantages include stent distortion and dislodgement from stent manipulation. We describe two cases of successful PCI to bifurcation lesions using the Szabo technique and confirmation of correct placement in the ostium with optical coherence tomography.

Keywords: Cardiac catheterization; Bifurcation lesion; Percutaneous coronary intervention; Optical coherence tomography; Ostial stenosis

Core tip: Percutaneous intervention of ostial and bifurcation lesions is associated with higher rates of restenosis and procedural complications. Vessel anatomy, histology, and the variable angle of takeoff of ostial lesions contribute to the challenging nature of intervention. Lesion histology demonstrates greater calcification, rigidity, eccentricity as well as thicker muscular and elastic tissue, which contribute to greater elastic recoil. The Szabo two-wire technique provides accurate and complete stent positioning within the ostium, with less dependence on angiography. Intravascular imaging such as with intravascular ultrasound and optical coherence tomography (OCT) can confirm proper stent positioning. We describe two cases of successful percutaneous coronary intervention to bifurcation lesions using the Szabo technique and confirmation of correct placement in the ostium with OCT.