Szabo technique versus conventional angiographic placement in bifurcations 010-001 of Medina and in aorto-ostial stenting: angiographic and procedural results.

AIMS

The best strategy for stenting in bifurcations remains unclear. Szabo et al described a technique for accurate stent placement in bifurcations 010-001 or in aorto-ostial lesions. Its feasibility has been validated in animal models and small clinical series, but its safety and procedural results have never been compared to conventional positioning.

METHODS AND RESULTS

In a retrospective search, 257 out of 2,596 intervened lesions corresponded to Medina 010 (108, 42.0%)/001 (66, 25.7%) bifurcations or aorto-ostial lesions (83, 32.3%). Szabo was the initial choice in 78. Crude analysis showed significant differences between groups in several control variables, that disappeared after propensity score matching. Cross-over occurred in nine (11.7%) Szabo cases vs. no case in the conventional group. Two independent blinded investigators evaluated the angiographic result immediately after stent deployment. Szabo reduced the incidence of stent malpositioning (6.4% vs. 41.0%, p=0.000001), protrusion in the non-stented vessel/aorta (6.4% vs. 34.6%, p=0.00003) and incomplete scaffolding of the plaque (0.0% vs. 7.7%, p=NA). No significant differences regarding complications, procedural success or procedural complexity were observed after 30 days follow-up.

CONCLUSIONS

The Szabo technique reduces the incidence of angiographic malpositioning in Medina 010/001 bifurcations and aorto-ostial lesions, without increasing procedural complications.