Covered Stent Fenestration for Side Branch Salvage in Bifurcation Coronary Perforation: A Systematic Bench-Test Evaluation

Journal of the Society for Cardiovascular Angiography & Interventions Pub Date : 2026-10-01 Epub Date: 2026-07-28 DOI:10.1016/j.jscai.2026.105521

Troels Yndigegn MD, PhD, Per Bondesson MD, Göran K. Olivecrona MD, PhD, Henrik Wagner MD, PhD, Sasha Koul MD, PhD, Matthias Götberg MD, PhD, Helle Soeholm MD, PhD, David Erlinge MD, PhD, Mihai Cocoi MD, Olivier Gach MD, PhD, Adrien Jossart MD, Quentin Trefois MD, Agostino Spano MD, Giuseppe Colletti MD, Gregor Leibundgut MD, Marouane Boukhris MD, Claudiu Ungureanu MD, Moman A. Mohammad MD, PhD

{"title":"Covered Stent Fenestration for Side Branch Salvage in Bifurcation Coronary Perforation: A Systematic Bench-Test Evaluation","authors":"Troels Yndigegn MD, PhD, Per Bondesson MD, Göran K. Olivecrona MD, PhD, Henrik Wagner MD, PhD, Sasha Koul MD, PhD, Matthias Götberg MD, PhD, Helle Soeholm MD, PhD, David Erlinge MD, PhD, Mihai Cocoi MD, Olivier Gach MD, PhD, Adrien Jossart MD, Quentin Trefois MD, Agostino Spano MD, Giuseppe Colletti MD, Gregor Leibundgut MD, Marouane Boukhris MD, Claudiu Ungureanu MD, Moman A. Mohammad MD, PhD","doi":"10.1016/j.jscai.2026.105521","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Coronary perforation at a bifurcation level is a life-threatening emergency. Covered stents may seal the defect but risk side-branch occlusion. We evaluated the feasibility and technical considerations of guide wire fenestration at coronary bifurcations and present a case where a covered side branch was successfully salvaged.</div></div><div><h3>Methods</h3><div>A transparent bifurcation phantom replicating coronary anatomy was constructed and integrated into a pulsatile flow system. Three fenestration strategies were evaluated: (1) a balloon-blocking approach, in which inflation of a balloon in the main branch after covered stent deployment was hypothesized to facilitate wire redirection and fenestration; (2) a microcatheter-assisted approach; and (3) a wire-only approach. These strategies were tested by 15 percutaneous coronary intervention operators with varying levels of experience. Seven guide wires with differing characteristics and tip loads ranging from 3 to 12 g were used.</div></div><div><h3>Results</h3><div>The balloon occlusion strategy achieved fenestration in all tests (n = 15) using both 12 g and 3 g wires, as did microcatheter-assisted fenestrations (n = 2). Wire-only strategy succeeded in 14 of 17 attempts across wires ranging from 3 to 12 g; however, 3 of 6 attempts using 3 g wires required conversion to balloon occlusion. Median time to fenestration was 69 seconds for both balloon occlusion and microcatheter strategies, compared with 81 seconds, 94 seconds, and 167 seconds for wire-only approaches using 12 g, 6 g, and 3 g wires, respectively. Angiography and micro–computed tomography demonstrated satisfactory results, but endoscopic analysis revealed polyurethane membrane recoil reducing the ostial area by up to 75%, necessitating side-branch stenting. All evaluated side-branch stenting techniques improved the ostial lumen area.</div></div><div><h3>Conclusions</h3><div>Covered stent fenestration is a feasible bailout strategy for preserving side-branch patency in critical bifurcation perforations.</div></div>","PeriodicalId":73990,"journal":{"name":"Journal of the Society for Cardiovascular Angiography & Interventions","volume":"5 10","pages":"Article 105521"},"PeriodicalIF":0.0000,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Society for Cardiovascular Angiography & Interventions","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772930326012688","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/7/28 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Coronary perforation at a bifurcation level is a life-threatening emergency. Covered stents may seal the defect but risk side-branch occlusion. We evaluated the feasibility and technical considerations of guide wire fenestration at coronary bifurcations and present a case where a covered side branch was successfully salvaged.

Methods

A transparent bifurcation phantom replicating coronary anatomy was constructed and integrated into a pulsatile flow system. Three fenestration strategies were evaluated: (1) a balloon-blocking approach, in which inflation of a balloon in the main branch after covered stent deployment was hypothesized to facilitate wire redirection and fenestration; (2) a microcatheter-assisted approach; and (3) a wire-only approach. These strategies were tested by 15 percutaneous coronary intervention operators with varying levels of experience. Seven guide wires with differing characteristics and tip loads ranging from 3 to 12 g were used.

Results

The balloon occlusion strategy achieved fenestration in all tests (n = 15) using both 12 g and 3 g wires, as did microcatheter-assisted fenestrations (n = 2). Wire-only strategy succeeded in 14 of 17 attempts across wires ranging from 3 to 12 g; however, 3 of 6 attempts using 3 g wires required conversion to balloon occlusion. Median time to fenestration was 69 seconds for both balloon occlusion and microcatheter strategies, compared with 81 seconds, 94 seconds, and 167 seconds for wire-only approaches using 12 g, 6 g, and 3 g wires, respectively. Angiography and micro–computed tomography demonstrated satisfactory results, but endoscopic analysis revealed polyurethane membrane recoil reducing the ostial area by up to 75%, necessitating side-branch stenting. All evaluated side-branch stenting techniques improved the ostial lumen area.

Conclusions

Covered stent fenestration is a feasible bailout strategy for preserving side-branch patency in critical bifurcation perforations.

查看原文本刊更多论文

冠状动脉分叉穿孔有盖支架开窗修复侧支：系统的台架试验评价

背景冠状动脉分叉水平穿孔是危及生命的紧急情况。覆盖支架可以封闭缺损，但有侧支闭塞的风险。我们评估了冠状动脉分叉处导丝开窗的可行性和技术考虑，并提出了一个成功抢救有盖侧支的病例。方法构建冠状动脉透明分岔假体复制解剖学，并将其集成到脉搏血流系统中。评估了三种开窗策略：(1)球囊阻塞方法，其中假设有盖支架部署后主分支球囊膨胀，以促进导线重定向和开窗；(2)微导管辅助入路；(3)只使用有线方式。这些策略由15名经验不同的经皮冠状动脉介入手术者进行了测试。使用了7根不同特性的导丝，尖端载荷从3到12克不等。结果球囊闭塞策略在使用12g和3g导线的所有测试中（n = 15）都实现了开窗，微导管辅助开窗（n = 2）也是如此。在3到12克的绳子上，17次尝试中只有14次成功；然而，使用3g钢丝的6次尝试中有3次需要转换为球囊闭塞。球囊闭塞和微导管策略到开窗的中位时间为69秒，相比之下，仅使用12g、6g和3g导线的方法分别为81秒、94秒和167秒。血管造影和显微计算机断层扫描显示了令人满意的结果，但内窥镜分析显示聚氨酯膜后坐力使口面积减少了75%，需要侧支支架置入。所有评估的侧支支架术均改善了口腔面积。结论有盖支架开窗是一种可行的救助策略，可保持严重分叉穿孔的侧支通畅。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊