A Sequential Approach to the Management of Ostial Coronary Lesions via the Modified Flower Petal Technique

Abstract

There is still no consensus on the optimal technique for performing percutaneous coronary intervention (PCI) in ostial coronary lesions, due to potential complications. The modified flower petal technique is one of the techniques to management of ostial lesions. It seems suitable technique in terms of covering the coronary ostium well. In this report, we discuss a patient who underwent PCI with sequential modified flower petal technique, first to the left anterior descending artery ostial lesion, and then to the circumflex artery (CXA) upon the ostium of CXA was affected after the procedure following coronary angiography.

Keywords

ostial coronary lesions - modified flower petal technique - percutaneous coronary intervention - new techniques - left main coronary artery

• References

• 1 Adriaenssens T, Byrne RA, Dibra A. et al. Culotte stenting technique in coronary bifurcation disease: angiographic follow-up using dedicated quantitative coronary angiographic analysis and 12-month clinical outcomes. Eur Heart J 2008; 29 (23) 2868-2876
• 2 Kinoshita Y, Katoh O, Matsubara T. et al. First clinical experience of “flower petal stenting”: a novel technique for the treatment of coronary bifurcation lesions. JACC Cardiovasc Interv 2010; 3 (01) 58-65
• 3 Dishmon DA, Elhaddi A, Packard K, Gupta V, Fischell TA. High incidence of inaccurate stent placement in the treatment of coronary aorto-ostial disease. J Invasive Cardiol 2011; 23 (08) 322-326
• 4 Taştan A, Özel E, Öztürk A. et al. Comparison of floating wire and single wire techniques in right coronary ostial lesions in terms of procedural features and one-year clinical follow-up results. Anatol J Cardiol 2015; 15 (10) 830-835
• 5 Chen GC, Lu XM, Song YM. et al. A 3-year experience of a simple, novel technique for accurate ostial/non-ostial coronary stenting: the buddy balloon anchor stent technique. Catheter Cardiovasc Interv 2018; 92 (06) 1147-1152
• 6 Medina A, Martín P, Suárez de Lezo J. et al. Vulnerable carina anatomy and ostial lesions in the left anterior descending coronary artery after floating-stent treatment. Rev Esp Cardiol 2009; 62 (11) 1240-1249
• 7 Cubeddu RJ, Wood FO, Saylors EK, Mann T. Isolated disease of the ostium left anterior descending or circumflex artery: management using a left main stenting technique. Clinical outcome at 2 years. J Invasive Cardiol 2007; 19 (11) 457-461
• 8 Brunel P, Martin G, Bressollette E, Leurent B, Banus Y. “Inverted” provisional T stenting, a new technique for Medina 0,0,1 coronary bifurcation lesions: feasibility and follow-up. EuroIntervention 2010; 5 (07) 814-820
• 9 Mishell JM, Vakharia KT, Ports TA, Yeghiazarians Y, Michaels AD. Determination of adequate coronary stent expansion using StentBoost, a novel fluoroscopic image processing technique. Catheter Cardiovasc Interv 2007; 69 (01) 84-93
• 10 Kern MJ, Ouellette D, Frianeza T. A new technique to anchor stents for exact placement in ostial stenoses: the stent tail wire or Szabo technique. Catheter Cardiovasc Interv 2006; 68 (06) 901-906
• 11 Patel Y, Depta JP, Patel JS. et al. Impact of intravascular ultrasound on the long-term clinical outcomes in the treatment of coronary ostial lesions. Catheter Cardiovasc Interv 2016; 87 (02) 232-240
• 12 Çayli M, Elbasan Z, Gür M. et al. Modified flower petal technique in the treatment of Medina type 0,0,1 or 0,1,0 lesions. EuroIntervention 2015; 11 (07) 772-779