Intricate medical devices are required for performing interventional procedures within the coronary arteries. For example, percutaneous transluminal coronary angioplasty is a procedure during which a balloon catheter is introduced into the narrowed portion of the coronary artery lumen and inflated to reopen the artery to allow the return of normal blood flow. During this procedure, often a coronary stent is also placed such that restenosis of the artery (the formation of new blockage) is significantly delayed. A stent is a device typically comprised of wire mesh that provides scaffolding to support the wall of the artery and keep its lumen open and free from the buildup of plaque. Balloon angioplasty and coronary stents have prevented numerous patients from having to undergo immediate coronary artery bypass graft surgery, which can be costly and painful. More recently, such stents have been produced with a variety of drug coatings in further attempts to minimize or eliminate the possibility of restenosis. While these drug-eluting stents have been a great improvement over angioplasty, it is generally considered that success rates will be further improved via new techniques in the future.
Coronary bifurcation stenting techniques.
A) V stenting technique: a stent is deployed in each of the branching arteries.
B) The Y stenting technique: a stent is deployed in each of the branching arteries. Next, a stent crimped over two balloons is deployed proximally in the parent branch. The balloons are inflated to deploy the proximal stent. The distal end of each balloon is positioned in each stented daughter branch during inflation.
C) The simultaneous kissing balloon technique: two stents are deployed by inflating both balloons simultaneously at the same pressure.
D) The T stenting technique: the main branch is stented first. Next, angioplasty is performed on the side branch to create an opening in the first stent and a second stent is placed in the side branch.
E) The culottes technique: similar to the T stenting technique, except that the proximal end of the second stent is positioned in the main branch.
F) The crush technique: the first stent is deployed in the side branch. The main branch is then stented, which "crushes" the proximal end of the first stent against the wall of the main branch.