A Novel Coronary Bifurcation Stenting Technique: Double Kissing Nano-Culotte Stenting

Percutaneous coronary intervention (PCI) of coronary bifurcation lesion (CBL) is challenging due to its complex anatomy resulting in difficulty in deciding on treatment procedure. Although there are advanced techniques and well-experienced operators, the optimal stenting strategy is still debated. The contemporary PCI techniques of CBL aim to achieve minimal stent protrusion to the main vessel and to minimize stent layers at the neocarina as well as the side branch (SB) ostium and proximal main vessel (PMV). In addition, it is necessary to avoid incomplete stent coverage at the SB ostium and stent malapposition. Traditional 2-stent strategies have been improved using minimal stent protrusion to the main vessel (MV) and double kissing (DK) balloon dilatation to reach optimal results. Although the DK crush has been the prominent treatment modality,1 there are studies showing that the DK culotte stenting may have better results especially in terms of stent malapposition and metal layers at the neocarina.2 In our case report, we demonstrate a novel minimal protruded DK nanoculotte stenting technique for the treatment of true CBL.