Double-Kissing (DK) Mini-Culotte Stentleme Tekniği
Özet
Koroner bifurkasyon lezyonlarının perkütan koroner girişimlerinde (PKG) kullanılan Culotte stentleme tekniği, zaman içinde gelişerek modern modifikasyonlara uğramıştır. İlk olarak Bernard Chevalier ve arkadaşları tarafından tarif edilen bu strateji, günümüz pratiğinde gerçek bifurkasyon lezyonlarında tercih edilen temel çift stent yöntemlerinden biridir. Beş ana basamakta uygulanan "Double-Kissing (DK) Mini-Culotte" tekniği; metalik neo-karina oluşumunu engellemesi, yan dal ostiumunu sirkumfrensiyal olarak tam kaplaması ve ana dal proksimalinde daha az stent örtüşme alanı bırakması gibi avantajlara sahiptir. Bu süreçte proksimal optimizasyonun (POT) yetersiz yapılması, tel dolanması veya ikinci stentin ilerletilememesi gibi sık karşılaşılan hatalar ve bunların spesifik çözüm yolları bulunmaktadır. Ayrıca, optik koherans tomografi (OCT) eşliğinde yürütülen ve örtüşmeyi en aza indiren "DK Single String Culotte" yönteminde "napkin halkası etkisi" yaratan dar genişleme kapasiteli stentlerden kaçınılması gerektiği ve ideal lezyon açısının 40-80 derece olduğu belirtilmektedir. Son olarak, dış ortamda hazırlanan "Single Cell DK-Culotte" ile kıvrımlı veya kalsifik damarlarda geçiş kolaylığı sunan ve tek bir re-wire gerektiren en güncel "DK Nano-Culotte" tekniklerinin uygulama adımları, avantajları ve kısıtlılıkları video açıklamalarıyla birlikte aktarılmaktadır.
The Culotte stenting technique, utilized in percutaneous coronary interventions (PCI) for coronary bifurcation lesions, has significantly evolved over time through various modern modifications. Originally described by Bernard Chevalier and colleagues, this method has become a mainstay dual-stent strategy for true bifurcation lesions in contemporary clinical practice. The "Double-Kissing (DK) Mini-Culotte" technique, detailed in five main procedural steps, offers distinct advantages such as eliminating the metallic neo-carina, providing circumferential coverage of the side branch ostium, and creating a smaller stent overlap zone in the proximal main vessel. Common procedural errors—including inadequate proximal optimization technique (POT), wire wrapping, or difficulty advancing the second stent—are outlined alongside their specific troubleshooting solutions. Furthermore, the "DK Single String Culotte" method, performed under optical coherence tomography (OCT) guidance to minimize proximal overlap, is explained, highlighting that thin-strut stents prone to the "napkin ring effect" should be avoided and that it is best suited for bifurcation angles between 40 and 80 degrees. Finally, the steps, benefits, and limitations of the bench-prepared "Single Cell DK-Culotte" and the recently introduced "DK Nano-Culotte" technique, which facilitates device delivery in tortuous or calcified vessels and requires only a single re-wire step, are comprehensively delineated.
Referanslar
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