PubMed · 16098425
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David O Williams, J Dawn Abbott. 2005-08-16. Bifurcation intervention: is it crush time yet?. https://doi.org/10.1016/j.jacc.2005.05.035
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Stent fracture is uncommon but may have consequences including restenosis. To date, stent fractures reported have been related to aggressive post dilation. We describe a case that involves fracture of a stent deployed to nominal pressure. Unlike most stent fractures reported that involve stent struts only our case demonstrated circumferential disruption with complete separation of the stent segments.
Bifurcation lesions can be technically demanding to manage, and even in the era of drug eluting stents, their procedural success is variable. The use of the crush technique followed by "kissing" balloon postdilatation has been shown to improve the overall outcome. However, crossing the crushed stent is essential to allow performance of a final dilatation with "kissing" balloons and is regarded as the main Achilles' heel of this technique. In this report, we describe the first reported, planned procedure to use a magnetic navigation system to steer a wire through the crushed stent to use "kissing" balloons that had previously failed with conventional wires.
AIM: Explain how research can advance the state-of the- practice in percutaneous coronary intervention (PCI). METHODS AND RESULTS: Identifying the success factors of PCI; identifying decision- making performance (power of judgement) as the factor that could be advanced faster than is currently the case; explaining why and how such advancement needs a different research approach than those currently pursued in medical research; presenting initial results of this approach in the form of a set of basic concepts (pivoting around risk) that are useful for describing the decision-making process during a PCI. CONCLUSION: Building a terminology (ontology) of PCI decision-making concepts and then eliciting expert knowledge about the decision-making process itself are promising ways of advancing the teachability of PCI and hence the state-of-the practice.