CARDIAC CATH LAB - Mount Sinai Hospital

The simultaneous kissing
stent (SKS) technique
involves guiding two
appropriately sized stents
to the bifurcation lesion,
and expanding them
together to “kiss”and
form an attachment.
Bifurcation Lesion Interventions
A bifurcation lesion (BL) refers to a blockage that begins before the
intersection of the main vessel (MV) and side branch (SB) and continues
beyond. Bifurcation lesion interventions represent roughly 15 percent
of medical procedures at most PCI centers. Based on lesion location
alone (pre-branch, post-branch, parent vessel only), bifurcation lesions
are complex and technically challenging for PCI. Successful treatment
through PCI requires familiarity with a wider selection of dedicated
bifurcation devices and techniques, particularly in regard to how to
navigate the varying angulations between the MV and SB, all of which
add up to higher learning curves for the interventionalists. Every
BL must be approached in the context of its own anatomy and
operator experience. Not surprisingly, PCI of BLs is also associated
with higher procedural costs, higher hospital length of stay, higher
complications largely related to side branch closure (caused by plaque
shift or dissection) and higher rates of subsequent restenosis. The
conventional BL intervention technique is to stent the MV and
balloon the SB, usually with a cutting balloon that also removes the
obstruction; but sometimes the balloon alone does
New
Carina
not do the job and we need to insert a stent in the
SB as well. Double stenting in such locations is
tricky because it must be done without blocking
the intersection. To do this correctly we have
popularized the simultaneous kissing stent (SKS)
technique. Two appropriately-sized DES are advanced
simultaneously toward the bifurcation along their
separate channels. When their leading edges meet
proximally, the two stents are simultaneously
inflated and deflated until their struts “kiss” and engage to form a
firm attachment at the carina. Clinical outcomes in the SKS-PRECISE
Trial completed in 2008 at Mount Sinai Hospital, which involved 100
randomized patients (half SKS and half conventional stent strategy),
showed better acute success and better long-term patency, especially
in the SB, compared with the standard technique without any early
or late stent thrombosis. We continue to develop and advance this
and other strategies for BL interventions.
18 Mount Sinai Hospital Cardiac Cath Lab