The STENTYS® Self-Apposing Stent in bifurcation lesions

Abstract

Introduction Although there has been tremendous progress in our understanding of the complexity of bifurcations, the management of these lesions remains contentious. A single stent strategy with provisional management of a “threatened” side branch either with ballooning or provisional stenting, followed by kissing balloon dilatation, remains the recommendation of the European Bifurcation Club. This is not surprising as there is limited data available with dedicated bifurcation stents and the deployment of some of these devices can be technically challenging and requires a steep learning curve. However, some of the best results in the treatment of bifurcation lesions have been obtained with self-expanding, drug-eluting stents, and progress has been made so that the difficulty in achieving precise positioning is no longer their Achilles heel. The STENTYS stent (STENTYS SA, Paris, France) is a provisional, self-expanding nitinol stent (drug-eluting or bare metal) with small interconnections that can be disconnected by a balloon inflation between the struts to provide access to the side branch and, at the same time, cover the ostium (Figure 1). It is designed to be effective in most commonly encountered bifurcation angulations regardless of the initial deployment position and with a learning curve comparable to current, cylindrical workhorse stent technology. The key advantage is the ability of the stent to conform to the anatomy of the bifurcation and to provide easy access to the side branch if necessary through its novel, disconnectable strut elements. The stent also offers the recommended provisional approach to bifurcation stenting in the choice between treatment strategies: i) main branch stenting only, ii) main branch stenting with disconnection or iii) main branch stenting with disconnection and T-stenting without a gap (Figure 2)