The Szabo Technique to Assist Geo-Positioning of Ostial Bifurcation Percutaneous Coronary Intervention

Abstract

Background: Ostial coronary artery lesions represent a significant interventional challenge, due in part to the risk of geographic miss when deploying the stent. The Szabo technique, originally described to treat aorto-ostial disease, may play an additional role when treating downstream epicardial bifurcation ostial disease (Medina 0,1,0 or 0,0,1). In particular, the Szabo technique may help limit excessive stent protrusion, important when treating ostial LAD and circumflex lesions. The Szabo technique involves twin guidewires, with the second (non-target vessel) wire back-loaded through the most proximal stent cell prior to the stent being advanced into the guide (bench-top photographs available). Once the stent is advanced into the target vessel, this second wire acts to hold the stent at the ostium during deployment. The Cases: The Szabo technique was employed in three consecutive cases with ostial lesions. Case 1: 66-year-old female, transradial approach, RCA treated with 4x18mm Xience Xpedition (Abbott Vascular). Case 2: 55-year-old female, transfemoral approach, LAD (Medina 0,1,0) treated with 3.5x24mm Promus Element (Boston Scientific). Case 3: 49-year-old female, transfemoral approach, circumflex (Medina 0,0,1) treated with 2.75x20mm Promus Element (Boston Scientific) drug eluting stent (images available). In all cases a balanced middleweight wire was used as the second ‘geo-locating’ wire. All cases were uncomplicated and excellent angiographic results were achieved. Conclusion: The Szabo technique may assist with accurate stent placement, minimise excessive stent protrusion and prevent geographic miss when treating epicardial bifurcation ostial disease. However, further studies are required in order to better understand the long-term results of this technique.