Szabo Technique Research Articles

TCTAP C-029 A Challenging Case of Szabo Technique for Ostial Lesion in a Left Main Trifurcation

TCTAP C-029 A Challenging Case of Szabo Technique for Ostial Lesion in a Left Main Trifurcation

Coronary stent loss in vertebral artery: an unusual complication of Szabo technique.

Celik, Aziz Inana; Bezgin, Tahira; Karaaslan, Muhammet Bugrab; Cagdas, Metina Author Information

Szabo versus provisional stenting of bifurcation coronary lesions

Highlights. This article presents a comparative analysis of the results of PCI of bifurcation coronary lesions using the Szabo technique and provisional stenting in patients with chronic coronary artery disease.Background. Coronary bifurcation and ostial stenosis are difficult to treat and require precise stent positioning in order to prevent restenosis and thrombosis.Aim. To perform a comparative analysis of the outocmes of percutaneous coronary interventions (PCI) of coronary bifurcation lesions using the Szabo technique and provisional stenting in patients with chronic coronary artery disease.Methods. The retrospective single-center observational study included 791 patients. In accordance with the performed bifurcation PCI technique, the patients were divided into two groups: 42 patients in the Szabo group and 749 in the provisional stenting group. Propensity score matching was performed for endpoint analysis, as a result of which 42 patients were selected out of 749 patients in the provisional stenting group, comparable in baseline characteristics with 42 patients in the Szabo group. Study endpoints were cardiac death, myocardial infarction, and repeat revascularization. A composite endpoint (MACE) including all of the above was also evaluated.Results. The median follow-up in the provisional stenting and Szabo groups was 1.3 and 1.4 years, respectively. There were no significant differences between the groups in terms of mortality, myocardial infarction, repeated revascularization and composite endpoint (MACE 23.80% provisional stenting and 19.04% Szabo, p = 0.594).Conclusion. Thus, Szabo is technically simple and safe technique for stenting coronary bifurcation lesions in patients with chronic coronary artery disease, which is not inferior in terms of efficiency to provisional stenting.

TCTAP C-051 Szabo Technique for Accurate Stent Placement

TCTAP C-051 Szabo Technique for Accurate Stent Placement

Ostial lesion of the anterior descending coronary artery treated via Szabo technique supported by stent boost imaging: a case report

BackgroundStenosis at the opening and bifurcation of the anterior descending branch and circumflex branch around the end of the left main trunk is difficult to repair. Accurate positioning of a stent is the key problem.Case presentationsHere we report the case of a 61-year-old man who suffered from paroxysmal chest pain for 1 year, without history of diabetes or hypertension. The coronary computed tomography showed mixed plaques in the proximal part of the anterior descending artery, with stenosis severe at 80–90%. The emergency coronary angiography showed occlusion of the anterior descending artery. During percutaneous coronary intervention, a drug-eluting stent was implanted into the anterior descending artery using the Szabo technique, supported by stent boost (StentBoost) imaging to pinpoint the location of the lesion. The patient’s paroxysmal chest pain was relieved after the procedure.ConclusionWe used StentBoost to verify the accuracy of stent placement and the Szabo technique to rectify long-term coronary stenosis, which achieved satisfactory results. Combining the Szabo technique with StentBoost imaging was helpful to accurately evaluate the area and locate the stent when treating this ostial lesion of the anterior descending coronary artery.

Optimization technique for stenting of ostial vertebral artery stenosis

Objective ‒ to develop a technique for endovascular treatment of symptomatic ostial stenosis of the vertebral arteries, which allows to minimize risks of delayed stent breakage and restenosis. Materials and methods. This is analysis of prospectively collected data from patients presenting from 2016 to 2019 in the endovascular center of the Dnepropetrovsk Regional Clinical Hospital named after I.I. Mechnikov. One hundred four stents were placed in 99 patients using the author’s complex method, which is based on our modification of Szabo technique. The principles of the method were developed based on a literature review and in vitro tests using 7 silicone models of the initial segments of the subclavian and vertebral arteries with different angles of divergence of the vertebral arteries (30, 45, 60, 90, 120, 135, 150°) and 9 balloon mounted drug-eluting stents with open-cell design Resolute (Medtronic).Results. There were no cases of displacement of the stent proximally or distally during implantation. In all cases, stents were implanted in the affected segment exactly and did not prolapse more than 1 mm beyond the ostium of the vertebral artery into the subclavian artery. There were no «clinical» ischemic complications in the early postoperative period. In 5 cases, isolated subclinical ischemic lessions in the carotid circulation were revealed during one-session stenting of ostial stenosis of the vertebral arteries and carotid stenting. In the posterior circulation, ischemic lessions on MRI in the early postoperative period were not detected in any observations.Conclusions. Developed complex stenting method based on our modification of Szabo technique allows us to achieve optimal long-term results of stenting of symptomatic ostial stenosis of the vertebral arteries.

Szabo 2-stent technique for coronary bifurcation lesions: procedural and short-term outcomes

BackgroundProvisional 1-stent technique is currently regarded as the default approach for the majority of bifurcation lesions. Nonetheless, 2-stent techniques may be required for complex bifurcations with high compromise risk or fatal consequences of side branch (SB) occlusion. Limitations exist in current approaches, as stents gap, multiple metal layers and stent malapposition caused by imprecise placement with fluoroscopic guide and intrinsic technical defects. This study was designed to investigate the effectiveness of the novel Szabo 2-stent technique for coronary bifurcation lesions.MethodsIn the Szabo 2-stent technique, one stent is precisely implanted at the SB ostium with Szabo technique resulting in a single strut protruding into the main vessel (MV). After MV rewiring and SB guidewire withdrawal, another stent is implanted in MV followed by proximal optimization technique, SB rewiring, and final kissing inflation (FKI).ResultsThe technique tested successfully in silicone tubes (n = 9) with: procedure duration, 31.2 ± 6.8 min; MV and SB rewiring time, 26.8 ± 11.2 s and 33.3 ± 15 s; easy FKI; and 2.3 ± 0.5 balloons/procedure. Bifurcation lesions (n = 22) were treated with angiographic success in MV and SB, respectively: increased minimal lumen diameter (0.63 ± 0.32 mm to 3.20 ± 0.35 mm; 0.49 ± 0.37 mm to 2.67 ± 0.25 mm); low residual stenosis (12.4 ± 2.4%; 12.4 ± 2.3%); and intravascular ultrasound confirmed (n = 19) full coverage; minimal overlap and malapposition; minimal lumen area (2.4 ± 1.2 mm2; 2.1 ± 1.0 mm2); plaque burden (78.1 ± 11.3%; 71.6 ± 15.5%); and minimal stent area (9.1 ± 1.6 mm2; 6.1 ± 1.3 mm2). Periprocedural cardiac troponin increased in 1 asymptomatic patient without electrocardiographic change. There was no target lesion failure (cardiac death, myocardial infarction, target lesion revascularization) at 6-month follow-up.ConclusionsThe Szabo 2-stent technique for bifurcation lesions provided acceptable safety and efficacy at short-term follow-up.

Zakończona powodzeniem przezskórna interwencja wieńcowa z zastosowaniem techniki Szabo w przypadku zmian aortalno-ostialnych z przewlekłym całkowitym zamknięciem prawej tętnicy wieńcowej

Percutaneous coronary intervention (PCI) in aorto-ostial lesions with chronic total occlusion is one of the most challenging scenarios, because geographic miss may lead to a higher rate of immediate and late adverse events when comparing with non-ostial lesions. Here we report a case, where aorto-ostial chronic total occlusion of right coronary artery in a 39-year-old male was successfully recanalised and perfectly stented using the Szabo technique.

Szabo's technique for the management of ostial lesions

Szabo's technique for the management of ostial lesions

Percutaneous coronary intervention for ostial and bifurcation lesions using the Szabo technique: a single center experience.

Aorto-ostial lesions as well as bifurcation lesions still provide challenges in percutaneous coronary intervention (PCI), as meticulous stent placement is needed. The Szabo-technique, which uses a second wire to anchor the stent at the ostium, may be helpful here. In this article, we will provide detailed information on the technique including video material as well as procedural and long-term follow-up data of a cohort of patients treated with this technique. A retrospective single-centre study was performed in patients undergoing Szabo-PCI from 2014 to 2016 (N.=28). Indications for PCI were elective in 53% and urgent/emergent in 47%. Target vessel was the ostial right coronary artery in 43%, the ostial left main artery in 7%, the proximal left anterior descending artery in 29% and the proximal circumflex artery in 21% of the cases. Primary success rate was 86%. In the other 14%, delivery of the stent failed due to a high-grade calcification. There were no periprocedural complications. During the follow-up time (mean 308 days) there was one case of cardiovascular and one case of non-cardiovascular death without any stroke events. In one case target lesions revascularisation was necessary. The Szabo-technique offers a feasible and safe approach for PCI of ostial and bifurcation lesions. Calcified lesions seem to be a challenging aspect.

Bioresorbable scaffold adjustment in an ostial lesion with the Szabo technique

Bioresorbable scaffold adjustment in an ostial lesion with the Szabo technique

Bioresorbable scaffold adjustment in an ostial lesion with the Szabo technique

Bioresorbable scaffold adjustment in an ostial lesion with the Szabo technique

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

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.

GW25-e4583 Safety and feasibility of Szabo technique in percutaneous coronary intervention of ostial lesions

GW25-e4583 Safety and feasibility of Szabo technique in percutaneous coronary intervention of ostial lesions

CRT-143 The Two Current Approaches to Thread Stent for Performing the Szabo Technique: Problems Related with Each Approach, and a Proposal of Stent Designed to Decrease Complications

Stenting ostial and/or bifurcated lesions (L) constitute always a challenge. Szabo Technique (SzT) is a simple way to deal with these problems, but Stent can be damaged during the process increasing nonfatal complication (NFC). From Jan'08 to May'13. SzT was attempted in 266 patients (pts) (65 ± 5

Use of the Szabo Technique to Guide Accurate Stent Placement at the Vertebral Artery Ostium

To evaluate the Szabo technique in stenting at the vertebral artery ostium. Between 2010 and 2011, 26 patients (21 men; mean age 67 years) with symptomatic vertebral artery ostial stenosis >60% were treated. Under distal filter protection, a 0.014-inch guidewire was introduced in the ipsilateral subclavian artery as the marker wire for the Szabo technique. The balloon-expandable paclitaxel-embedded Yinyi stent was mounted on the filter's guidewire in a monorail configuration. One strut segment only of the last stent cell was gently flared by forceps, and the outer end of the marker wire was introduced through the flared strut of the stent. The lifted strut was then crimped back into place. Holding the two wires together, the stent/balloon system was gently advanced into the ostial lesion until the marker wire stopped advancing and resistance was appreciated. The stent was deployed at 6 atmospheres, after which the balloon was deflated to 2 to 4 atmospheres, the marker wire was withdrawn, and the stent was postdilated at a high pressure (10-12 atmospheres) after withdrawing the balloon one half to one third outside of the stent to ensure that the protruding strut was flush against the wall of the subclavian artery. The technical success rate was 100% with accurate stent deployment. The mean degree of stenosis reduced from 84.5%±6.1% to 6.2%±3.1%. Symptoms were resolved in 20 cases and were improved in 6 cases with prior stroke. No obvious in-stent restenosis was revealed by imaging at 12.0±2.2 months. No procedure-related stroke or transient ischemic attacks occurred at a follow-up for 24.0±3.7 months. The Szabo technique is safe and effective in guiding accurate placement of the Yinyi stent at the vertebral artery ostium, which may help lower restenosis rates.

Side branch ostium stenting with main vessel drug-eluting balloon kissing (BOMB): An innovative approach for isolated coronary stenosis at side branch ostium

Side branch ostium stenting with main vessel drug-eluting balloon kissing (BOMB): An innovative approach for isolated coronary stenosis at side branch ostium

Causes of failure with Szabo technique – An analysis of nine cases

The objective of this case series is to identify and define causes of failure of Szabo technique in rapid-exchange monorail system for ostial lesions. From March 2009 to March 2011, 42 patients with an ostial lesion were treated percutaneously at our institution using Szabo technique in a monorail stent system. All patients received unfractionated heparin during intervention. Loading dose of clopidogrel, followed by clopidogrel and aspirin was administered. In 57% of patients, drug-eluting stents were used and in 42.8% patients bare metal stents. The stent was advanced over both wires, the target wire and the anchor wire. The anchor wire, which was passed through the proximal trailing strut of the stent helps to achieve precise stenting. The procedure was considered to be successful if stent was placed precisely covering the lesion and without stent loss or anchor wire prolapsing. Of the total 42 patients, the procedure was successful in 33, while failed in 9. Majority of failures were due to wire entanglement, which was fixed successfully in 3 cases by removing and reinserting the anchor wire. Out of other three failures, in one stent dislodgment occurred, stent could not cross the lesion in one and in another anchor wire got looped and prolapsed into target vessel. This case series shows that the Szabo technique, in spite of some difficulties like wire entanglement, stent dislodgement and resistance during stent advancement, is a simple and feasible method for treating variety of ostial lesions precisely compared to conventional angioplasty.

Preliminary experience with a novel TITAN-V stent for ostial coronary lesions in an experimental animal model

Accurate stent placement for ostial coronary stenosis in percutaneous coronary intervention (PCI) is essential for optimal clinical results but its execution is technically challenging under angiographic guidance [1,2]. The Szabo technique appears to be the most promising technique to achieve precise stenting of ostial coronary lesions [3,4]. This technique, however, is not without its limitation as stent-related complications [5,6] can occur. It is possible that manual manipulation of the stent outside the guiding catheter before implantation contributes to these complications, hence, a new approach is needed.

SAFETY AND FEASIBILITY OF SZABO TECHNIQUE IN PERCUTANEOUS CORONARY INTERVENTION OF OSTIAL LESIONS

ObjectivesPercutaneous coronary intervention (PCI) on ostial lesions in coronary arteries can pose unique challenges and associated with higher procedural and medium-term complication rates. It has been technically difficult because it...