This work reports the concept and the practical feasibility of Reversed Single String bifurcation stenting technique by demonstrating three in vitro cases.

Provisional T stenting is the most used interventional technique to treat coronary bifurcation lesions. However, after main branch (MB) stenting, treatment of the side branch (SM) becomes often indicated to provide with good final result. Currently applied methods all have their morphologic or structural limitations with respect to wall coverage, multiple strut layers, apposition rate. We sought that reversing the Single String technique principle may be used as a bail out for such clinical situations. This proof-of-concept report describes and evaluates the procedure.

We simulated in three silicone bifurcation phantoms the scenario when stenting the SB becomes indicated after deployment of the MB stent and performing kissing balloon dilatation. Thereafter, as first step of Reversed Single String, a stent was positioned and deployed into the SB ostium with one single protruding stent-cell into the MB. After wiring that stent-cell and positioning MB balloon across it, final kissing balloon dilation was performed.

Result of the three in vitro Reversed Single String cases was evaluated by X-ray and by optical frequency domain imaging and 3D reconstruction (OFDI). Each case was performed successfully. In the bifurcation area perfect apposition was documented in over 81% of the struts. Malapposition occurred most frequently in area of neo-carina, but still remained below 4% of struts for each case. 3D OFDI reconstruction did not reveal any strut fracture.

This report suggests that Reversed Single String technique might offer a potential bail out solution for provisional T-stenting cases, when treatment of the SB becomes indicated.