Culottes stenting technique for coronary bifurcation

Culottes stenting technique for coronary bifurcation

Culottes stenting technique for coronary bifurcation gives good coverage of the bifurcation, but has more metal in the proximal segment. Initially both branches are wired and balloon dilated. Then a stent is placed in the most angulated branch (usually the side branch), jutting well into the proximal segment. The guide wire from the other branch is removed and the stent deployed in the more angulated branch. Wire is removed from the stented branch and the stent is crossed with the wire into the unstented branch and balloon dilated. A second stent is introduced into the unstented branch and expanded, with stent overlap in the proximal segment. The first stent is then recrossed and dilated followed by final kissing balloon inflation. The main advantage of the culottes technique is that it is suitable for bifurcations with all types of angles and provides good coverage of the side branch ostium. But the disadvantage is the double layer of metal at the carina and proximal vessel. The process of re-wiring through stent struts is time consuming and can be difficult.