Success Rate of Szabo Technique in Ostial Coronary Pci. Techniques, Angiographic and IVUS Findings

Abstract

Background: Percutaneous coronary intervention (PCI) in ostial coronary artery lesions has been technically difficult because it should be done with precise stent placement in ostium and absence of side branch compromise. The Szabo technique consists of side branch wiring through most proximal stent strut as well as main branch wiring through stent lumen. The side branch wire or anchor wire prevents stent advancement beyond ostial segment and makes possible the accurate stent implantation in ostium. The purpose of this study is to evaluate the feasibility and success rate of Szabo technique analysing technical, angiographic and IVUS(Intravascular Ultrasonography) findings success rate.Methods: We analysed retrospectively in our cath lab, 13 PCIs in 13 patients with a significant lesion at a coronary artery ostium which was treated percutaneously using Szabo technique. The procedure was defined as technically successful if there was neither stent loss nor second guide wire pull back during stent advancement. A successful procedure from angiographic point of view was defined as a precise stent implantation at ostium without side branch compromise. We defined also successful procedure from IVUS point of view consisting of accurate stent placement in ostium without proximal protrusion and without any stent uncovered area.Results: Of a total of 13 patients with 10 (76.9%) males, 46.2% had diabetes, 69.2% hypertension, 53.8% hypercholesterolemia and 23.1 % were smoker or former smoker. They aged from 37-81 years with a mean age of 63±11 years. In 11 (84.6%) patients 6F and in 2 (15.4%) patients 7F sheathless guiding catheter (Asahi Intecc Co; LTD. Japan) were used. The access was radial in 12 (92.3%) and femoral in 1 (7.7%). The culprit vessel was left anterior descending (LAD) in 9 (69.2%), right coronary artery (RCA) 2 (15.4%), circumflex- obtuse marginal (LCX-OM) 1(7.7%), and posterior descending (PDA) 1(7.7%). In 9 (69.2%) IVUS was performed through culprit vessel and in 2 (15.4%) IVUS was done also in side branch after stent implantation. In 11 (84.6%) the procedure was technically successful. Among technically successful patients all (100%) had angiographic success. IVUS examination of culprit vessel showed accurate stent placement in ostium 7 (77.8%) and slight stent proximal protrusion in 2 patients (22.2%).Conclusions: This study shows that Szabo technique is safe and feasible for PCI in ostial coronary artery lesions with a high angiographic success rate. In a high percentage of cases the accurate position of stent in ostium can be confirmed by IVUS.