Culotte versus the novel nano-crush technique for unprotected complex bifurcation left main stenting: difference in procedural time, contrast volume and X-ray exposure and 3-years outcomes

  • Gianluca RigatelliEmail author
  • Marco Zuin
  • Dobrin Vassilev
  • Huy Dinh
  • Sara Giatti
  • Mauro Carraro
  • Francesco Zanon
  • Loris Roncon
  • Ho Thuong Dung
Original Paper


To assess the procedural performance and 3-years outcomes of unprotected complex bifurcation Left Main (LM) stenting using either Culotte or the novel nano-crush techniques, consisting in the use of two ultra-thin strut stents with a 1-ring stent crushed into the LM. We analysed the records of patients with complex distal/bifurcation LM disease and contraindications and/or refusal of bypass surgery, who from 1 January 2014 to 1 November 2017, received at operators’ discretion LM double stenting by means of nano-crush technique using Orsiro (Biotronik Inc, Bulack, Switzerland) or Onyx (Medtronic Inc, Galway, Ireland) stents or Culotte stenting using same stent platforms. Among 65 patients (28 females, mean age 77.2 ± 6.2 years), 32 received nano-crush while 33 patients received Culotte technique. Mean angles between left anterior descending coronary artery and left circumflex was 63.6 ± 21.3°. Post-operative success was achieved in 100% of cases. Nano-crush patients showed lower contrast medium volume and X-ray exposure, shorter fluoroscopy and procedural times compared to Culotte patients group. At a mean follow-up of 27.4 ± 10.8 months, clinical-driven target lesion revascularization, myocardial infarction and cardiovascular death were 0 versus 4/33 (12.1%, p = 0.04), 1/32 (3.1%) versus 6/33 (18.1%, p = 0.03) and 2/32 (6.2%) versus 8/33 (24.2%, p = 0.04) in nano-crush versus Culotte patients, respectively. In this single center study, the nano-crush technique was associated with less use of contrast, less procedural time and less X-ray exposure compared to the culotte technique for the treatment of unprotected left main bifurcation lesions.


Left main PCI Stent Crush Interventional 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Gianluca Rigatelli
    • 1
    • 6
    Email author
  • Marco Zuin
    • 4
  • Dobrin Vassilev
    • 2
  • Huy Dinh
    • 3
  • Sara Giatti
    • 4
  • Mauro Carraro
    • 4
  • Francesco Zanon
    • 4
  • Loris Roncon
    • 4
  • Ho Thuong Dung
    • 5
  1. 1.Cardiovascular Diagnosis and Endoluminal InterventionsRovigo General HospitalRovigoItaly
  2. 2.Department of Internal DiseasesSofiaBulgaria
  3. 3.Department of Interventional CardiologyTam Duc Heart HospitalHo Chi Minh CityVietnam
  4. 4.Division of CardiologyRovigo General HospitalRovigoItaly
  5. 5.Department of CardiologyThong Nhat HospitalHo Chi Minh CityVietnam
  6. 6.Santa Maria della Misericordia HospitalRovigoItaly

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