The Y-stenting technique for pulmonary artery bifurcation stenosis: Initial results and mid-term outcomes

BACKGROUND: Treatment for main or peripheral PBS is challenging. An interventional approach is generally preferred as surgical angioplasty often results in residual stenosis. However, there is limited data on the mid- and long-term results of the different interventional approaches. The aim of this study is to report on initial and mid-term results of the Y-stenting technique for pulmonary artery bifurcation stenosis (PBS).

METHODS: A single centre retrospective study of all Y-stenting procedures for main or peripheral PBS was conducted. Patient and procedural data as well as mid-term outcomes were analysed.

RESULTS: 11 Y-stenting procedures were performed, 9 in the main pulmonary bifurcation and 2 in the PA periphery. In 8 patients the bifurcation stents were connected, in 3 patients there was no connection between the stents. Y-stenting creates a geometry close to the physiological PA bifurcation anatomy with complete alignment to the vessel wall without flow separation. Control angiography showed unrestricted blood flow after all procedures. Median right/left ventricle pressure ratio decreased from 0.9 to 0.5. No immediate or delayed adverse events were seen. During a median follow-up of 33.5 months, 2 patients in the non-connected group and 3 patients in the connected group needed a total of 6 re-interventions. No intima proliferation was seen in patients with connected stents.

CONCLUSIONS: Y-stenting is a safe and effective treatment for PBS. When both bifurcation stents are connected, this may result in lower rates of in-stent intima proliferation in comparison to other PBS stenting techniques.