Case Report A Novel Paclitaxel-Eluting Dedicated Bifurcation Stent: A Case Report From the First Human Use Taxus Petal Trial Thomas W. Johnson, 1 BSc, MBBS, MRCP , MD, I. Patrick Kay, 2 MBChB, PhD, FRACP , FESC, and John A. Ormiston, 1,2 * MBChB, FRACP , FRANZCR, FRCP A dedicated bifurcation stent has the potential to simplify and improve the outcomes of percutaneous coronary bifurcation intervention. We report a patient from the first human use trial of a novel paclitaxel-eluting dedicated bifurcation stent. By 6 months, there were no adverse events and the stent lumen and, in particular, the side-branch ostium were widely patent on angiography and intravascular ultrasound. This device may offer superior results without the limitations of conventional stent techniques in the treatment of coronary bifurcation disease. ' 2009 Wiley-Liss, Inc. Key words: percutaneous coronary intervention; drug delivery; stent INTRODUCTION Dedicated bifurcation stents have been developed to overcome the limitations of conventional stents in the percutaneous treatment of coronary bifurcations. The Taxus Petal (Boston Scientific, Natick, MA) dedicated bifurcation stent (Fig. 1), constructed from platinum chromium alloy and coated with a Translute polymer containing paclitaxel, has unique petal elements that deploy up to 2 mm into the side-branch (SB) ostium, scaffolding and applying antiproliferative drug to the most common site of restenosis [1,2]. The petal ele- ments hold atheromatous plaque out of the SB lumen and prevent displacement of the bifurcation flow di- vider (carina) into the SB, thus maintaining a larger SB ostial area [3]. It is a side-branch access stent, where delivery over two wires retains access to the SB without wire entrap- ment outside a stent. Deployment of the body of the stent by a cylindrical balloon and the side branch pet- als by an elliptical balloon is simultaneous as the bal- loon lumens are connected and inflated by a single inflation device (Fig. 2). Separation of markers con- firms rotational alignment of the SB petals with the SB (Fig. 2). CASE REPORT A 56-year-old hypertensive, dyslipidemic man with a history of smoking and a strong family history of coro- nary artery disease presented with a 2-month history of shortness of breath on exertion. A Bruce Protocol tread- mill test was stopped at 7 min 30 sec because of severe shortness of breath and 1.5-mm electrocardiographic ST segment depression in the inferolateral leads. Coronary angiography (Fig. 3A) revealed a severe bifurcation lesion (Medina classification 1, 0, 0) at the crux of the right coronary artery. The patient was sub- sequently enrolled into the Taxus Petal first human use trial. Through an 8F caliber guide catheter, a 0.014@ BMW (Abbott Vascular, Santa Clara, CA) wire was advanced to the posterior descending coronary artery and the bifurcation lesion was predilated with a 2.5 mm diameter balloon advanced over this wire. To limit the potential for wire tangling (wrap), the Taxus Petal stent was advanced towards the crux over this single wire, with a SB wire protruding several centimeters from the SB catheter lumen (Fig. 3B). As the stent approached the crux, the SB wire was advanced to a posterolateral branch of the right coronary artery 1 Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand 2 Mercy Angiography, Auckland, New Zealand *Correspondence to: John A. Ormiston, Mercy Angiography, Mercy Hospital, Newmarket, PO Box 9911, Auckland 1031, New Zealand. E-mail: johno@mercyangiography.co.nz Received 28 November 2008; Revision accepted 10 December 2008 DOI 10.1002/ccd.21943 Published online 11 February 2009 in Wiley InterScience (www. interscience.wiley.com). ' 2009 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 73:637–640 (2009)