Bifurcation lesions: two stents versus one stent—immediate and follow-up results

• Published in: Journal of the American College of Cardiology Vol. 35; no. 5; pp. 1145 - 1151
• Main Authors: Yamashita, Takehiro, Nishida, Takahiro, Adamian, Milena G, Briguori, Carlo, Vaghetti, Marco, Corvaja, Nicola, Albiero, Remo, Finci, Leo, Di Mario, Carlo, Tobis, Jonathan M, Colombo, Antonio
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2000; Elsevier Science
• Subjects: Aged; Angioplasty, Balloon, Coronary - instrumentation; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Coronary Angiography; Coronary Disease - classification; Coronary Disease - complications; Coronary Disease - diagnostic imaging; Coronary Disease - mortality; Coronary Disease - therapy; Diseases of the cardiovascular system; Female; Follow-Up Studies; Hospital Mortality; Humans; Incidence; Male; Medical sciences; Middle Aged; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Risk Factors; Severity of Illness Index; Stents; Treatment Outcome; DCA; MLD; MACE; TIMI; NQMI; TLR; CABG; MI; QMI; QCA; Human; Endoprosthesis; Prognosis; Treatment; Coronary artery; Instrumentation therapy; Bifurcation; Instrumental dilatation; Technique
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(00)00534-9

OBJECTIVES The purpose of this study was to evaluate two different techniques of stent placement in bifurcation lesions. BACKGROUND Although stent placement with dedicated techniques has been suggested to be a useful therapeutic modality for bifurcation lesions, limited information is available if stent placement on the side branch and on the parent branch provides any advantage over a simpler strategy of stenting the parent vessel and balloon angioplasty of the side branch. METHODS Between March 1993 and April 1999, we treated a total of 92 patients with bifurcation lesions with two strategies: stenting both vessels (group B, n = 53) or stenting the parent vessel and balloon angioplasty of the side branch (group P, n = 39). Paired angiograms were analyzed by quantitative angiography, and clinical follow-up was obtained. RESULTS Stent placement on both branches resulted in a lower residual stenosis (7.4 ± 10.9% vs. 23.4% ± 18.7%, p < 0.001) in the side branch. Acute procedural success was similar in the two groups (group B: 87% vs. Group P: 92%). In-hospital major adverse cardiac events (MACE) occurred only in group B (13% vs. 0%, p < 0.05). At the six-month follow-up, the angiographic restenosis rate (group B: 62% vs. Group P: 48%) and the target lesion revascularization rate (38% vs. 36%, respectively) were similar in the two groups. There was no difference in the incidence of six-month total MACE (51% vs. 38%). CONCLUSIONS For the treatment of true bifurcation lesions, a complex strategy of stenting both vessels provided no advantage in terms of procedural success and late outcome versus a simpler strategy of stenting only the parent vessel.