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
• DOI: 10.1016/S0735-1097(00)00534-9
• ISSN: 0735-1097

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.