Mini-crush versus T-provisional techniques in bifurcation lesions: clinical and angiographic long-term outcome after implantation of drug-eluting stents.

Abstract

OBJECTIVES:

This retrospective study sought to assess the clinical and angiographic long-term outcome after implanting drug-eluting stents in bifurcation lesions with the T-provisional (T-prov) technique and mini-crush (MC) technique.

BACKGROUND:

The best option on the treatment of coronary bifurcation lesions is a subject of considerable debate. However, recent evidence suggests that bifurcation lesions might be treated by drug-eluting stent on both branches using the MC technique with a low rate of major adverse cardiac event and restenosis.

METHODS:

From April 2004 to July 2006, 457 patients were consecutively treated with either MC technique (n = 199) or T-prov technique (n = 258). Of these latter, 170 patients were treated with 1 stent and 88 patients with 2 stents. The 9-month angiographic follow-up was completed in 188 of 229 (82.1%) bifurcation lesions of MC patients and in 207 of 266 lesions (77.8%) of T-prov patients.

RESULTS:

After a propensity score adjustment, 2-year cumulative major adverse cardiac events were similar between groups (p = 0.16). The MC group compared with the T-prov 1-stent group had significantly lower main and side branches restenosis (hazard ratio [HR]: 0.52, 95% confidence interval [CI]: 0.27 to 0.99; p = 0.047; and HR: 0.41, 95% CI: 0.20 to 0.85; p = 0.016, respectively). However, the MC group compared with the T-prov-only group had significantly lower side branch restenosis (HR: 0.55, 95% CI: 0.37 to 0.82; p = 0.004).

CONCLUSIONS:

Both techniques of bifurcation treatment met high procedural success with low complication rates and similar major adverse cardiac event long-term outcome. However, the MC technique yields a lower restenosis rate at both main and side branches. These results may confirm the advantage of using prescheduled 2-stent technique to give a complete coverage of the side branches' ostium.

• Authors: Alfredo R Galassi, Salvatore D Tomasello, Davide Capodanno, Giovambattista Barrano, Gian Paolo Ussia, Corrado Tamburino
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 2 Issue 3 Pg. 185-94 (Mar 2009) ISSN: 1876-7605 [Electronic] United States
• PMID: 19463424 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antineoplastic Agents, Phytogenic
• Immunosuppressive Agents
• Paclitaxel
• Sirolimus

Topics

• Aged
• Angioplasty, Balloon, Coronary (instrumentation, methods)
• Antineoplastic Agents, Phytogenic (therapeutic use)
• Confidence Intervals
• Coronary Angiography
• Coronary Artery Disease (drug therapy, therapy)
• Drug-Eluting Stents
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Paclitaxel (therapeutic use)
• Retrospective Studies
• Sirolimus (therapeutic use)
• Time Factors
• Treatment Outcome