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Drug-eluting stents in bifurcation lesions: to stent one branch or both?
Catheter Cardiovasc Interv. 2006 Dec; 68(6):891-6.CC

Abstract

OBJECTIVES

The objective of this study was to compare two techniques to treat bifurcation lesions: a single drug-eluting stent (DES) implanted in the main branch combined with balloon dilatation for the side branch vs. stenting of both branches (double stent).

BACKGROUND

Percutaneous coronary intervention in coronary bifurcation lesions remains challenging. Although DES reduce restenosis in lesions, the double stent procedure has not shown clear advantages over a single stent with balloon dilation.

METHODS

Fifty-three symptomatic patients with true bifurcation lesions were treated using either the double stent technique (n = 25) or one stent in the parent vessel plus balloon angioplasty of the side branch (n = 28). Procedural results and major adverse cardiac event rates (MACE: cardiac death, myocardial infarction, target vessel revascularization (TVR)) were compared.

RESULTS

Angiographic procedural success (residual stenosis <30% in both branches) was 75% in the single stent group and 100% in the double stent group (P = 0.01). All differences were due to residual stenosis of the side branch. Clinical follow-up (6-18 months) was available for all patients; 90.5% of patients had a coronary angiography or nuclear stress test. Three patients (11%) in the single stent group and two (8%) in the double stent group had ischemia-driven TVR (P = NS). Asymptomatic angiographic restenosis (>50% diameter stenosis) in the ostium of the side branch was seen in two patients in the double-stent group. At 6 months, MACE-free was comparable between groups (89.3% vs. 88%, P = 0.7).

CONCLUSIONS

When treating bifurcation lesions with sirolimus-eluting stents, restenosis following a single stent procedure is comparable to stenting both parent and side branch vessels. Thus, stenting the main-branch lesion, coupled with balloon angioplasty in the side branch, produces a high success rate and good clinical outcomes at 6 months.

Authors+Show Affiliations

Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17086532

Citation

Assali, Abid R., et al. "Drug-eluting Stents in Bifurcation Lesions: to Stent One Branch or Both?" Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 68, no. 6, 2006, pp. 891-6.
Assali AR, Assa HV, Ben-Dor I, et al. Drug-eluting stents in bifurcation lesions: to stent one branch or both? Catheter Cardiovasc Interv. 2006;68(6):891-6.
Assali, A. R., Assa, H. V., Ben-Dor, I., Teplitsky, I., Solodky, A., Brosh, D., Fuchs, S., & Kornowski, R. (2006). Drug-eluting stents in bifurcation lesions: to stent one branch or both? Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 68(6), 891-6.
Assali AR, et al. Drug-eluting Stents in Bifurcation Lesions: to Stent One Branch or Both. Catheter Cardiovasc Interv. 2006;68(6):891-6. PubMed PMID: 17086532.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Drug-eluting stents in bifurcation lesions: to stent one branch or both? AU - Assali,Abid R, AU - Assa,Hana V, AU - Ben-Dor,Itsik, AU - Teplitsky,Igal, AU - Solodky,Alejandro, AU - Brosh,David, AU - Fuchs,Shmuel, AU - Kornowski,Ran, PY - 2006/11/7/pubmed PY - 2007/2/28/medline PY - 2006/11/7/entrez SP - 891 EP - 6 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 68 IS - 6 N2 - OBJECTIVES: The objective of this study was to compare two techniques to treat bifurcation lesions: a single drug-eluting stent (DES) implanted in the main branch combined with balloon dilatation for the side branch vs. stenting of both branches (double stent). BACKGROUND: Percutaneous coronary intervention in coronary bifurcation lesions remains challenging. Although DES reduce restenosis in lesions, the double stent procedure has not shown clear advantages over a single stent with balloon dilation. METHODS: Fifty-three symptomatic patients with true bifurcation lesions were treated using either the double stent technique (n = 25) or one stent in the parent vessel plus balloon angioplasty of the side branch (n = 28). Procedural results and major adverse cardiac event rates (MACE: cardiac death, myocardial infarction, target vessel revascularization (TVR)) were compared. RESULTS: Angiographic procedural success (residual stenosis <30% in both branches) was 75% in the single stent group and 100% in the double stent group (P = 0.01). All differences were due to residual stenosis of the side branch. Clinical follow-up (6-18 months) was available for all patients; 90.5% of patients had a coronary angiography or nuclear stress test. Three patients (11%) in the single stent group and two (8%) in the double stent group had ischemia-driven TVR (P = NS). Asymptomatic angiographic restenosis (>50% diameter stenosis) in the ostium of the side branch was seen in two patients in the double-stent group. At 6 months, MACE-free was comparable between groups (89.3% vs. 88%, P = 0.7). CONCLUSIONS: When treating bifurcation lesions with sirolimus-eluting stents, restenosis following a single stent procedure is comparable to stenting both parent and side branch vessels. Thus, stenting the main-branch lesion, coupled with balloon angioplasty in the side branch, produces a high success rate and good clinical outcomes at 6 months. SN - 1522-1946 UR - https://www.unboundmedicine.com/medline/citation/17086532/Drug_eluting_stents_in_bifurcation_lesions:_to_stent_one_branch_or_both L2 - https://doi.org/10.1002/ccd.20870 DB - PRIME DP - Unbound Medicine ER -