Immediate and long-term outcomes of type Ⅳ bifurcation lesion of left main bifurcation lesions after implantation of domestic drug-eluting stents with modified crush stenting technique / 中国介入心脏病学杂志

ABSTRACT

Objective To verify the safety and efficacy of percutaneous coronary intervention of Type Ⅳ bifurcation lesion of left main by using a left main bifurcation strategy and crush stenting technique with domestic drug-eluting stents(DES).Methods The study population consisted of patients with isolated unprotected ostial stenosis of the left anterior descending(LAD)or circumflex(LCX)artery.Sequential steps of crush stent deployment and post-dilation were undertaken followed by a modified crush stenting technique with domestic DES.Clinical and angiographic follow up was obtained to assess the primary endpoint of death,non-fatal myocardial infarction(MI)or target lesion revascularization(TLR).Results Twenty-nine patients(21 males,8 females)with a mean age of 62.57?14.21 years were evaluated.All patients were successfully treated using crush stenting technique with which final kissing balloon inflations were performed.The radial approach was utilized in 44.8% of the procedures.The mean procedural time was 36.2?9.4 minutes while the mean fluoroscopic time was 18.3?3.5 minutes.LAD ostial lesion was found in 58.6% of the patients.Predilatation with balloon angioplasty was performed in 44.8% of the patients.Partner stents and Excel stents were used in 79.3% and 20.7% of the patients respectively.The average stent diameter was 3.76 mm and the average stent length was 18.19 mm of main branch.GP IIb/IIIa inhibitors were used in 6(20.7%)patients.Angiographic results from Quantitative coronary angiographic(QCA)data showed mean target lesion length was of 13.20?4.71 mm and the baseline ostial stenosis was 78.4%.Follow-up angiography at a mean interval of 11.5?2.7 months revealed late lumen loss of 0.06?0.10 mm and 0.21?0.12 mm in the main branch and in the side branch,respectively.Binary restenosis did not occur within the main branch and side branch stents.Clinical follow up was available in all patients with mean duration of 14.2?5.2 months.No cardiac death,non-fatal MI occurred and no TLR needed during the followup of all patients.Conclusion The application of modified crush stenting technique and final kissing balloon inflations with domestic DES may be a reasonable option for the treatment of Type Ⅳ bifurcation lesion of left main.