Percutaneous treatment of bifurcation coronary stenosis: a long-term follow-up.

ABSTRACT

BACKGROUND: The treatment of bifurcation coronary stenosis involved several techniques in the last few years, with the use of one stent, two stents, kissing balloon, crush stenting. Basic objective was to reduce MACE rate and improve event-free survival. OBJECTIVE: To examine the performance of some techniques of stent placement adopted in the last few years by evaluating MACE (major adverse cardiac events) and TLR (target lesion revascularization). METHODS: Between 1999 and 2003, 74 consecutive patients with bifurcation lesions were treated with either stenting two vessels (type A, n = 8) or single vessels (type B, n = 66) and were followed for 30 days, 6 months, with a mean follow-up of 23 months for clinically driven MACE and TLR. RESULTS, The mean reference diameters of the main and side branches were 2.97 +/- 0.27 mm and 2.28 +/- 0.49 mm, respectively. The side branch was stented in 11% cases. Less than 30% residual stenosis in the main branch was achieved in 100% cases, <50% in the side branch in 94.5% of the cases. In-hospital major adverse cardiac events were non-Q-wave MI in 5% patients. During follow-up, death was 1.35%, subacute stent thrombosis (SAT) was 4%, and TLR (CABG) was 10.8%. Multivariate analysis showed type 1 lesion, and STEMI was associated with more MACE than others. There was 4.35-fold greater odds of MACE, associated with stenting both vessels in bifurcation lesion. CONCLUSION, Stenting of the main branch along with kissing balloon dilatation or provisional stenting of the side branch is a safe and effective treatment of coronary bifurcation lesions with acceptable TLR rates.