Bifurcation lesions: two stents versus one stent—immediate and follow-up results

Yamashita, Takehiro; Nishida, Takahiro; Adamian, Milena; Briguori, Carlo; Vaghetti, Marco; Corvaja, Nicola; Albiero, Remo; Finci, Léo; Mario, Carlo Di; Tobis, Jonathan M.; Colombo, Antonio

doi:10.1016/s0735-1097(00)00534-9

Cited by 273 publications

(179 citation statements)

References 25 publications

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“…Long-term (24.4 ± 15.1 months) MACE occurred in about 16% of the total study population, with rates of death and stent thrombosis respectively of 4.7% and 2.7%. Rates of adverse cardiac events are quite variable across literature, reflecting continuous improvement over time, in stenting techniques and devices [1,15,18,[24][25][26][27]. Overall, we experienced a relatively low rate of MACE, and our results are in line with previous studies.…”

Section: Discussionsupporting

confidence: 85%

Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

Roversi

Biondi‐Zoccai

Romagnoli

et al. 2013

International Journal of Cardiology

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Background: Coronary artery disease is most common in older patients, but may occur in younger subjects. The outlook of young patients after percutaneous coronary intervention (PCI) of challenging lesion subsets such as coronary bifurcations, is not established. We thus aimed to appraise the early and long-term results of PCI for bifurcations in young patients. Methods: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between 2002 and 2006 in 22 Italian centers. Patients were divided in 2 groups: age ≤45 years, and age >45 years. The primary end-point was long-term rate of major adverse cardiac events (MACE). Results: 4,314 patients were included: 195 (4.5%) in the younger group, and 4119 (95.5%) in the older group. 30-day outcomes did not show significant differences in MACE rates, with 1.0% in the ≤45 years group and 2.1% in the >45 years group (p=0.439), with death in 0.5% and 1.2% (p=0.388). At long-term follow-up (24.4± 15.1 months), younger patients showed similar rates of MACE, (12.8% vs. 16.6%, p=0.161), myocardial infarction (3.1% vs. 3.7%, p=0.633), target lesion revascularization (11.3% vs. 12.5%, p =0.627), or stent International Journal of Cardiology xxx (2012) xxx-xxx ☆ All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Section: Discussionsupporting

confidence: 85%

Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

Roversi

Biondi‐Zoccai

Romagnoli

et al. 2013

International Journal of Cardiology

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“…Bare metal stent implantation for bifurcation lesions produced higher rates of restenosis and TLR. 5,11 A DES has been proved to significantly reduce restenosis rates compared with a BMS, but it is still comparatively higher at the side branch. 7,12 The results of this study indicated that there was no difference in restenosis rate in the main branch between the 2 groups, but in the side branch it was significantly higher in the 1-DES group than in the 2-DES group.…”

Section: Discussionmentioning

confidence: 99%

“…2 -4 Specifically, the use of bare metal stents (BMSs) for both branches has not improved the results compared with 1-stent plus the kissing balloon technique. 5,6 Recently, several randomized and controlled trials have demonstrated great advantages of drug-eluting stents (DESs) in significantly reducing restenosis and recurrence of symptoms, and improving clinical outcomes after percutaneous coronary intervention (PCI). 7,8 Little is known about the comparative effects of 1-DES plus the kissing balloon technique with the 2-DES for bifurcation angioplasty in a Chinese population.…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of Simple Versus Complex Stenting of Coronary Artery Bifurcation Lesions in Daily Practice in Chinese Patients

Gao

Yang

2008

Clinical Cardiology

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Background: Recently, several randomized and controlled trials have demonstrated great advantages of a drug-eluting stent (DES) with respect to significant reduction in restenosis and recurrence of symptoms, and improvement in clinical outcomes after percutaneous coronary intervention (PCI). Little is known about the comparative effects of the 1-DES plus the kissing balloon technique with the 2-DES for bifurcation angioplasty in a Chinese population. Methods: From April 2004 to June 2006, 566 consecutive Chinese patients underwent DES implantation for true bifurcation lesions, including 346 1-DES with the kissing balloon technique (300 male, 57.7±11.5 y old) and 220 2-DES (183 male, 58.1±10.7 y old) were analyzed. Clinical and angiographic follow-up was performed after 7 mo. Results: The major adverse cardiac event (MACE) rates were higher in the 2-DES group than in the 1-DES group (5.5% versus 2.0%; p=0.032), which was mainly contributed to by acute myocardial infarction (AMI) (4.5% versus 1.4%; p=0.032), rather than death and target lesion revascularization (TLR) (0% versus 0.5%; p=0.389, 1.4% versus 2.7%; p=0.352). Stent thrombosis rates were higher in the 2-DES group than in the 1-DES group (0.6% versus 2.7%; p=0.042), except for 1 late-stent thrombosis in the 2-DES group, and all of them were subacute stent thrombosis (2 in the 1-DES group and 5 in the 2-DES group). The 7 mo angiographic follow-up rate was 36.4%. In the main branch there was no difference in restenosis rate in the 1-DES group compared with the 2-DES group (9.8% versus 11.9%; p=0.652), but in the side branch the restenosis rate was higher in the 1-DES group (33.6% versus 15.5%; p=0.004). However, there was no difference in in-segment late loss between the 2 groups, either in the main or side branch. Conclusion: Compared with the 2-DES strategy, if a final kissing balloon could be achieved, the 1-DES strategy may be more efficient and safe.

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“…Furthermore, patients with long sidebranch lesions were systematically excluded from the randomized trials [4]. Registries, though available in greater numbers [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], are of variable quality and use different lesion classification systems, quantitative coronary angiography (QCA) measurements performed in unclear technical conditions, with identical technical strategies bearing different names or different techniques grouped under a single name. Other than the comparison between stent deployment in one versus two branches, a meta-analysis of these various reports has proven quite impossible.…”

Section: Introductionmentioning

confidence: 99%

Classification of coronary artery bifurcation lesions and treatments: Time for a consensus!

Louvard

Thomas

Džavík

et al. 2007

Cathet Cardio Intervent

277

139

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Background: Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains a subject of debate. Many studies have been published in this setting. They are often small scale and display methodological flaws and other shortcomings such as inaccurate designation of lesions, heterogeneity, and inadequate description of techniques implemented. Methods: The aim is to propose a consensus established by the European Bifurcation Club (EBC), on the definition and classification of bifurcation lesions and treatments implemented with the purpose of allowing comparisons between techniques in various anatomical and clinical settings. Results: A bifurcation lesion is a coronary artery narrowing occurring adjacent to, and/or involving, the origin of a significant side branch. The simple lesion classification proposed by Medina has been adopted. To analyze the outcomes of different techniques by intention to treat, it is necessary to clearly define which vessel is the distal main branch and which is (are) the side branche(s) and give each branch a distinct name. Each segment of the bifurcation has been named following the same pattern as the Medina classification. The classification of the techniques (MADS: Main, Across, Distal, Side) is based on the manner in which the first stent has been implanted. A visual presentation of PCI techniques and devices used should allow the development of a software describing quickly and accurately the procedure performed. Conclusion: The EBC proposes a new classification of bifurcation lesions and their treatments to permit accurate comparisons of well described techniques in homogeneous lesion groups. '

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Bifurcation lesions: two stents versus one stent—immediate and follow-up results

Abstract: 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.

Cited by 273 publications

References 25 publications

Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

Comparative Study of Simple Versus Complex Stenting of Coronary Artery Bifurcation Lesions in Daily Practice in Chinese Patients

Classification of coronary artery bifurcation lesions and treatments: Time for a consensus!

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