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CLINICAL STUDIES

Immediate and long-term outcome of intracoronary stent implantation for true bifurcation lesions

^a Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA

Manuscript received June 8, 1999; revised manuscript received October 25, 1999, accepted December 2, 1999.

Reprint requests and correspondence: Dr. David R. Holmes, Jr., Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905
holmes.david{at}mayo.edu

OBJECTIVES

The aim of this study was to evaluate the immediate and long-term outcome of intracoronary stent implantation for the treatment of coronary artery bifurcation lesions.

BACKGROUND

Balloon angioplasty of true coronary bifurcation lesions is associated with a lower success and higher complication rate than most other lesion types.

METHODS

We treated 131 patients with bifurcation lesions with 1 stent. Patients were divided into two groups; Group (Gp) 1 included 77 patients treated with a stent in one branch and percutaneous transluminal coronary angioplasty (PTCA) (with or without atherectomy) in the side branch, and Gp 2 included 54 patients who underwent stent deployment in both branches. The Gp 2 patients were subsequently divided into two subgroups depending on the technique of stent deployment. The Gp 2a included 19 patients who underwent Y-stenting, and Gp 2b included 33 patients who underwent T-stenting.

RESULTS

There were no significant differences between the groups in terms of age, gender, frequency of prior myocardial infarction (MI) or coronary artery bypass grafting (CABG), or vessels treated. Procedural success rates were excellent (89.5 to 97.4%). After one-year follow-up, no significant differences were seen in the frequency of major adverse events (death, MI, or repeat revascularization) between Gp 1 and Gp 2. Adverse cardiac events were higher with Y-stenting compared with T-stenting (86.3% vs. 30.4%, p = 0.004).

CONCLUSIONS

Stenting of bifurcation lesions can be achieved with a high success rate. However, stenting of both branches offers no advantage over stenting one branch and performing balloon angioplasty of the other branch.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CCS = Canadian Cardiovascular Society   CK = creatine kinase   Gp = group   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty

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