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J Am Coll Cardiol, 2000; 35:1145-1151
© 2000 by the American College of Cardiology Foundation
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ARTICLE

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

Takehiro Yamashita, MD, PhD* {dagger}, Takahiro Nishida, MD* {dagger}, Milena G. Adamian, MD* {dagger}, Carlo Briguori, MD* {dagger}, Marco Vaghetti, MD* {dagger}, Nicola Corvaja, MD* {dagger}, Remo Albiero, MD* {dagger}, Leo Finci, MD* {dagger}, Carlo Di Mario, MD, PhD, FACC* {dagger}, Jonathan M. Tobis, MD, FACC* {dagger} and Antonio Colombo, MD, FACC{dagger}

* EMO Centro Cuore Columbus, Milan, Italy
{dagger} Division of Cardiology, University of California, Los Angeles, California, USA

Manuscript received July 21, 1999; revised manuscript received November 9, 1999, accepted December 29, 1999.

Reprint requests and correspondence: Dr. Antonio Colombo, Emo Centro Cuore Columbus, via M. Buonarroti, 48, 20145 Milan, Italy
columbus{at}micronet.it

OBJECTIVES

The purpose of this study was to evaluate two different techniques of stent placement in bifurcation lesions.

BACKGROUND

Although stent placement with dedicated techniques has been suggested to be a useful therapeutic modality for bifurcation lesions, limited information is available if stent placement on the side branch and on the parent branch provides any advantage over a simpler strategy of stenting the parent vessel and balloon angioplasty of the side branch.

METHODS

Between March 1993 and April 1999, we treated a total of 92 patients with bifurcation lesions with two strategies: stenting both vessels (group B, n = 53) or stenting the parent vessel and balloon angioplasty of the side branch (group P, n = 39). Paired angiograms were analyzed by quantitative angiography, and clinical follow-up was obtained.

RESULTS

Stent placement on both branches resulted in a lower residual stenosis (7.4 ± 10.9% vs. 23.4% ± 18.7%, p < 0.001) in the side branch. Acute procedural success was similar in the two groups (group B: 87% vs. Group P: 92%). In-hospital major adverse cardiac events (MACE) occurred only in group B (13% vs. 0%, p < 0.05). At the six-month follow-up, the angiographic restenosis rate (group B: 62% vs. Group P: 48%) and the target lesion revascularization rate (38% vs. 36%, respectively) were similar in the two groups. There was no difference in the incidence of six-month total MACE (51% vs. 38%).

CONCLUSIONS

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.

Abbreviations and Acronyms
  CABG = coronary artery bypass grafting
  DCA = directional coronary atherectomy
  MACE = major adverse cardiac events
  MI = myocardial infarction
  MLD = minimum luminal diameter
  NQMI = Non-Q wave myocardial infarction
  QCA = quantitative coronary angiography
  QMI = Q wave myocardial infarction
  TIMI = thrombolysis in myocardial infarction
  TLR = target lesion revascularization




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