ARTICLE
Bifurcation lesions: two stents versus one stent—immediate and follow-up results
Takehiro Yamashita, MD, PhD*  ,
Takahiro Nishida, MD* ,
Milena G. Adamian, MD* ,
Carlo Briguori, MD* ,
Marco Vaghetti, MD* ,
Nicola Corvaja, MD* ,
Remo Albiero, MD* ,
Leo Finci, MD* ,
Carlo Di Mario, MD, PhD, FACC* ,
Jonathan M. Tobis, MD, FACC* and
Antonio Colombo, MD, FACC
* EMO Centro Cuore Columbus, Milan, Italy
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.
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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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