CLINICAL RESEARCH: FOCUS ISSUE: TREATMENT OF BIFURCATION LESIONS
Clinical and Angiographic Outcome After Implantation of Drug-Eluting Stents in Bifurcation Lesions With the Crush Stent Technique
Importance of Final Kissing Balloon Post-Dilation
Lei Ge, MD*, ,
Flavio Airoldi, MD*,
Ioannis Iakovou, MD*,
John Cosgrave, MD*,
Iassen Michev, MD*,
Giuseppe M. Sangiorgi, MD*,
Matteo Montorfano, MD*,
Alaide Chieffo, MD*,
Mauro Carlino, MD*,
Nicola Corvaja, MD* and
Antonio Colombo, MD, FACC*,*
* EMO Centro Cuore Columbus and San Raffaele Hospital, Milan, Italy
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
Manuscript received January 13, 2005;
accepted March 10, 2005.
* Reprint requests and correspondence: Dr. Antonio Colombo, EMO Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy. (Email: info{at}emocolumbus.it).
OBJECTIVES: The purpose of this research was to evaluate the long-term outcomes after implantation of drug-eluting stents (DES) in bifurcation lesions with the "crush" technique.
BACKGROUND: The long-term outcome of "crush" stenting technique has yet to be determined.
METHODS: We identified 181 consecutive patients who were treated with DES with the "crush" stent technique from April 2002 to April 2004. Based on the usage of final kissing balloon post-dilation (FKB), the patients were divided into an FKB group (n = 116) and a non-FKB group (n = 65).
RESULTS: Clinical follow-up at nine months was available in all patients, and angiographic follow-up in 80% of patients. Three cases (1.7%) of intraprocedural stent thrombosis and five (2.8%) cases of postprocedural stent thrombosis occurred. Restenosis rate of the main branch in the entire cohort lesions was 11.5%. Restenosis rate of the side branch was lower in the FKB group than that in the non-FKB group (11.1% vs. 37.9%, p < 0.001). The target lesion revascularization (TLR) rate for all patients was 14.9%. The lack of FKB was a predictor for TLR (hazard ratio [HR] 4.17; 95% confidence interval [CI] 1.30 to 14.3, p = 0.02). Diabetes was also a predictor for TLR (HR 1.79; 95% CI 1.14 to 2.80, p = 0.01). Premature discontinuation of dual antiplatelet therapy (odds ratio [OR] 16.8; 95% CI 1.31 to 159.5, p = 0.03) and age (OR 1.10; 95% CI 1.00 to 1.21, p = 0.048) was associated with the occurrence of postprocedural stent thrombosis.
CONCLUSIONS: Compared to the absence of FKB, the "crush" stenting technique with FKB appears to be associated with more favorable long-term outcomes. When utilizing the "crush" stenting technique, FKB is mandatory.
|
Abbreviations and Acronyms
| | AMI = acute myocardial infarction | | CI = confidence interval | | DES = drug-eluting stent | | FKB = final kissing balloon after dilation | | HR = hazard ratio | | MACE = major adverse cardiac events | | OR = odds ratio | | PES = paclitaxel-eluting stent | | SES = sirolimus-eluting stent | | TLR = target lesion revascularization | | TVR = target vessel revascularization |
|
Related Article
-
Bifurcation Intervention: Is it Crush Time Yet?
- David O. Williams and J. Dawn Abbott
J. Am. Coll. Cardiol. 2005 46: 621-624.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
F Zhang, L Dong, and J Ge
Simple versus complex stenting strategy for coronary artery bifurcation lesions in the drug-eluting stent era: a meta-analysis of randomised trials
Heart,
October 15, 2009;
95(20):
1676 - 1681.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-Y. Hahn, Y. B. Song, S.-Y. Lee, J.-H. Choi, S.-H. Choi, D. K. Kim, S. H. Lee, and H.-C. Gwon
Serial Intravascular Ultrasound Analysis of the Main and Side Branches in Bifurcation Lesions Treated With the T-Stenting Technique.
J. Am. Coll. Cardiol.,
July 7, 2009;
54(2):
110 - 117.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. C.Y. To, G. Armstrong, I. Zeng, and M. W.I. Webster
Noncardiac Surgery and Bleeding After Percutaneous Coronary Intervention
Circ Cardiovasc Interv,
June 1, 2009;
2(3):
213 - 221.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. R. Galassi, S. D. Tomasello, D. Capodanno, G. Barrano, G. P. Ussia, and C. Tamburino
Mini-Crush Versus T-Provisional Techniques in Bifurcation Lesions: Clinical and Angiographic Long-Term Outcome After Implantation of Drug-Eluting Stents
J. Am. Coll. Cardiol. Intv.,
March 1, 2009;
2(3):
185 - 194.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. V. Kaplan
Percutaneous Coronary Intervention Treatment of Bifurcation Lesions--A Work in Progress: The Importance of Single-Center Studies
J. Am. Coll. Cardiol. Intv.,
March 1, 2009;
2(3):
195 - 196.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. R. Smith
Surgery, Not Percutaneous Revascularization, Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis
Circulation,
February 24, 2009;
119(7):
1013 - 1020.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. S. Teirstein
Percutaneous Revascularization Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis
Circulation,
February 24, 2009;
119(7):
1021 - 1033.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Colombo, E. Bramucci, S. Sacca, R. Violini, C. Lettieri, R. Zanini, I. Sheiban, L. Paloscia, E. Grube, J. Schofer, et al.
Randomized Study of the Crush Technique Versus Provisional Side-Branch Stenting in True Coronary Bifurcations: The CACTUS (Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents) Study
Circulation,
January 6, 2009;
119(1):
71 - 78.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Palmerini, A. Marzocchi, C. Tamburino, I. Sheiban, M. Margheri, G. Vecchi, G. Sangiorgi, A. Santarelli, A. Bartorelli, C. Briguori, et al.
Impact of Bifurcation Technique on 2-Year Clinical Outcomes in 773 Patients With Distal Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents
Circ Cardiovasc Interv,
December 1, 2008;
1(3):
185 - 192.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Adriaenssens, R. A. Byrne, A. Dibra, R. Iijima, J. Mehilli, O. Bruskina, A. Schomig, and A. Kastrati
Culotte stenting technique in coronary bifurcation disease: angiographic follow-up using dedicated quantitative coronary angiographic analysis and 12-month clinical outcomes
Eur. Heart J.,
December 1, 2008;
29(23):
2868 - 2876.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Shaoliang Chen, Junjie Zhang, Fei Ye, Zhongsheng Zhu, Song Lin, Nailiang Tian, Zhizhong Liu, Weiyi Fang, Yundai Chen, Xuewen Sun, et al.
Crush Stenting With Paclitaxel-Eluting or Sirolimus-Eluting Stents for the Treatment of Coronary Bifurcation Lesions
Angiology,
August 1, 2008;
59(4):
475 - 483.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. A. Ormiston, M. W.I. Webster, B. Webber, J. T. Stewart, P. N. Ruygrok, and R. I. Hatrick
The "Crush" Technique for Coronary Artery Bifurcation Stenting: Insights From Micro-Computed Tomographic Imaging of Bench Deployments
J. Am. Coll. Cardiol. Intv.,
August 1, 2008;
1(4):
351 - 357.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. C. Routledge, M.-C. Morice, T. Lefevre, P. Garot, F. De Marco, B. Vaquerizo, and Y. Louvard
2-Year Outcome of Patients Treated for Bifurcation Coronary Disease With Provisional Side Branch T-Stenting Using Drug-Eluting Stents
J. Am. Coll. Cardiol. Intv.,
August 1, 2008;
1(4):
358 - 365.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Waksman and L. Bonello
The 5 Ts of Bifurcation Intervention: Type, Technique, Two Stents, T-Stenting, Trials
J. Am. Coll. Cardiol. Intv.,
August 1, 2008;
1(4):
366 - 368.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Latib and A. Colombo
Bifurcation Disease: What Do We Know, What Should We Do?
J. Am. Coll. Cardiol. Intv.,
June 1, 2008;
1(3):
218 - 226.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Kelbaek, L. Klovgaard, S. Helqvist, J. F. Lassen, L. R. Krusell, T. Engstrom, H. E. Botker, E. Jorgensen, K. Saunamaki, S. Aljabbari, et al.
Long-Term Outcome in Patients Treated With Sirolimus-Eluting Stents in Complex Coronary Artery Lesions: 3-Year Results of the SCANDSTENT (Stenting Coronary Arteries in Non-Stress/Benestent Disease) Trial
J. Am. Coll. Cardiol.,
May 27, 2008;
51(21):
2011 - 2016.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. V. Anderson
Drug-Eluting Stents: Life Insurance With a Better Death Benefit
J. Am. Coll. Cardiol.,
May 27, 2008;
51(21):
2025 - 2027.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. S. Teirstein
Unprotected left main intervention patient selection, operator technique, and clinical outcomes.
J. Am. Coll. Cardiol. Intv.,
February 1, 2008;
1(1):
5 - 13.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Romagnoli, G. M. Sangiorgi, J. Cosgrave, E. Guillet, and A. Colombo
Drug-eluting stenting the case for post-dilation.
J. Am. Coll. Cardiol. Intv.,
February 1, 2008;
1(1):
22 - 31.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Tsuchikane, T. Aizawa, H. Tamai, Y. Igarashi, K. Kawajiri, N. Ozawa, S. Nakamura, K. Oku, M. Kijima, T. Suzuki, et al.
Pre Drug-Eluting Stent Debulking of Bifurcated Coronary Lesions
J. Am. Coll. Cardiol.,
November 13, 2007;
50(20):
1941 - 1945.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Colombo and A. Chieffo
Drug-Eluting Stent Update 2007: Part III: Technique and Unapproved/Unsettled Indications (Left Main, Bifurcations, Chronic Total Occlusions, Small Vessels and Long Lesions, Saphenous Vein Grafts, Acute Myocardial Infarctions, and Multivessel Disease)
Circulation,
September 18, 2007;
116(12):
1424 - 1432.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Jaffe and B. H. Strauss
Late and Very Late Thrombosis of Drug-Eluting Stents: Evolving Concepts and Perspectives
J. Am. Coll. Cardiol.,
July 10, 2007;
50(2):
119 - 127.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. V. Finn, G. Nakazawa, M. Joner, F. D. Kolodgie, E. K. Mont, H. K. Gold, and R. Virmani
Vascular Responses to Drug Eluting Stents: Importance of Delayed Healing
Arterioscler Thromb Vasc Biol,
July 1, 2007;
27(7):
1500 - 1510.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Tsuchida, A. Colombo, T. Lefevre, K. G. Oldroyd, V. Guetta, G. Guagliumi, W. von Scheidt, W. Ruzyllo, C. W. Hamm, M. Bressers, et al.
The clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent: insights from the Arterial Revascularization Therapies Study part II (ARTS II)
Eur. Heart J.,
February 2, 2007;
28(4):
433 - 442.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Jorgensen and S. Helqvist
Stent treatment of coronary artery bifurcation lesions
Eur. Heart J.,
February 2, 2007;
28(4):
383 - 385.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Rixe, S. Achenbach, D. Ropers, U. Baum, A. Kuettner, U. Ropers, W. Bautz, W. G. Daniel, and K. Anders
Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography
Eur. Heart J.,
November 1, 2006;
27(21):
2567 - 2572.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Joner, A. V. Finn, A. Farb, E. K. Mont, F. D. Kolodgie, E. Ladich, R. Kutys, K. Skorija, H. K. Gold, and R. Virmani
Pathology of Drug-Eluting Stents in Humans: Delayed Healing and Late Thrombotic Risk
J. Am. Coll. Cardiol.,
July 4, 2006;
48(1):
193 - 202.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Tung, S. Kaul, G. A. Diamond, and P. K. Shah
Narrative review: drug-eluting stents for the management of restenosis: a critical appraisal of the evidence.
Ann Intern Med,
June 20, 2006;
144(12):
913 - 919.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Kereiakes and D. P. Faxon
Left Main Coronary Revascularization at the Crossroads
Circulation,
May 30, 2006;
113(21):
2480 - 2484.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Tsimikas
Drug-Eluting Stents and Late Adverse Clinical Outcomes: Lessons Learned, Lessons Awaited
J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
2112 - 2115.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Hoye, I. Iakovou, L. Ge, C. A.G. van Mieghem, A. T.L. Ong, J. Cosgrave, G. M. Sangiorgi, F. Airoldi, M. Montorfano, I. Michev, et al.
Long-Term Outcomes After Stenting of Bifurcation Lesions With the "Crush" Technique: Predictors of an Adverse Outcome
J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
1949 - 1958.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Colombo, F. Airoldi, I. Iakovou, G. Stankovic, and L. Ge
Reply
J. Am. Coll. Cardiol.,
May 2, 2006;
47(9):
1916 - 1917.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Pristipino, V. Pasceri, and G. Richichi
Limitations of Crush Technique
J. Am. Coll. Cardiol.,
May 2, 2006;
47(9):
1915 - 1916.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. P. Kappetein, K. D. Dawkins, F. W. Mohr, M. C. Morice, M. J. Mack, M. E. Russell, J. Pomar, and P. W.J.C. Serruys
Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease. Insights from the SYNTAX run-in phase.
Eur. J. Cardiothorac. Surg.,
April 1, 2006;
29(4):
486 - 491.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, D. Sahn, and S. Tsimikas
Highlights of the Year in JACC 2005
J. Am. Coll. Cardiol.,
January 3, 2006;
47(1):
184 - 202.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Pislaru and R. D. Simari
The Translation of Transcription
Circ. Res.,
November 25, 2005;
97(11):
1083 - 1084.
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Iakovou, L. Ge, and A. Colombo
Contemporary Stent Treatment of Coronary Bifurcations
J. Am. Coll. Cardiol.,
October 18, 2005;
46(8):
1446 - 1455.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
