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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

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JACC 2005 46: 621-624. [Full Text]  

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