CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Long-Term Outcomes After Stenting of Bifurcation Lesions With the "Crush" Technique
Predictors of an Adverse Outcome
Angela Hoye, MB ChB, PhD*,
Ioannis Iakovou, MD ,
Lei Ge, MD,
Carlos A.G. van Mieghem, MD*,
Andrew T.L. Ong, MD*,
John Cosgrave, MD,
Giuseppe M. Sangiorgi, MD,
Flavio Airoldi, MD,
Matteo Montorfano, MD,
Iassen Michev, MD,
Alaide Chieffo, MD,
Mauro Carlino, MD,
Nicola Corvaja, MD,
Jiro Aoki, MD*,
Gaston A. Rodriguez Granillo, MD*,
Marco Valgimigli, MD*,
Georgios Sianos, MD, PhD*,
Willem J. van der Giessen, MD, PhD*,
Pim J. de Feyter, MD, PhD*,
Ron T. van Domburg, PhD*,
Patrick W. Serruys, MD, PhD*,* and
Antonio Colombo, MD
* Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
EMO Centro Cuore Columbus and San Raffaele Hospital, Milan, Italy.
Manuscript received August 28, 2005;
revised manuscript received November 23, 2005,
accepted November 28, 2005.
* Reprint requests and correspondence: Prof. Patrick W. Serruys, Thoraxcenter, Bd 406, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. (Email: p.w.j.c.serruys{at}erasmusmc.nl).
OBJECTIVES: The purpose of this study was to evaluate predictors of an adverse outcome after "crush" bifurcation stenting.
BACKGROUND: The "crush" technique is a recently introduced strategy with limited data regarding long-term outcomes.
METHODS: We identified 231 consecutive patients treated with drug-eluting stent implantation with the "crush" technique for 241 de novo bifurcation lesions. Clinical follow-up was obtained in 99.6%.
RESULTS: The in-hospital major adverse cardiac event (MACE) rate was 5.2%. At 9 months, 10 (4.3%) patients had an event consistent with possible post-procedural stent thrombosis. Survival free of target lesion revascularization (TLR) was 90.3%; the only independent predictor of TLR was left main stem (LMS) therapy (odds ratio [OR] 4.97; 95% confidence interval [CI] 2.00 to 12.37, p = 0.001). Survival free of MACE was 83.5% and independent predictors of MACE were LMS therapy (OR 3.79; 95% CI 1.76 to 8.14, p = 0.001) and treatment of patients with multivessel disease (OR 4.21; 95% CI 0.95 to 18.56, p = 0.058). Angiographic follow-up was obtained in 77% of lesions at 8.3 ± 3.7months. The mean late loss of the main vessel and side branch were 0.30 ± 0.64 mm and 0.41 ± 0.67 mm, respectively, with binary restenosis rates of 9.1% and 25.3%. Kissing balloon post-dilation significantly reduced the side branch late lumen loss (0.24 ± 0.50 mm vs. 0.58 ± 0.77 mm, p < 0.001).
CONCLUSIONS: The crush technique of bifurcation stenting with drug-eluting stents is associated with favorable outcomes for most lesions; however, efficacy appears significantly reduced in LMS bifurcations, and further research is needed before the technique can be routinely recommended in this group. Furthermore, the incidence of possible stent thrombosis is of concern and requires further investigation. Kissing balloon post-dilatation is mandatory to reduce side branch restenosis.
|
Abbreviations and Acronyms
| | AMI = acute myocardial infarction | | BMS = bare-metal stent | | CABG = coronary artery bypass graft | | CI = confidence interval | | DES = drug-eluting stent | | LMS = left main stem | | MACE = major adverse cardiac event | | MLD = minimal lumen diameter | | OR = odds ratio | | PES = paclitaxel-eluting stent | | SES = sirolimus-eluting stent | | TLR = target lesion revascularization | | TVR = target vessel revascularization |
|
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]
|
|
|
|
|
|
|
B. Vaquerizo, T. Lefevre, O. Darremont, M. Silvestri, Y. Louvard, J. L. Leymarie, P. Garot, H. Routledge, F. de Marco, T. Unterseeh, et al.
Unprotected Left Main Stenting in the Real World: Two-Year Outcomes of the French Left Main Taxus Registry
Circulation,
May 5, 2009;
119(17):
2349 - 2356.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Eisenberg, P. R. Richard, D. Libersan, and K. B. Filion
Safety of Short-Term Discontinuation of Antiplatelet Therapy in Patients With Drug-Eluting Stents
Circulation,
March 31, 2009;
119(12):
1634 - 1642.
[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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
Randomized Comparison of Coronary Bifurcation Stenting With the Crush Versus the Culotte Technique Using Sirolimus Eluting Stents: The Nordic Stent Technique Study
Circ Cardiovasc Interv,
February 1, 2009;
2(1):
27 - 34.
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
R. J. Shemin
Coronary Artery Bypass Grafting Versus Stenting for Unprotected Left Main Coronary Artery Disease: Where Lies the Body of Proof?
Circulation,
December 2, 2008;
118(23):
2326 - 2329.
[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]
|
|
|
|
|
|
|
W. Rademacher, A. Knape, J. Schumm, M. Ferrari, A. Lauten, H. Mudra, and H. R. Figulla
Acute and long-term outcome of unprotected left main coronary angioplasty compared to the anticipated surgical risk
Interactive CardioVascular and Thoracic Surgery,
October 1, 2008;
7(5):
871 - 877.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. C. John, R. Wessely, A. Kastrati, A. Schomig, M. Joner, M. Uchihashi, J. Crimins, S. Lajoie, F. D. Kolodgie, H. K. Gold, et al.
Differential Healing Responses in Polymer- and Nonpolymer-Based Sirolimus-Eluting Stents
J. Am. Coll. Cardiol. Intv.,
October 1, 2008;
1(5):
535 - 544.
[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]
|
|
|
|
|
|
|
K. E. Kip, K. Hollabaugh, O. C. Marroquin, and D. O. Williams
The Problem With Composite End Points in Cardiovascular Studies The Story of Major Adverse Cardiac Events and Percutaneous Coronary Intervention.
J. Am. Coll. Cardiol.,
February 19, 2008;
51(7):
701 - 707.
[Abstract]
[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. 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]
|
|
|
|
|
|
|
S. Windecker and B. Meier
Late Coronary Stent Thrombosis
Circulation,
October 23, 2007;
116(17):
1952 - 1965.
[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]
|
|
|
|
|
|
|
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The Year in Interventional Cardiology
J. Am. Coll. Cardiol.,
July 17, 2007;
50(3):
270 - 285.
[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]
|
|
|
|
|
|
|
D. R. Holmes Jr, D. J. Kereiakes, W. K. Laskey, A. Colombo, S. G. Ellis, T. D. Henry, J. J. Popma, P. W.J.C. Serruys, T. Kimura, D. O. Williams, et al.
Thrombosis and Drug-Eluting Stents: An Objective Appraisal
J. Am. Coll. Cardiol.,
July 10, 2007;
50(2):
109 - 118.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Bifurcation Stenting with the Crush Technique
Journal Watch Cardiology,
June 28, 2006;
2006(628):
5 - 5.
[Full Text]
|
|
|
|
