Mechanical debulking versus balloon angioplasty for the treatment of true bifurcation lesions
Harold L. Dauerman, MDa,
Peter J. Higgins, MDa,
Anthony M. Sparano, BS*,
C. Michael Gibson, MD, MS*,
Gary R. Garber, MD, FACCa,1,
Joseph P. Carrozza, Jr., MD, FACCa,
Richard E. Kuntz, MD, MSca,
Roger J. Laham, MDa,
Samuel J. Shubrooks, Jr., MD, FACCa,
Donald S. Baim, MD, FACCa and
David J. Cohen, MD, MSca
a Cardiovascular Division, Beth Israel–Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
* Cardiovascular Division, West Roxbury Veterans Administration Medical Center, and Harvard Medical School, Boston, Massachusetts, USA
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Figure 1 Coronary angiograms demonstrating true bifurcation lesions. Duke class D lesion (A) with an 85% stenosis in the proximal LAD and an 89% stenosis in the distal LAD and with a 77% stenosis in the ostium of the contiguous diagonal branch. Duke class F lesion (B) with an 84% stenosis in the proximal LAD and a diffuse 65% stenosis in the ostium and proximal portion of the diagonal branch.
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Figure 2 Cumulative frequency distribution of minimum lumen diameter at baseline, after PTCA alone or after combined debulking and adjunctive PTCA as shown for the parent vessel (A) and the side branch (B). The final minimum lumen diameter after debulking plus postdilation was significantly larger than after balloon dilation alone in both the parent vessel (2.48 ± 0.57 vs. 1.97 ± 0.65 mm, p = 0.001) and the side branch (2.22 ± 0.53 vs. 1.39 ± 0.55 mm, p < 0.001). (A) Open triangles = PTCA baseline; open circles = debulking baseline; solid squares = PTCA final; solid triangles = debulking final. (B) Open triangles = debulking baseline; solid triangles = debulking final; open squares = PTCA baseline; solid squares = PTCA final.
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Figure 3 Kaplan-Meier estimates of the need for repeat target vessel revascularization after treatment of true bifurcation lesions by either PTCA alone or debulking plus adjunctive PTCA.
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Figure 4 Six-month target vessel revascularization (TVR) rates analyzed according to the dichotomous variable of side branch diameter (>2.3 mm). In patients with large side branches, there was a significant reduction in the incidence of target vessel revascularization (29% vs. 64%, p = 0.03), but the TVR rates were not significantly different for patients with smaller side branches (19% vs. 29%, p = NS).
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