Intervention Of True Bifurcated Coronary Lesions

Objective: The purpose of this study is to evaluate the two different strategies ofsirolimus-eluting stent placement in true bifurcated lesions: the simple approach-stenting the main vessel and balloon dilatation for the side branch versus the complexapproach-stentts for both the vessels (crush technique).Methods: To compare the two kinds of strategies, a retrospective study wasconducted in 69 patients with true coronary bifurcation lesions, selected from Oct2004 to May 2006. Condition of selection: true bifurcated lesions responsible forischemic symptoms matched the following criteria: (1) target lesion located in amajor bifurcation point (2) parent coronary vessel diameter≥3.0mm and side branchdiameter≥2.5mm (3) significant stenosis (≥50%) in both parent vessel and sidebranch. All patients received an SES at the main vessel, covering the side branch.Patients in group A (n=37) received a balloon dilatation of the involved side branch(simple strategy); patients in group B (n=32) received a second stent in the sidebranch, using crush technique(complex strategy). There were no differences betweengroups in baseline clinical and angiographic data. Quantitative coronary angiography(QCA) was performed with the dye-filled catheter as a reference before/afterangioplasty and during follow-up. Intravascular ultrasound (IVUS) was performedafter angioplasty and during follow-up. After nine months, follow-up angiographywas performed, and major adverse cardiac events (MACEs) in-hospital and duringfollow-up recorded.Results: 1. In-hospital MACEs occurred in one patient in group A (with non-Q-wavemyocardial infarction) and one patient in group B (with Q-wave myocardialinfarction). 2. In follow-up, restenosis in patient's stents occurred in one patient ingroup A and two patients in group B; two patients in group A and five patients ingroup B occurred restenosis in side branches; one patient in group B occurredrestenosis in both branches; and target lesion revascularization was performed in onepatient in group A and two patients in group B. 3. QCA:(1) Side branches of group B showed smaller residual stenosis than that of group A after the procedure (12±6 vs.28±4%, P＜0.05). (2) Side branches of group B showed greater minimal lumendiameter than that of group A after the procedure (2.32±0.16 vs. 1.96±0.18, P＜0.05).4. IVUS: (1) Side branches of group B showed greater minimal steut area than that ofgroup A after the procedure (4.7±2.2 vs. 3.5±2.0, P＜0.05). (2) The main vessels underorigin of side branches and the origins of side branches of group B showed greaterminimal stent/lumen area than that of group A after the procedure (6.8±3.1 vs.7.6±2.7; 2.7±2.2 vs. 3.2±2.1, P＜0.05).Conclusions: 1. Both strategies are effective in treating true bifurcated lesions, withno differences in clinical outcome. 2. If an elective/provisional SB stenting had todone, crush-stenting would be a choice, which is a simple and effective technique. 3.In the majority of true bifurcated lesions treated with crush technique, the smallestminimal stent area (MSA) and minimal lumen area (MLA) appeared at the SB ostiumand intrastent of MV under the SB ostium, this may contribute to a higher restenosisrate at this location, especially in group B. But the rate of target lesionrevascularization (TLR) had no difference between group A and group B. 4. Whenutilizing the crush-stenting technique, final kissing balloon (FKB) is mandatory.