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Treatment of bifurcation lesions with two stents: one year angiographic and clinical follow up of crush versus T stenting
  1. L Ge*,
  2. I Iakovou,
  3. J Cosgrave,
  4. P Agostoni,
  5. F Airoldi,
  6. G M Sangiorgi,
  7. I Michev,
  8. A Chieffo,
  9. M Montorfano,
  10. M Carlino,
  11. N Corvaja,
  12. A Colombo
  1. EMO Centro Cuore Columbus and San Raffaele Hospital, Milan, Italy
  1. Correspondence to:
    Dr Antonio Colombo
    EMO Centro Cuore Columbus, 48 Via M Buonarroti, 20145 Milan, Italy; colombo{at}emocolumbus.it

Abstract

Objectives: To compare long term outcomes of the crush versus the T technique in bifurcation lesions.

Design: 182 consecutive patients were identified who underwent percutaneous coronary interventions for bifurcation lesions with drug eluting stents between April 2002 and January 2004. Two techniques were used according to the operator’s discretion: crush (group C, n  =  121) or T (group T, n  =  61).

Results: In-hospital outcome differed significantly between the two groups. Angiographic follow up was available for 142 (78%) patients. Groups C and T did not differ significantly regarding late loss (0.42 (0.39) mm v 0.34 (0.35) mm, p  =  0.52) and rate of restenosis (16.2% v 13.0%, p  =  0.80) in both the main and the side branch without final kissing balloon post-dilatation. However, when final kissing balloon post-dilatation was performed, group C had significantly lower late lumen loss (0.23 (0.21) mm v 0.37 (0.33) mm, p  =  0.02) and restenosis rate (8.6% v 26.5%, p  =  0.04) in the side branch. At one year’s clinical follow up, group C compared with group T had lower rates of target lesion revascularisation (14.0% v 31.1%, p  =  0.01) and target vessel revascularisation (16.5% v 32.8%, p  =  0.02).

Conclusions: In non-selected bifurcation lesions treated with drug eluting stents, the restenosis rate remains relatively high in the side branch. Compared with the T stenting technique, crush stenting with kissing balloon post-dilatation is associated with a reduced rate of restenosis in the side branch.

  • AMI, acute myocardial infarction
  • CI, confidence interval
  • CK, creatine kinase
  • DES, drug eluting stents
  • PES, paclitaxel eluting stent
  • SES, sirolimus eluting stent
  • TLR, target lesion revascularisation
  • TVR, target vessel revascularisation
  • stents
  • restenosis
  • revascularisation

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Footnotes

  • * Also the Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China

  • Published Online First 17 June 2005

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