Article Text

Three-year follow-up of 100 consecutive bifurcation lesions treated with taxus stents and the Crush-T stent technique
  1. CD Chue1,
  2. HC Routledge2,
  3. PF Ludman3,
  4. JN Townend3,
  5. ACR Epstein3,
  6. NP Buller3,
  7. SN Doshi3
  1. 1Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK,
  2. 2University Hospitals Coventry and Warwickshire, Coventry, UK,
  3. 3University Hospital Birmingham NHS Foundation Trust, Birmingham, UK


Introduction A simple provisional side-branch stenting strategy is favoured over a more complex approach in the majority of bifurcation lesions. In the subset of lesions that require a two-stent strategy the optimal treatment remains controversial. The Crush-T stent technique is advocated to minimise the risk of side-branch restenosis by ensuring complete circumferential stent coverage. Long-term follow-up outcome data for this technique are not available.

Aim To determine procedural outcomes and rates of 1, 2 and 3-year major adverse cardiac events (MACE) in a consecutive series of 100 bifurcation lesions treated with paclitaxel-eluting stents using the Crush technique at University Hospital Birmingham.

Methods In a prospective registry data were recorded for 100 cases treated between May 2003 and July 2005. Clinical follow-up was by telephone contact or hospital visit. Myocardial infarction (MI) during follow-up was defined according to European Society of Cardiology/American College of Cardiology definitions. Standard definitions of target lesion revascularisation (TLR) and target vessel revascularisation (TVR) were used. MACE was defined as any cardiac death, TVR or MI. The Academic Research Consortium definitions of stent thrombosis were used. Complete follow-up data are available for all patients at 3 years.

Results The mean age was 62 ± 11 years (range 37–86) with 75% males, 15% patients with diabetes and 53% presenting with an acute coronary syndrome. Paclitaxel-eluting stents were used in all cases and exclusively in 96%. A glycoprotein IIb/IIIa inhibitor was used in all cases. The site of bifurcation was 81% left anterior descending/distal, 12% circumflex artery/obtuse marginal, 6% distal left main stem and 1% right posterior descending artery/atrioventricular continuation. 93% were true bifurcations (⩾50% stenosis in main vessel and side branch). Technical success was 98% due to two failed attempts to deliver a side branch stent. A final kissing balloon dilatation was attempted in 68 patients and was successful in 51. Inpatient MACE was due to four non-Q wave MI. Symptom-driven TLR was 8% comprising seven repeat PCI procedures and one bypass. In univariate analyses the absence of a final kissing inflation was a significant predictor of TVR and TLR (p<0.05) but not of cardiac death, MI, stent thrombosis or 3-year MACE. Stent thrombosis was 3% (all probable) of which one was subacute (<30 days) and two were very late (>365 days). There was no significant correlation between the site of bifurcation, gender, diabetes or mode of presentation and any outcome variable.

Conclusion The long-term outcome of Crush stenting using paclitaxel-eluting stents in true bifurcation lesions was acceptable and comparable to long-term outcomes of provisional T stenting. Revascularisation rates were low when compared with published data. Failure to perform kissing balloon inflation successfully is a drawback of this technique. The absence of a final kissing inflation predicts TLR but does not increase the risk of cardiac death, stent thrombosis or MI at 3 years.

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MACE, major adverse cardiac event.

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