Objectives The unprotected left main coronary artery (ULMCA) bifurcation stenosis remains challenging for percutaneous coronary intervention (PCI). The aim of the study was to evaluate the effectiveness and safety of bifurcation technique on the treatment of ULMCA bifurcation stenosis in drug eluting stent era.

Methods Between March 2004 and November 2011, a total of 224 patients (168 male) underwent bifurcation technique with drug eluting stent for true bifurcation lesions of ULMCA. Patients with cardiogenic shock were excluded from the analysis. We defined true bifurcations as Medina 1,1,1 or 1,0,1 or 0,1,1. The indexes of in-hospital, angiographic restenosis at 12-months and major adverse cardiac events (MACE) including cardiac death, myocardial infarction or any target lesion revascularisation were evaluated.

Results The procedural was successful in all patients. Bifurcation techniques included T stenting in 78(34.8%), Cullotte stenting in 69(30.8%) and Crush stenting in 77(34.3%) patients. Final “kissing balloon” inflation was preferred in 196 cases (87.5%). Intravascular ultrasound (IVUS) was performed in 79 cases during procedural. The mean stent diameter was (3.4 ± 0.40) mm in ULMCA. The overall rate of MACE was 1.3% (3/224) during hospital stay, including one acute stent thrombosis during procedure and 2 patients underwent repeat angioplasty for subacute stent thrombosis after PCI procedure. One patient died for subacute stent thrombosis during hospital stay. All patients were followed-up for at least 12 months. Two patients died for congestive heart failure during follow-up. Angiographic follow-up was obtained in 96(42.9%) patients. Binary in-stent restenosis occurred in 15(6.7%) patients and all of them were treated with CABG (7/15) or repeat PCI (8/15). The rate of target vessel revascularisation was significantly lower in patients with final kissing inflation during the index procedure compared with those without final kissing (4.1% (8/196) vs 25.0% (7/28); P < 0.01).

Conclusions Our experience indicated that bifurcation stenting for LMCA bifurcation lesions in elective patients could achieve a high technical success rate. Final kissing balloon might reduce the need for target vessel revascularisation.