Drug-eluting stents for the treatment of bifurcation lesions: A randomized comparison between paclitaxel and sirolimus stents

Pan, Manuel; Lezo, José Suárez de; Medina, Alfonso; Romero, Miguel; Delgado, António; Segura, José; Ojeda, Soledad; Mazuelos, Francisco; Hernández, Enrique; Melián, Francisco; Pavlovic, Djordje; Esteban, Fátima; Herrador, Juan

doi:10.1016/j.ahj.2006.10.017

Cited by 95 publications

(61 citation statements)

References 33 publications

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“…One randomized study reported that restenosis and TLR occurred less frequently in bifurcation lesions treated with sirolimus-eluting stents compared with paclitaxel-eluting stents. 20 Surprisingly, performing kissing ballooning increased the risk of MACE and TLR in 1 stent group of the present study, opposite of what we had predicted. Final kissing ballooning has been reported to be associated with a lower incidence of angiographic restenosis, TLR, MI and ST. 3,5,11 However, the role of final kissing ballooning has been studied mostly after 2-stent strategies including crush stenting in previous studies and data was limited with 1-stent strategies.…”

Section: Predictors Of Mace and Tlrcontrasting

confidence: 57%

Long-Term Clinical Results and Predictors of Adverse Outcomes After Drug-Eluting Stent Implantation for Bifurcation Lesions in a Real-World Practice - The COBIS (Coronary Bifurcation Stenting) Registry -

Gwon

Choi

Song

et al. 2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp oronary bifurcation lesions are one of the most challenging lesion subsets and known to have a lower angiographic success rate and a higher risk of procedural complications with a greater restenosis rate than non-bifurcation lesions. 1-3 Therefore, coronary bifurcation lesions have been the subject of many studies; however, realworld practice patterns and long-term clinical outcomes have not been adequately addressed by previous studies. Most previous studies focused on either treatment strategies or techniques and were of a small to medium sample size with a follow-up period of 6-12 months in a randomized setting. 1,4,5 Although a few of these previous studies used real-world data sets, these studies were not based on registries dedicated to bifurcation lesions and had only a medium sample size that was inadequate to identify prognostic factors by multivariate analysis. 6,7 Therefore, we investigated long-term clinical results and predictors of adverse outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for coronary bifurcation lesions using data from a dedicated, large, multicenter real-world registry.

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Section: Predictors Of Mace and Tlrcontrasting

confidence: 57%

Long-Term Clinical Results and Predictors of Adverse Outcomes After Drug-Eluting Stent Implantation for Bifurcation Lesions in a Real-World Practice - The COBIS (Coronary Bifurcation Stenting) Registry -

Gwon

Choi

Song

et al. 2010

Circ J

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“…• Vessel size: there is no consensus on what the cutoff value for vessel size should be to determine which SB size should be protected and treated during bifurcation PCI. Notably, the size of the SB and its correspondent myocardial territory are the most important factors determining the clinical consequences of SB compromise during procedure [10]. Regardless of the technical approach, smaller SBs appear to have increased likelihood to become compromise during procedure and also to develop restenosis [3,[15][16][17][18][19][20][21].…”

Section: Bifurcation Lesion Classification and Morphologymentioning

confidence: 99%

Bifurcation lesion morphology and intravascular ultrasound assessment

Costa

Moussa

2011

Int J Cardiovasc Imaging

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This repot reviews the angiographic and intravascular (IVUS) assessment of coronary bifurcation lesions. Overall, bifurcation lesion anatomy and morphology is critical for technical decision making, and a key factor for successful bifurcation PCI. Optimal viewing is essential for proper angiographic assessment, especially for evaluation of the degree of SB involvement. Current classifications based on the presence or absence of significant angiographic stenosis within the three segments of the bifurcation anatomy may not provide sufficient anatomic and morphologic information to guide technical decision making. Dedicated 2D bifurcation quantitative coronary angiography with segmental analysis of the bifurcation provides greater accuracy for quantification of the degree of stenosis in the PV and especially the SB ostium. IVUS assessment at preprocedure provides valuable information regarding vessel size, and plaque morphology and distribution (particularly in relation to the SB ostium) that may help select treatment strategy. At postprocedure, IVUS imaging evaluates stent apposition within the stented segment(s) and the appropriateness of stent expansion particularly at the SB ostium, what may impact long-term outcomes.

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“…These stent types have been compared in 2 previous bifurcation studies, both of which suggested that sirolimus-coated stents offer superior results. 20,21 In the CACTUS study (Coronary bifurcations: Application of the Crushing Technique Using Sirolimus-eluting stents), 22 350 patients with coronary bifurcations were randomized to crush or provisional T stenting with sirolimus stents. Kissing balloon inflations were mandated in both groups and were achieved in 92% and 90%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Simple Versus Complex Drug-Eluting Stenting for Bifurcation Lesions

et al. 2010

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Background-The optimal strategy for treating coronary bifurcation lesions remains a subject of debate. With bare-metal stents, single-stent approaches appear to be superior to systematic 2-stent strategies. Drug-eluting stents, however, have low rates of restenosis and might offer improved outcomes with complex stenting techniques. Methods and Results-Patients with significant coronary bifurcation lesions were randomized to either a simple or complex stenting strategy with drug-eluting stents. In the simple strategy, the main vessel was stented, followed by optional kissing balloon dilatation/T-stent. In the complex strategy, both vessels were systematically stented (culotte or crush techniques) with mandatory kissing balloon dilatation. Five hundred patients 64Ϯ10 years old were randomized; 77% were male. Eighty-two percent of lesions were true bifurcations (Ͼ50% narrowing in both vessels). In the simple group (nϭ250), 66 patients (26%) had kissing balloons in addition to main-vessel stenting, and 7 (3%) had T stenting. In the complex group (nϭ250), 89% of culotte (nϭ75) and 72% of crush (nϭ169) cases were completed successfully with final kissing balloon inflations. The primary end point (a composite at 9 months of death, myocardial infarction, and target-vessel failure) occurred in 8.0% of the simple group versus 15.2% of the complex group (hazard ratio 2.02, 95% confidence interval 1.17 to 3.47, Pϭ0.009). Myocardial infarction occurred in 3.6% versus 11.2%, respectively (Pϭ0.001), and in-hospital major adverse cardiovascular events occurred in 2.0% versus 8.0% (Pϭ0.002), respectively. Procedure duration and x-ray dose favored the simple approach. Conclusions-When coronary bifurcation lesions are treated, a systematic 2-stent technique results in higher rates of in-hospital and 9-month major adverse cardiovascular events. This difference is largely driven by periprocedural myocardial infarction. Procedure duration is longer, and x-ray dose is higher. The provisional technique should remain the preferred strategy in the majority of cases. Clinical Trial Registration Information-URL: http://www.clinicaltrials.gov. Unique identifier: NCT 00351260.

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Drug-eluting stents for the treatment of bifurcation lesions: A randomized comparison between paclitaxel and sirolimus stents

Cited by 95 publications

References 33 publications

Long-Term Clinical Results and Predictors of Adverse Outcomes After Drug-Eluting Stent Implantation for Bifurcation Lesions in a Real-World Practice - The COBIS (Coronary Bifurcation Stenting) Registry -

Long-Term Clinical Results and Predictors of Adverse Outcomes After Drug-Eluting Stent Implantation for Bifurcation Lesions in a Real-World Practice - The COBIS (Coronary Bifurcation Stenting) Registry -

Bifurcation lesion morphology and intravascular ultrasound assessment

Randomized Trial of Simple Versus Complex Drug-Eluting Stenting for Bifurcation Lesions

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