Impact of Bifurcation Technique on 2-Year Clinical Outcomes in 773 Patients With Distal Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents

Palmerini, Tullio; Marzocchi, Antonío; Tamburino, Corrado; Sheiban, Imad; Margheri, Massimo; Vecchi, Giuseppe; Sangiorgi, Giuseppe; Santarelli, Andrea; Bartorelli, Antonio L.; Briguori, Carlo; Vignali, Luigi; Pede, Francesco Di; Ramondo, Angelo; Inglese, Luigi; Carlo, Marco De; Falsini, Giovanni; Benassi, Alberto; Palmieri, Cataldo; Filippone, Vincenzo; Sangiorgi, Diego; Barlocco, Fabio; Servi, Stefano De

doi:10.1161/circinterventions.108.800631

Cited by 111 publications

(68 citation statements)

References 25 publications

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“…Another important point is that the high rate of TLR is a well-known limitation of LM branch stenting in any 2-SS. 3,5,8,10 Our study results indicated that UDLM patients treated with 2-SS tended to have more complex lesions than those treated with 1-SS, resulting in a higher rate of repeat revascularizations. TLR was mainly driven by revascularization for LCx restenosis, with the TLR-SB rates for the 2-SSs exceeding 23% at 5 years.…”

Section: Discussionmentioning

confidence: 63%

“…2,13 Even in the DES era, a 2-SS is still associated with a higher risk of cardiac mortality, ST, and the need for repeat revascularization because of lesion-specific problems and procedural complexity. [3][4][5]8 However, the role of a 2-SS remains controversial in UDLM disease even when necessary because of diffuse disease extending from the ostium of the LCx artery. Notably, we demonstrated that the treatment of UDLM disease with a 2-SS was safe and feasible despite lesion complexity when compared with a 1-SS, with a low occurrence of definite or probable ST.…”

Section: Discussionmentioning

confidence: 99%

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Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease

Takagi

Naganuma

Chieffo

et al. 2016

Circ: Cardiovascular Interventions

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Background— There are only little data available on the comparison of clinical outcomes between a 1-stent strategy (1-SS) and a 2-stent strategy (2-SS) for percutaneous coronary intervention in unprotected distal left main disease. Methods and Results— Between April 2005 and August 2011, we recruited 937 consecutive unprotected distal left main patients treated with drug-eluting stents (1-SS, 608 patients; 2-SS, 329 patients). Major adverse cardiovascular events were defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR) during the median follow-up period of 1592 days. Furthermore, the individual components of major adverse cardiovascular events, cardiac death, and stent thrombosis were evaluated. More complex lesions were seen with 2-SS than with 1-SS. Cardiac death occurred more frequently with 1-SS than with 2-SS (propensity score–adjusted hazard ratio, 0.52; 95% confidence interval, 0.29–0.64; P =0.03), whereas TLR occurred more frequently with 2-SS than with 1-SS (propensity score–adjusted hazard ratio, 1.59; 95% confidence interval, 1.15–2.20; P =0.005). TLR was mainly driven by revascularizations after restenosis at the ostial left circumflex artery (propensity score–adjusted hazard ratio, 1.94; 95% confidence interval, 1.33–2.82; P =0.001). However, there were no differences in major adverse cardiovascular events, all-cause death, stent thrombosis, and myocardial infarction. Of the 139 pairs that were propensity score matched, only TLRs were significantly higher in the 2-SS group (hazard ratio, 1.59; 95% confidence interval, 1.00–2.53; P =0.05). Conclusions— The difference between 1-SS and 2-SS in percutaneous coronary intervention for unprotected distal left main disease may be summarized by the high incidence of TLR, mainly because of restenosis at the ostial left circumflex artery in the 2-SS group.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease

Takagi

Naganuma

Chieffo

et al. 2016

Circ: Cardiovascular Interventions

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“…Balloon angioplasty and bare metal stents have gradually been replaced by drug-eluting stents. [1][2][3][4][5][6] When stenting is used, a major question is whether both the main vessel and the side branch should be stented. Such double stenting is appealing because it produces attractive postprocedural angiographic results.…”

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confidence: 99%

Double Versus Single Stenting for Coronary Bifurcation Lesions

Katritsis

Siontis

Ioannidis

2009

Circ: Cardiovascular Interventions

123

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Background-Several trials have addressed whether bifurcation lesions require stenting of both the main vessel and side branch, but uncertainty remains on the benefits of such double versus single stenting of the main vessel only. Methods and Results-We have conducted a meta-analysis of randomized trials including patients with coronary bifurcation lesions who were randomly selected to undergo percutaneous coronary intervention by either double or single stenting. Six studies (nϭ1642 patients) were eligible. There was increased risk of myocardial infarction with double stenting (risk ratio, 1.78; Pϭ0.001 by fixed effects; risk ratio, 1.49 with Bayesian meta-analysis). The summary point estimate suggested also an increased risk of stent thrombosis with double stenting, but the difference was not nominally significant given the sparse data (risk ratio, 1.85; Pϭ0.19). No obvious difference was seen for death (risk ratio, 0.81; Pϭ0.66) and target lesion revascularization (risk ratio, 1.09; Pϭ0.67). Key Words: angioplasty Ⅲ coronary bifurcation Ⅲ PCI Ⅲ stents Ⅲ meta-analysis P ercutaneous coronary intervention (PCI) of bifurcation lesions remains a subject of debate in terms of optimum treatment technique. Balloon angioplasty and bare metal stents have gradually been replaced by drug-eluting stents. [1][2][3][4][5][6] When stenting is used, a major question is whether both the main vessel and the side branch should be stented. Such double stenting is appealing because it produces attractive postprocedural angiographic results. However, there have been concerns about long-term major adverse cardiac events and, in particular, stent thrombosis with adjacent stents. Among several randomized trials published so far, 7-13 the deployment of an additional stent on the side branch of a bifurcation lesion has never been shown to result in significantly improved clinical outcomes as initially hypothesized. These trials, however, have been of too limited a sample size to allow robust conclusions, when seen in isolation. A synopsis of 3 randomized and 3 observational comparisons failed to detect any significant differences between double and single stenting in a bifurcation. 14 However, several other trials have appeared recently. We have, therefore, performed a meta-analysis of randomized trials to examine the relative outcomes of the double versus single stenting strategies for bifurcation lesions in terms of mortality, myocardial infarction, stent thrombosis, and target lesion revascularization. Conclusions-Stenting Clinical Perspective on p 415 Methods Study Eligibility and SelectionWe have conducted a meta-analysis of randomized trials including patients with coronary bifurcation lesions who were randomly selected to undergo PCI by either single stenting of the main vessel only (simple strategy) or double stenting of both the main vessel and the side branch (complex strategy) with any PCI technique. For study selection, we searched PubMed, using the terms bifurcation, coronary, and stent (last update, February 26, 2009). In...

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“…When considering these factors for distal LMCA bifurcation, the 2-stent procedure using DES has been reported to be associated with a higher TLR rate than the single-stent procedure, which was therefore the preferable strategy. 9, 25 The incidences of adverse event and angiographic restenosis were similar between complex and simple stent strategy using BMS. 29 However, comparison of the long-term impact of stenting strategy for LMCA between the DES and BMS groups has not yet been done.…”

Section: Discussionmentioning

confidence: 88%

Seven-Year Clinical Outcomes of Unprotected Left Main Coronary Artery Stenting With Drug-Eluting Stent and Bare-Metal Stent

Kubo

Kadota

Shimada

et al. 2013

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp oronary artery bypass grafting (CABG) has long been considered the standard procedure for revascularization of unprotected left main coronary artery (LMCA) stenosis. 1-4 Drug-eluting stents (DES) have been shown to dramatically reduce the rate of restenosis and target lesion revascularization (TLR) compared with bare-metal stents (BMS). 5, 6 As the indications for DES have expanded, LMCA stenting has been performed more frequently. Recent studies have reported positive short-and long-term outcomes for percutaneous coronary intervention (PCI) with DES implantation for unprotected LMCA disease. 7-12 However, there are some concerns about DES. The late catch-up phenomenon and very late stent thrombosis, for example, have been reported to occur more frequently with DES than with BMS. 13-15 After PCI for LMCA disease, late in-stent restenosis and stent thrombosis have become particularly important problems compared with stenting at other sites. Because no data are available on the long-term outcomes of DES and BMS implantations beyond 5 years after LMCA stenting, the duration of superiority of DES over BMS implantation for LMCA disease is unclear. In this study, we compared the 7-year clinical outcomes of DES and BMS implantations for unprotected LMCA disease. Background: The superiority of drug-eluting stents (DES) over bare-metal stents (BMS) 7 years after unprotected left main coronary artery (LMCA) stenting has not been investigated.

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Impact of Bifurcation Technique on 2-Year Clinical Outcomes in 773 Patients With Distal Unprotected Left Main Coronary Artery Stenosis Treated With Drug-Eluting Stents

Cited by 111 publications

References 25 publications

Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease

Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease

Double Versus Single Stenting for Coronary Bifurcation Lesions

Seven-Year Clinical Outcomes of Unprotected Left Main Coronary Artery Stenting With Drug-Eluting Stent and Bare-Metal Stent

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