Modified double-stent strategy may be an optimal choice for coronary bifurcation lesions

Lv, Yonghui; Guo, Cheng; Li, Min; Zhang, Mingbo; Wang, Zhilu

doi:10.1097/md.0000000000013377

Cited by 3 publications

(2 citation statements)

References 34 publications

(44 reference statements)

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“… 18 In comparison, the conventional culotte technique was associated with a higher incidence of restenosis and ST. 19 In addition, both techniques were related to a higher incidence of SB occlusion. 20 Fortunately, the crush and culotte techniques have undergone improvements. One modification of the crush technique was the optimization of the stent placement procedure, where a separate step was used to crush the SB stent, followed by inserting a stent into the MV.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes Following Simple or Complex Stenting for Coronary Bifurcation Lesions: A Meta-Analysis

Zhang

Huan

Han

et al. 2022

Clin Med Insights Cardiol

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Background: Stent placement remains a challenge for coronary bifurcation lesions. While both simple and complex stenting strategies are available, it is unclear which one results in better clinical outcomes. This meta-analysis aims to explore the long-term prognosis following treatment with the 2 stenting strategies. Method: Randomized controlled trials found from searches of the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were included in this meta-analysis. The complex stent placement strategy was identified as the control group, and the simple stent placement strategy was identified as the experimental group. Data were synthesized with a random effects model. The quality of the randomized controlled trials was assessed by Jadad scale scores. The clinical endpoints at 6 months, 1 year, and 5 years were analyzed. Results: A total of 11 randomized controlled trials met the inclusion criteria. A total of 2494 patients were included in this meta-analysis. The odds ratio [OR] of the major adverse cardiac events (MACEs) at 6 months was 0.85 (95% confidence interval [CI] 0.53-1.35; P = .49, I2 = 0%). The OR of the MACEs at 1 year was 0.61 (95% CI 0.36-1.05; P = .08, I2 = 0%). The OR of the MACEs at 5 years was 0.69 (95% CI 0.51-0.92; P = .01, I2 = 0%). Compared with the complex strategy, the simple strategy was associated with a lower incidence of MACEs at 5 years. Conclusion: Compared to the complex stenting strategy, the simple stenting strategy can better reduce the occurrence of long-term MACEs for coronary bifurcation lesions.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes Following Simple or Complex Stenting for Coronary Bifurcation Lesions: A Meta-Analysis

Zhang

Huan

Han

et al. 2022

Clin Med Insights Cardiol

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“…Their findings show that the double stenting strategy resulted in a higher risk of stent thrombosis (RR: 2.31, 95% CI: 1.33-4.03) and MIs (RR: 1.86, 95% CI: 1.34-2.60). While Nairooz et al and Ford et al evaluated long-term outcomes, another meta-analysis by Lv et al [ 20 ] evaluated short-term outcomes for provisional stenting and modified double stenting. They evaluated 6 studies (1683 patients) using outcomes in a <6-month window and >6-month window as primary endpoints.…”

Section: A Comparison Of Stenting Techniquesmentioning

confidence: 99%

Coronary Bifurcation Stenting: Review of Current Techniques and Evidence

Aedma

Naik

Kanmanthareddy

2023

CCR

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Background: Coronary bifurcation stenting constitutes 20% of all PCI performed. Given the extensive prevalence of bifurcation lesions, various techniques have sought to optimally stent the bifurcation to improve revascularization while also decreasing rates of stent thrombosis and lesion recurrence. Advanced techniques, such as planned two-stent approaches, have been shown to have improved outcomes, but also require fluoroscopy and procedure time, posing an economical argument as well as a patient-outcome one. Objective: Because of the many strategies posited in the literature, it becomes essential to objectively evaluate evidence from randomized controlled trials and meta-analyses to help determine the optimal stenting strategy. Methods: We perform a review of the clinical evidence on the efficacy of coronary bifurcation stenting. Results: In this review, we review the most recent randomized controlled trials and meta-analyses on the efficacy of various stenting techniques and advances in stenting technologies published to gauge the current state of understanding, and chart where the field is heading. Conclusion: Bifurcation stenting is a maturing problem in the field of interventional cardiology that is adapting to the needs of the patients and advances in technology.

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A drug-eluting Balloon for the trEatment of coronarY bifurcatiON lesions in the side branch: a prospective multicenter ranDomized (BEYOND) clinical trial in China

Jing

Zhao

Han

et al. 2020

Chinese Medical Journal

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Background Treatment of coronary bifurcation lesions remains challenging; a simple strategy has been preferred as of late, but the disadvantage is ostium stenosis or even occlusion of the side branch (SB). Only a few single-center studies investigating the combination of a drug-eluting stent in the main branch followed by a drug-eluting balloon in the SB have been reported. This prospective, multicenter, randomized study aimed to investigate the safety and efficacy of a paclitaxel-eluting balloon (PEB) compared with regular balloon angioplasty (BA) in the treatment of non-left main coronary artery bifurcation lesions. Methods Between December 2014 and November 2015, a total of 222 consecutive patients with bifurcation lesions were enrolled in this study at ten Chinese centers. Patients were randomly allocated at a 1:1 ratio to a PEB group (n = 113) and a BA group (n = 109). The primary efficacy endpoint was angiographic target lesion stenosis at 9 months. Secondary efficacy and safety endpoints included target lesion revascularization, target vessel revascularization, target lesion failure, major adverse cardiac and cerebral events (MACCEs), all-cause death, cardiac death, non-fatal myocardial infarction, and thrombosis in target lesions. The main analyses performed in this clinical trial included case shedding analysis, base-value equilibrium analysis, effectiveness analysis, and safety analysis. SAS version 9.4 was used for the statistical analyses. Results At the 9-month angiographic follow-up, the difference in the primary efficacy endpoint of target lesion stenosis between the PEB (28.7% ± 18.7%) and BA groups (40.0% ± 19.0%) was –11.3% (95% confidence interval: –16.3% to –6.3%, P superiority <0.0001) in the intention-to-treat analysis, and similar results were recorded in the per-protocol analysis, demonstrating the superiority of PEB to BA. Late lumen loss was significantly lower in the PEB group than in the BA group (–0.06 ± 0.32 vs. 0.18 ± 0.34 mm, P < 0.0001). For intention-to-treat, there were no significant differences between PEB and BA in the 9-month percentages of MACCEs (0.9% vs. 3.7%, P = 0.16) or non-fatal myocardial infarctions (0 vs. 0.9%, P = 0.49). There were no clinical events of target lesion revascularization, target vessel revascularization, target lesion failure, all-cause death, cardiac death or target lesion thrombosis in either group. Conclusions In de novo non-left main coronary artery bifurcations treated with provisional T stenting, SB dilation with the PEB group demonstrated better angiographic results than treatment with regular BA at the 9-month follow-up in terms of reduced target lesion stenosis. Trial registration ClinicalTrials.gov, NCT02325817; https://clinicaltrials.gov

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Modified double-stent strategy may be an optimal choice for coronary bifurcation lesions

Abstract: Supplemental Digital Content is available in the text

Cited by 3 publications

References 34 publications

Clinical Outcomes Following Simple or Complex Stenting for Coronary Bifurcation Lesions: A Meta-Analysis

Clinical Outcomes Following Simple or Complex Stenting for Coronary Bifurcation Lesions: A Meta-Analysis

Coronary Bifurcation Stenting: Review of Current Techniques and Evidence

A drug-eluting Balloon for the trEatment of coronarY bifurcatiON lesions in the side branch: a prospective multicenter ranDomized (BEYOND) clinical trial in China

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