Stenting of bifurcation lesions using the bestent: A prospective dual‐center study

Abstract

Treatment of bifurcation lesions remains a technical challenge. Among 13 stents previously tested in a bench study, the Bestent seemed of particular interest in this indication as it provided good access to the side branch after stent implantation in the main branch associated with a satisfactory coverage of the lesion after kissing balloon inflation. The use of Bestent implanted in the main branch or both branches for treatment of bifurcation lesions involving a side branch > or = 2.2 mm in diameter was prospectively evaluated in a dual-center prospective study with a prospective 6-month clinical follow-up. All angiographic documents were analyzed by an independent corelab (CORISIS). Between 11 September 1997 and 21 February 1998, 96 patients were consecutively included (mean age, 63.7 +/- 11.4 years; 81.3% male; 58.3% with unstable angina and 6.3% acute myocardial infarction). The lesion involved the left anterior descending-diagonal coronary bifurcation in 55% of cases, left circumflex-marginal 23%, posterior descending-postero-lateral 12%, distal left main 6%, and others 4%. The main branch (proximal reference diameter: 3.43 +/- 0.45 mm) was stented in 98% of cases and the side branch (2.72 +/- 0.38 mm) in 38% (both branches in 34% of cases). T-stenting or provisional T-stenting was used in 88% of cases and final kissing balloon inflation was performed in 78% of cases. Procedural success was obtained in 100% of cases in the main branch and 98% in both branches. Major cardiac and cerebral events (MACCE) during hospitalization occurred in 4.2% of cases, non-Q-wave myocardial infarction (MI) in 3.1%, Q-wave MI in 1.0%, repeat PTCA in 2.1%; there were no major access site complication, no emergency coronary artery bypass grafting operation, no death. At 6-month follow-up, total MACCE rate was 14.6% (Q-wave MI, 3.1%; non-Q-wave MI, 3.1%; target vessel revascularization, 9.4%; death, 2.1%). Patients with target vessel revascularization (TVR) had restenosis of both branches in 22.2% of cases, main branch in 22.2%, and side branch in 55.6%. This study shows that using a simple strategy of provisional T-stenting of the side branch in the majority of cases, the Bestent can be used for treating bifurcation lesions with a high rate of success and an acceptable rate of TVR at 6-month follow-up.

Provisional T‐stenting and kissing balloon in the treatment of coronary bifurcation lesions: Results of the French multicenter “TULIPE” study

“…Treatment of the side branch after that of the main vessel allows, we believe, to prevent effectively plaque shifting, the main mechanism of side branch disruption [16]. This primary success rate was comparable to the results obtained in other studies of bifurcation lesions treatment with different T-stenting techniques, which reported a 92% success rate, [14] or Ystenting, with success rates between 89 and 97% [17].…”

“…Several studies conducted in 1, 2, or 3 French medical centers have applied the provisional T-stenting technique and reported promising results, including rates of target lesion revascularization (TLR) between 10 and 15% at 7 months [14]. This technique involves the placement of a stent within the main vessel, with or without ''jailing'' of a guide wire in the side branch and crossing of the stent with a balloon toward the side branch for the performance of ''kissing'' balloon.…”

Classification of coronary artery bifurcation lesions and treatments: Time for a consensus!

“…Furthermore, patients with long sidebranch lesions were systematically excluded from the randomized trials [4]. Registries, though available in greater numbers [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], are of variable quality and use different lesion classification systems, quantitative coronary angiography (QCA) measurements performed in unclear technical conditions, with identical technical strategies bearing different names or different techniques grouped under a single name. Other than the comparison between stent deployment in one versus two branches, a meta-analysis of these various reports has proven quite impossible.…”

Diretriz de Indicações e Utilizações das Intervenções Percutâneas e Stent Intracoronariano na Prática Clínica

“…[94][95][96][97] . Inúmeras técnicas foram idealizadas e apresentadas, visando a contornar a grande variação morfológica observada nas estenoses localizadas em bifurcação.…”

“…Se a opção for pela abordagem percutânea, o consenso atual, baseado na experiência de centros com grande experiência no tratamento desses casos, propõe implante de stent no ramo principal e realização de angioplastia convencional com stent provisional no ramo secundário. Por tratarse de uma área ainda controversa, a intervenção coronariana percutânea em estenoses bifurcadas deve ser individualizada, com cuidadosa análise anatomofuncional, associada à experiência do operador com esta apresentação morfológica, que é fundamental para o sucesso do procedimento [94][95][96][97] (Classe IIb, nível de evidência C). G) Intervenção percutânea multiarterial -No passado, seis trabalhos multicêntricos e randomizados compararam, em pacientes com doença multiarterial, os resultados da angioplastia com o balão e os da cirurgia de revascularização, demonstrando que ambas as possibilidades de tratamento exibiam resultados tardios similares, em termos de sobrevida e taxas de infarto do miocárdio.…”