Randomized Trial on Routine Vs. Provisional T-stenting in the Treatment of De Novo Coronary Bifurcation Lesions

Overview

Journal Eur Heart J

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2008 Oct 11

PMID 18845665

Citations 47

Authors

Miroslaw Ferenc

Michael Gick

Rolf-Peter Kienzle

Hans-Peter Bestehorn

Klaus-Dieter Werner

Thomas Comberg

Piotr Kuebler

Heinz Joachim Buttner

Franz-Josef Neumann

Affiliations

Soon will be listed here.

Abstract

Aims: We investigated whether routine T-stenting reduces restenosis of the side branch as compared with provisional T-stenting in patients with de novo coronary bifurcation lesions.

Methods And Results: Our randomized study assigned 101 patients with a coronary bifurcation lesion to routine T-stenting with sirolimus-eluting stents (SES) in both branches and 101 patients to provisional T-stenting with SES placement in the main branch followed by kissing-balloon angioplasty and provisional SES placement in the side branch only for inadequate results. Primary endpoint was per cent diameter stenosis of the side branch at 9 month angiographic follow-up. Angiographic follow-up in 192 (95%) patients revealed a per cent stenosis of the side branch of 23.0 +/- 20.2% after provisional T-stenting (19% with side-branch stent) and of 27.7 +/- 24.8% (P = 0.15) after routine T-stenting (98.2% with side-branch stent). The corresponding binary restenosis rates were 9.4 and 12.5% (P = 0.32), prompting re-intervention in 5.0 and 7.9% (P = 0.39), respectively. In the main branch, binary restenosis rates were 7.3% after provisional and 3.1% after routine T-stenting (P = 0.17). The overall 1 year incidence of target lesion re-intervention was 10.9% after provisional and 8.9% after routine T-stenting (P = 0.64).

Conclusions: Routine T-stenting with SES did not improve the angiographic outcome of percutaneous coronary intervention of coronary bifurcation lesions as compared with stenting of the main branch followed by kissing-balloon angioplasty and provisional side-branch stenting.

Citing Articles

Evaluating Drug-Eluting Balloons Versus Stenting for Provisional Bifurcation Lesions: Short-Term Outcomes and Future Directions.

Ziyad M, Shah S, Rauf M, Shah S, Ullah S, Ullah R Cureus. 2025; 17(2):e78436.

PMID: 40046367 PMC: 11882106. DOI: 10.7759/cureus.78436.

Evaluation of Small Vessel Bifurcation Stenting Using the Double-Kissing Culotte and Culotte Technique in Acute Coronary Syndrome: 12-Month Clinical Outcomes.

Barycki M, Rola P, Wlodarczak A, Wlodarczak S, Pecherzewski M, Wlodarczak P Clin Cardiol. 2024; 47(11):e70043.

PMID: 39545312 PMC: 11565065. DOI: 10.1002/clc.70043.

An Approach to Non-left Main Bifurcation Lesions: A Contemporary Review.

Calik A, Cader F, Rafflenbeul E, Okutucu S, Khan S, Canbolat I US Cardiol. 2024; 17:e10.

PMID: 39493947 PMC: 11526486. DOI: 10.15420/usc.2022.25.

Shepherd's Crook Curve: A Novel Technique for Angulated Side Branch Access in Bifurcation Angioplasty.

Lalani K, Rao M, Dhanse S, Devasia T, Kareem H, Paramasivam G Methodist Debakey Cardiovasc J. 2024; 20(1):59-64.

PMID: 39131797 PMC: 11312719. DOI: 10.14797/mdcvj.1413.

Provisional or 2-Stent Technique for Bifurcation Lesions in the Second-Generation Drug-Eluting Stent Era.

Fujisaki T, Kuno T, Numasawa Y, Takagi H, Briasoulis A, Kwan T J Soc Cardiovasc Angiogr Interv. 2024; 1(5):100410.

PMID: 39131456 PMC: 11307680. DOI: 10.1016/j.jscai.2022.100410.

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