Key result
Main branch stenting without side branch protection showed similar outcomes to a double wire strategy, with overall 1-year death at 2.4%, while side branch dilatation had 8.6% stent thrombosis.
Why the study?
Does the choice of stenting strategy (single vs double wire) affect 1-year clinical outcomes in patients undergoing PCI for bifurcation coronary artery disease with sirolimus-eluting stents?
Observational (n=161)
Yes
Does the choice of stenting strategy (single vs double wire) affect 1-year clinical outcomes in patients undergoing PCI for bifurcation coronary artery disease with sirolimus-eluting stents?
Main branch stenting without side branch protection is the most common approach for bifurcation PCI in the US and is associated with acceptably low 1-year adverse outcomes, though side branch dilatation may increase stent thrombosis risk.
May support unprotected main branch stenting in bifurcation PCI; leaves open optimal side branch management in randomized trials.
OBJECTIVES: Our goal is to report the first large multicenter data for percutaneous coronary intervention (PCI) of bifurcation disease with drug-eluting stents (DES) in the United States. BACKGROUND: Bifurcation PCI remains a challenge to this date. There are limited data on outcomes of patients treated with bifurcation DES implantation, particularly in the United States. METHODS: There were 161 patients with bifurcation disease [side branch (SB) >or=2-mm] treated with >or=1 sirolimus-eluting stents at 41 centers participating in the Stent deployment Techniques on cLinicaL outcomes of patients treated with the cypheRstent (STLLR) trial. There was no protocol mandated strategy for bifurcation PCI. One-year outcome data were collected. Angiographic and clinical data were adjudicated independently. RESULTS: There were 147 patients (91.3%) treated with single stent strategy. Only 14 (8.7%) patients received sirolimus-eluting stents implantation in both branches. Among patients with single stent strategy, double wire strategy (DW) was selected in 27 (18.4%) patients whereas single wire strategy (SW) was selected in 120 (81.6%) patients. There were 48 (32.7%) Medina 1,1,1 bifurcations treated with SW (n = 34; 70.8%) and DW (n = 14; 29.2%). There were 26 procedures started with SW which had SB dilatation during the procedure, one as a bailout (TIMI-1 grade flow in the SB). Overall 1-year death, myocardial infarction, and target lesion revascularization occurred in 2.4, 4.0, and 5.6%, respectively. There was no significant difference in clinical outcomes between SW and DW. SB dilatation was associated with a high rate of stent thrombosis (8.6%). CONCLUSIONS: Main branch stenting without SB protection is the most common approach utilized in the STLLR study, which may reflect contemporary DES bifurcation strategies in the Unite States. This strategy was associated with an acceptable low incidence of adverse outcomes at 1-year.
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Suzuki et al. (2008) conducted an observational in Bifurcation coronary artery disease (n=161). Single wire strategy (main branch stenting without side branch protection) vs. Double wire strategy was evaluated on 1-year death, myocardial infarction, and target lesion revascularization. Main branch stenting without side branch protection showed similar outcomes to a double wire strategy, with overall 1-year death at 2.4%, while side branch dilatation had 8.6% stent thrombosis.
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