Clinical and Angiographic Outcome After Implantation of Drug-Eluting Stents in Bifurcation Lesions With the Crush Stent Technique
Key result
FKB during crush stenting is linked to ~27-point lower side branch restenosis.
- P<0.001
- n=181
Why the study?
The long-term outcome of the crush stenting technique with drug-eluting stents in bifurcation lesions has yet to be determined.
Does final kissing balloon post-dilation improve clinical and angiographic outcomes in patients undergoing crush stenting for bifurcation lesions?
Study Design
Type
Cohort (n=181)
Structured PICO
Does final kissing balloon post-dilation improve clinical and angiographic outcomes in patients undergoing crush stenting for bifurcation lesions?
P
Population
181 consecutive patients treated with drug-eluting stents for bifurcation lesions using the 'crush' technique, followed clinically for 9 months.
E
Exposure
Final kissing balloon post-dilation (FKB) (n=116)
C
Comparator
No final kissing balloon post-dilation (non-FKB) (n=65)
O
Outcome
Clinical and angiographic outcomes (restenosis, target lesion revascularization, and stent thrombosis) at 9 monthshard clinical
Main Result
Absolute Event Rate: 11.1% vs 37.9%
p-value: p=<0.001
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“For bifurcation lesions, two stents are probably needed about 30% of the time. In such cases, the kissing balloon technique is almost mandatory.”
Implication
Final kissing balloon post-dilation is mandatory when utilizing the crush stenting technique for bifurcation lesions due to significantly lower rates of side branch restenosis and target lesion revascularization.
Abstract
OBJECTIVES: The purpose of this research was to evaluate the long-term outcomes after implantation of drug-eluting stents (DES) in bifurcation lesions with the "crush" technique. BACKGROUND: The long-term outcome of "crush" stenting technique has yet to be determined. METHODS: We identified 181 consecutive patients who were treated with DES with the "crush" stent technique from April 2002 to April 2004. Based on the usage of final kissing balloon post-dilation (FKB), the patients were divided into an FKB group (n = 116) and a non-FKB group (n = 65). RESULTS: Clinical follow-up at nine months was available in all patients, and angiographic follow-up in 80% of patients. Three cases (1.7%) of intraprocedural stent thrombosis and five (2.8%) cases of postprocedural stent thrombosis occurred. Restenosis rate of the main branch in the entire cohort lesions was 11.5%. Restenosis rate of the side branch was lower in the FKB group than that in the non-FKB group (11.1% vs. 37.9%, p < 0.001). The target lesion revascularization (TLR) rate for all patients was 14.9%. The lack of FKB was a predictor for TLR (hazard ratio [HR] 4.17; 95% confidence interval [CI] 1.30 to 14.3, p = 0.02). Diabetes was also a predictor for TLR (HR 1.79; 95% CI 1.14 to 2.80, p = 0.01). Premature discontinuation of dual antiplatelet therapy (odds ratio [OR] 16.8; 95% CI 1.31 to 159.5, p = 0.03) and age (OR 1.10; 95% CI 1.00 to 1.21, p = 0.048) was associated with the occurrence of postprocedural stent thrombosis. CONCLUSIONS: Compared to the absence of FKB, the "crush" stenting technique with FKB appears to be associated with more favorable long-term outcomes. When utilizing the "crush" stenting technique, FKB is mandatory.
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Cite This Study
Ge et al. (2005) conducted a cohort in Bifurcation lesions (n=181). Final kissing balloon post-dilation (FKB) vs. Non-FKB was evaluated on Side branch restenosis (p=<0.001). Final kissing balloon post-dilation (FKB) during 'crush' stenting was associated with lower side branch restenosis compared to no FKB (11.1% vs 37.9%, p<0.001).