Optimal Stenting Strategy For True Bifurcation Lesions
Condition: Coronary Artery Disease
MeSH terms: Coronary Artery Disease
Study type: Interventional
Phase: Phase 4

Summary: 
      It is unclear which stenting strategy will be optimal for true bifurcation coronary lesions.
    

Detailed description: 
      The outcome of percutaneous coronary intervention of bifurcation lesions with bare-metal
      stents is hindered by increased rates of procedural complications and long-term major adverse
      cardiac events compared with non-bifurcated lesions.1 Randomized studies have demonstrated
      that drug-eluting stents reduce restenosis when used in relatively simple lesions; and recent
      data have demonstrated efficacy of the sirolimus-eluting stent for bifurcation lesions
      compared with historical data of BMS. In one study of bifurcation lesions, the overall
      restenosis rate was 23%, with the majority of side branch restenoses occurring at the ostium
      after use of a T-stenting technique. Indeed, side branch restenosis occurred in 16.7% after
      T-stenting, compared with 7.1% after other stenting techniques.

      The "crush" technique of bifurcation stenting with DESs was introduced by Colombo et al. in
      2003 as a relatively simple technique that ensures complete coverage of the side branch
      ostium, thereby facilitating drug delivery at this site. Initial data of 20 patients treated
      with this technique with SES suggest that it is a safe method, with an acceptable rate of
      procedural complications and no further adverse events up to 30 days follow-up. Recently,
      angiographic data have shown the importance of simultaneous kissing balloon post-dilation in
      reducing restenosis and need for target lesion revascularization. They also reported that
      compared to T-stenting, crushing with final kissing balloon dilatation was associated with
      lower rate of restenosis and target lesion revascularization. Consequently, the crushing is
      currently most promising technique in treating bifurcation lesions using two stents. However,
      despite the advance of bifurcation stenting technique, the superiority of bifurcation
      stenting with crushing technique over simple stenting in bifurcation lesion has not been
      demonstrated.

      Therefore, we conducted the prospective randomized study comparing crushing technique with
      final kissing balloon dilatation and a simple technique (main vessel stenting and provisional
      T-stenting) for treatment of true bifurcation lesions.
    

Intervention name(s): Crush technique; provisional T stenting
Intervention type(s): Procedure; Procedure
Intervention description(s): Crush technique; Provisional T stenting
Other intervention name(s): Sirolimus, Paclitaxel, Zotarolimus and Everolimus stents; Sirolimus, Paclitaxel, Zotarolimus and Everolimus stents
Intervention MeSH terms: Sirolimus; Paclitaxel; Albumin-Bound Paclitaxel; Everolimus; Temsirolimus; MTOR Inhibitors
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: stent; bifurcation; coronary artery stenosis; balloon angioplasty