Culotte versus T-stenting in bifurcation lesions: immediate clinical and angiographic results and midterm clinical follow-up.
ABSTRACT Stenting the main vessel with provisional stenting of the side branch (SB) is the method of choice for most bifurcation lesions. There is limited data on which of the two techniques of bifurcation stenting compatible with a provisional approach, culotte or T-stenting, offers the best outcome.
Between February 2004 and October 2005, 80 consecutive patients with bifurcation lesions requiring a second stent on the SB were treated with either culotte (n = 45) or T-stenting (n = 35). Coronary angiograms were analyzed using a quantitative angiography system dedicated to bifurcations. Propensity scores were used to adjust for baseline differences between groups.
Acute procedural success was 100% for both groups. Residual diameter stenosis of the SB ostium was 3.44% +/- 7.39% in the culotte group versus 12.55% +/- 11.47% in the T-stenting group (P < .0001). One patient (2.2%) in the culotte group had subacute thrombosis 2 days after the procedure. The culotte group had a lower target lesion revascularization rate compared with the T-stenting group (8.9% vs 27.3% propensity score adjusted; P = .014) and a trend toward lower major cardiac adverse events at 9 months (13.3% vs 27.3%; P = .051).
Both techniques of provisional SB stenting in bifurcation lesions achieve high procedural success with low complication rates. The culotte technique yields a better immediate angiographic result at the SB ostium, and, using drug-eluting stents, a better clinical outcome at 9 months.
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ABSTRACT: Objectives: To determine the 3 year safety and efficacy of crush-stenting with paclitaxel-eluting stents. Background: The optimum two-stent strategy for treatment of coronary bifurcation lesions is undetermined. Crush-stenting is advocated to minimize restenosis through complete circumferential stent coverage; long-term follow-up data are lacking. Methods and Results: In a single center prospective registry, 100 consecutive patients with bifurcation lesions were treated with the Crush technique. The vast majority (93%) were true bifurcations, predominantly involving the left anterior descending and diagonal arteries. Technical success was 98%. Final kissing balloon dilatation, which became standard practice during the study, was attempted in 68 patients and successful in 51. Abciximab was used in all cases. There were no peri-procedural stent thromboses. Follow-up was 100% at 3 years. Symptom-driven target lesion revascularisation was 8% at 3 years. Cumulative 3-year major adverse cardiac events was 28% (7 cardiac deaths, 15 myocardial infarctions, 11 target vessel revascularisations). Absence of a final kissing inflation predicted repeat revascularisation but not death, infarction or stent thrombosis. Three probable stent thromboses occurred, of which two were very late. Conclusion: Where a two-stent bifurcation strategy is required, Crush-stenting with paclitaxel-eluting stents is safe and effective in the long-term. Failure to perform a final kissing dilatation increases the likelihood of revascularisation but not other adverse events. © 2009 Wiley-Liss, Inc.Catheterization and Cardiovascular Interventions 08/2009; 75(4):605 - 613. · 2.51 Impact Factor
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ABSTRACT: Objectives The aim of the study was to compare long-term follow-up results of crush versus culotte stent techniques in coronary bifurcation lesions. Background The randomized Nordic Stent Technique Study showed similar 6-month clinical and 8-month angiographic results with the crush and culotte stent techniques of de novo coronary artery bifurcation lesions using sirolimus-eluting stents. Here, we report the 36-month efficacy and safety of the Nordic Stent Technique Study. Methods A total of 424 patients with a bifurcation lesion were randomized to stenting of both main vessel and side branch with the crush or the culotte technique and followed for 36 months. Major adverse cardiac events—the composite of cardiac death, myocardial infarction, stent thrombosis, or target vessel revascularization—were the primary endpoint. Results Follow-up was complete for all patients. At 36 months, the rates of the primary endpoint were 20.6% versus 16.7% (p = 0.32), index lesion restenosis 11.5% versus 6.5% (p = 0.09), and definite stent thrombosis 1.4% versus 4.7% (p = 0.09) in the crush and the culotte groups, respectively. Conclusions At 36-month follow-up, the clinical outcomes were similar for patients with coronary bifurcation lesions treated with the culotte or the crush stent technique. (Nordic Bifurcation Study. How to Use Drug Eluting Stents [DES] in Bifurcation Lesions? NCT00376571)JACC Cardiovascular Interventions 01/2013; 6(11):1160–1165. · 7.42 Impact Factor
- International journal of cardiology 06/2013; · 6.18 Impact Factor