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 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. · 7.44 Impact Factor
- International journal of cardiology 06/2013; · 6.18 Impact Factor
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ABSTRACT: A 63-year-old female patient, with history of 8-year hypertension and 10-year hyperlipidemia, presented with severe left main coronary bifurcation stenosis (LMCS) associated with the right coronary artery chronic total occlusion (CTO-RCA). On the day of admission, she received drug treatment with aspirin, clopidogrel, heparin, statins, angiotensin converting enzyme inhibitors and β-blocker. On the next day, she underwent CTO recanalization with 6F guiding-catheter and two rapamycin-eluting stents, and showed no postoperative discomfort after interventional treatment. Considering having hypertensive nephropathy and chronic renal insufficiency, the patient then received intravenous saline full hydration therapy. Two weeks after successful completion of the RCA revascularization, the original collateral circulation in the blood flow from the LMC to RCA became two-way flow. Under the safe and reliable protective condition, staged percutaneous coronary intervention (PCI) with 6F XB3.0 guiding catheter and rapamycin-eluting stents was applied to treat the LMCL. 9-month postoperative follow-up with coronary computed tomographic imaging showed no restenosis inside the original stent, without any myocardial ischemic event. Our successful approach to turn the original unprotected LMCS combined with CTO-RCA into a protective one reduces the interventional risk and provides additional option besides coronary artery bypass graft surgery to treat such complex coronary artery disease (CAD).International Journal of Clinical and Experimental Medicine 01/2014; 7(11):4509-14. · 1.42 Impact Factor