Culotte versus T-stenting in bifurcation lesions: Immediate clinical and angiographic results and midterm clinical follow-up
Royal Brompton and Harefield NHS Foundation Trust, Harefield, England, United Kingdom American heart journal
(Impact Factor: 4.46).
09/2007; 154(2):336-43. DOI: 10.1016/j.ahj.2007.04.019
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.
Available from: Azeem Latib
- "Which Is a Randomized Study Author, Year (Ref. #) Aim No. of Bifurcations Follow-Up Restenosis, % TLR, % ST, %* Restenosis, % TLR, % ST, %* MB SB MB SB FKI No FKI Ge et al., 2005 (19) Crush with FKI vs. without 181 9 months 8.9 11.1 † 9.5 2.6 15.5 37.9 † 24.6 3.0 Hoye et al., 2006 (18) Crush 241 9 months 6.4 9.6 † N/A 9.7% overall 4 10 41.3 † N/A 9.7% overall 4.2 Moussa et al., 2006 (20) Crush 120 6 months N/A N/A 11.3% overall 1.7% overall N/A N/A 11.3% overall 1.7% overall Sharma et al., 2005 (21) Simultaneous kissing stents 200 9 Ϯ 2 months N/A N/A 4 1 N/A N/A N/A N/A Galassi et al., 2007 (22) Mini-Crush 52 8 months 12.2 2.0 12.2 2.2 N/A N/A N/A N/A Burzotta et al., 2007 (23) T-stenting and small protrusion 73 9 months N/A N/A 6.8 1.4 N/A N/A N/A N/A Crush (n ؍ 121) T-stenting (n ؍ 61) Ge et al., 2006 (24) Crush vs. T 182 1 yr 16.2 19.2 14 † 1.6 13 26.1 31.1 † 0 Culotte (n ؍ 45) T-stenting (n ؍ 35) Kaplan et al., 2007 (25) Culotte vs. T 80 9 months N/A N/A 8.9 † 2.2 N/A N/A 27.3 † 0 Crush (n ؍ 210) Culotte (n ؍ 215) Niemela et al., 2007 (26) Culotte vs. Crush 425 6 months N/A N/A TVR ϭ 3.3 1.9 N/A N/A TVR ϭ 3.3 1.4 "
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ABSTRACT: The percutaneous treatment of coronary bifurcations has moved past an important milestone in that the 1- versus 2-stent debate appears to have been resolved. The provisional approach of implanting one stent on the main branch should be the default approach in most bifurcations lesions. Selection of the most appropriate strategy for an individual bifurcation is important. Some bifurcations require 1 stent, whereas others require the stenting of both branches. Irrespective of whether a 1- or 2-stent strategy is chosen, the results after bifurcation percutaneous coronary intervention (PCI) have dramatically improved. Dedicated bifurcation stents are an exciting new technology that may further simplify the management of bifurcation PCI and change some of these concepts.
Available from: Javaid Iqbal
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ABSTRACT: Percutaneous coronary intervention for the treatment of bifurcation lesions is associated with a lower success rate and increased risk of subacute stent thrombosis and restenosis. The goal of this manuscript is to review the current classification of coronary bifurcation lesions and techniques. An algorithmic approach for the treatment of bifurcation lesions based on the recently published simplified and comprehensive classification is proposed in this manuscript.
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