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Sequential vs. kissing balloon angioplasty for stenting of bifurcation coronary lesions
Martin Brueck1, Dierk Scheinert, Frank A Flachskampf
1Department of Cardiology, University of Erlangen-Nuremberg, Erlangen, Germany. martinbrueck@t-online.de
Insights
The kissing balloon technique for coronary bifurcation stenting reduced side-branch occlusion compared to sequential angioplasty. However, neither method improved procedural success or long-term outcomes for these complex lesions.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Devices
Background:
- Coronary bifurcation lesions present significant technical challenges in angioplasty.
- These lesions are associated with lower procedural success and higher reintervention rates.
- Side-branch occlusion is a common complication during bifurcation stenting.
Purpose of the Study:
- To compare immediate and long-term outcomes of sequential versus simultaneous (kissing balloon) angioplasty for bifurcation lesions.
- To evaluate procedural success, angiographic results, and clinical events.
- To assess the impact on side-branch compromise.
Main Methods:
- A prospective study involving 59 patients with symptomatic type III bifurcation lesions.
- Patients were randomized to either sequential balloon angioplasty (33 patients) or kissing balloon technique (26 patients).
- Main-vessel stenting was mandatory; side-branch stenting and adjunctive therapies were operator-dependent.
Main Results:
- The kissing balloon technique significantly reduced the rate of transient side-branch occlusion (33% vs. 0%; P = 0.003).
- No significant difference was observed in procedural success between the two techniques.
- Major clinical events and target vessel revascularization rates at 6-month follow-up were similar for both groups.
Conclusions:
- Kissing balloon angioplasty is superior to sequential balloon angioplasty in preventing transient side-branch occlusion during bifurcation stenting.
- Despite improved side-branch patency, the kissing balloon technique did not offer advantages in immediate or long-term clinical and angiographic outcomes.
- Further research may be needed to optimize stenting strategies for complex coronary bifurcation lesions.
Abstract:
Coronary angioplasty of bifurcation lesions remains a technical challenge and is believed to result in low procedural success associated with the risk of side-branch occlusion. Furthermore, long-term results are associated with a high rate of reintervention. The aim of the study was to evaluate the immediate and long-term clinical and angiographic results of sequential vs. simultaneous balloon angioplasty (kissing balloon technique) for stenting of bifurcation coronary lesions. Between December 1999 and January 2001, 59 patients underwent coronary angioplasty because of symptomatic bifurcation lesions type III (i.e., side branch originates from within the target lesion of the main vessel, and both main and side branch are angiographically narrowed more than 50%). Twenty-six patients were treated with simultaneous and 33 patients with sequential balloon angioplasty. Main-vessel stent placement was mandatory; side-branch stenting and platelet IIb/IIIa antagonists were allowed at the discretion of the operator. Kissing balloon technique offered no advantage in terms of procedural success or need for repeat target vessel revascularization due to restenosis at 6-month follow-up. Using sequential balloon angioplasty, permanent or transient side-branch compromise rate (TIMI flow < 3) was significantly higher than after kissing balloon technique (33% vs. 0%, respectively; P = 0.003). Major clinical events in-hospital or at 6-month follow-up, however, showed no significant differences. Kissing balloon angioplasty reduces the rate of transient side-branch occlusion compared to sequential PTCA but does not improve immediate or long-term outcome compared to sequential PTCA for stenting of bifurcation lesions.
