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A prospective registry to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions using the
Issam Moussa1, Ricardo A Costa, Martin B Leon
1Cardiovascular Research Foundation and New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA. imoussa@crf.org
Insights
The crush technique using sirolimus-eluting stents offers predictable success for complex coronary bifurcation lesions. While safe, restenosis in the side branch ostium may still necessitate revascularization.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Biomedical Engineering
Background:
- Coronary artery bifurcation lesions present treatment challenges.
- The crush technique is a proposed method for stenting these lesions.
- Limited data exist on the long-term safety and efficacy of the crush technique.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of the crush technique for coronary bifurcation lesions.
- To assess the safety and efficacy of sirolimus-eluting stents used with the crush technique.
- To identify potential complications and restenosis patterns associated with this stenting method.
Main Methods:
- A prospective study of 120 patients with coronary bifurcation lesions treated with sirolimus-eluting stents.
- The crush technique with final kissing balloon inflation was employed.
- Clinical follow-up was conducted at 30 days and 6 months, assessing procedural success, stent thrombosis, and target lesion revascularization.
Main Results:
- High procedural success rate (97.5%) was achieved.
- Low rates of cardiac death (0%) and subacute stent thrombosis (1.7%) were observed.
- Target lesion revascularization was needed in 11.3% of patients, primarily due to restenosis at the side branch ostium.
Conclusions:
- The crush technique, combined with final kissing balloon inflation, is a safe option for experienced operators treating complex bifurcation lesions with sirolimus-eluting stents.
- The safety profile appears comparable to other bifurcation stenting techniques.
- While main vessel patency is good, side branch ostial restenosis remains a concern, indicating a need for further optimization.
Abstract:
The "crush technique" has been proposed as an alternative approach to treat bifurcation lesions because of its predictability and high procedural success rate. However, few data are available regarding its safety and long-term efficacy. We report the long-term clinical outcomes of patients with coronary bifurcation lesions treated with sirolimus-eluting stents using the crush technique. From April 2003 to May 2004, 120 patients with coronary bifurcation lesions were treated with sirolimus-eluting stents using the crush technique. Six months of clinical follow-up was completed in 95.8% of patients. Mean patient age was 64 years; 36% had diabetes mellitus, and the left anterior descending artery/diagonal was the most frequent bifurcation location (69%). Final kissing balloon inflation was performed in 87.5% of patients. Compared with the main vessel, side branch lesions were shorter, with a smaller reference diameter and final in-stent minimum lumen diameter. Procedural success was achieved in 97.5%. At 30 days of follow-up, 1 patient had died of noncardiac causes and 2 patients (1.7%) had subacute stent thrombosis. At 6 months of follow-up, target lesion revascularization was required in 13 patients (11.3%), all of whom had focal restenosis predominantly at the side branch ostium. In conclusion, the crush technique with final kissing balloon inflation can be safely used by experienced operators to treat highly complex bifurcation lesions with sirolimus-eluting stents. The safety profile of this technique is similar to that of other bifurcation stenting techniques reported thus far. Nonetheless, despite the excellent patency rates of the main vessel, the need for revascularization at the ostium of the side branch was not fully eliminated.