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[Percutaneous treatment of bifurcation lesions by crush T stenting: immediate and medium-term outcomes]
Luis S Díaz de la Llera1, Sara M Ballesteros, Agustín Guisado
1Unidad de Hemodinámica y Cardiología Intervencionista, Hospital General Universitario Virgen del Rocío, 41500 Seville, Spain. luissalvadordiaz@hotmail.com
Insights
Crush T stenting effectively treats coronary artery bifurcations, achieving high success rates and reducing complications. This technique lowers restenosis and major adverse cardiac events at one year.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Coronary artery bifurcation lesions present significant challenges for percutaneous coronary intervention (PCI).
- Traditional PCI techniques for bifurcations are associated with lower success rates, higher complication rates, and increased need for revascularization.
Purpose of the Study:
- To prospectively evaluate the clinical and angiographic outcomes of crush T stenting for coronary bifurcations.
- To assess the safety and efficacy of this specific bifurcation stenting technique.
Main Methods:
- The study involved 82 patients treated with crush T stenting between December 2003 and February 2005.
- The crush T stenting technique involves protruding the side branch stent 3-4 mm into the main vessel beyond the carina.
- Kissing balloon post-dilatation was utilized in 87% of cases.
Main Results:
- High rates of angiographic (100%) and clinical (96.4%) success were achieved.
- Follow-up included 100% clinical at 12 months and 77% angiographic at a mean of 8.7 months.
- Target lesion revascularization was required in 10.8% of patients.
Conclusions:
- Crush T stenting is a safe and effective method for treating coronary bifurcation lesions.
- This technique demonstrates a reduction in both restenosis and major adverse cardiac events at one year.
Introduction And Objectives:
Percutaneous coronary intervention for coronary bifurcations is usually associated with a low success rate, a high rate of complications, and a more frequent need for target lesion revascularization. The aim of this prospective study was to evaluate immediate and medium-term clinical and angiographic outcomes after the application of crush T stenting.
Methods:
This approach to bifurcation stenting follows the same steps as modified T stenting. The only difference is that the side branch stent protrudes 3-4 mm into the main vessel from the carina. The aim is to ensure that the circumference of the side branch ostium is covered by the stent strut.
Results:
Between December 2003 and February 2005, 82 patients were included in the study. The lesion involved the left main coronary artery in 53% of patients, the left anterior descending or diagonal coronary artery in 29%, the circumflex or marginal branch in 11%, and the right coronary artery or the posterior or posterolateral descending branch in 7%. Angiographic and clinical success was obtained in 100% and 96.4% of cases, respectively. Final dilatation was performed using a kissing balloon in 87%. Overall, 100% of patients were followed up clinically for 12 months and 77% were followed up angiographically for a mean of 8.7 (3.3) months. Target lesion revascularization was performed in 9 patients (10.8%).
Conclusions:
Treatment of coronary bifurcation lesions using the crush T stenting technique is safe and effective. It reduces both the restenosis rate and the major adverse cardiac event rate at one year.
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