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Acute and long-term results of bifurcation stenting (from the Coroflex Registry)
Sascha Rux1, Steffen Sonntag, Ralph Schulze
1ukb Academic Teaching Hospital, Berlin, Germany.
Insights
Simplified bifurcation stenting using a dedicated bare metal stent achieved high technical success. This approach resulted in a low rate of major adverse cardiac events (MACE) at discharge and six months.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Bifurcation lesions pose significant challenges in percutaneous coronary interventions.
- Traditional techniques for bifurcation stenting can be complex and time-consuming.
Purpose of the Study:
- To evaluate the efficacy and safety of a simplified approach to bifurcation stenting using a specific high-end bare metal stent.
- To assess procedural success and major adverse cardiac events (MACE) in patients undergoing bifurcation stenting.
Main Methods:
- A prospective registry of 421 consecutive patients undergoing bifurcation stenting with the Coroflex bare metal stent across 6 European centers.
- Data collection included lesion characteristics, procedural outcomes, and hospital/6-month MACE (myocardial infarction, death, revascularization, angina hospitalization).
- The technique allowed side branch angioplasty through stent struts, obviating the need for two-wire techniques and kissing balloons.
Main Results:
- Technical success (residual stenosis <50%) was achieved in 90% of bifurcations (99% in the main vessel).
- The rate of MACE at discharge was 2%.
- At 6 months, the cumulative MACE rate was 22%, with 17% of patients requiring target lesion revascularization or coronary artery bypass grafting.
Conclusions:
- Successful bifurcation stenting is achievable in most patients with a simplified approach using a dedicated high-end bare metal stent.
- This method demonstrates a low rate of major adverse cardiac events, making it a viable option for complex coronary interventions.
Abstract:
Angioplasty of bifurcation lesions represents a continuing challenge. A total of 421 consecutive patients were prospectively followed in a registry on bifurcation stenting with a high-end bare metal stent (Coroflex, BBraun, Berlin, Germany), allowing side branch percutaneous transluminal coronary angioplasty through the stent struts without distraction of the main vessel stent from the vessel wall or other distortions. This approach obviated the 2-wire technique and kissing balloons. Detailed data, including lesion location, stenosis morphology, procedural success, and hospital and follow-up major adverse cardiac events (MACEs; acute myocardial infarction, death, revascularization, hospitalization due to angina), were collected from 6 European centers. Of the patients, 60% had stable angina, 23% had unstable angina pectoris/non-ST-elevation myocardial infarction, and 17% had ST-elevation myocardial infarction. In 17% of patients, the main vessel alone was stented; in 71%, stenting of the main vessel was complemented by side branch percutaneous transluminal coronary angioplasty. Technical success (residual stenosis <50%) in the 2 branches was achieved in 90% (main vessel in 99%). The rate of MACEs at discharge was 2%. After 6 months, 17% of patients had undergone target lesion revascularization or coronary artery bypass grafting. The total 6-month MACE rate was 22%. In conclusion, successful bifurcation stenting with a low MACE rate is possible in most patients using a simplified approach with a dedicated high-end bare metal stent.
