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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation
Terje K Steigen1, Michael Maeng, Rune Wiseth
1Department of Cardiology, University Hospital of Tromsoe, Tromsoe, Norway.
Insights
For coronary artery bifurcation lesions, stenting only the main vessel (MV) is as effective as stenting both the main vessel and side branch (MV+SB). The MV strategy offers shorter procedure times and fewer complications.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
Background:
- Optimal stenting strategy for coronary artery bifurcation lesions remains undetermined.
- Sirolimus-eluting stents are utilized in current treatment protocols.
Purpose of the Study:
- To compare the efficacy and safety of two stenting strategies for coronary artery bifurcation lesions: main vessel only (MV) versus main vessel plus side branch (MV+SB).
Main Methods:
- Randomized controlled trial involving 413 patients with bifurcation lesions.
- Primary endpoint: major adverse cardiac event (MACE) at 6 months.
- Quantitative coronary assessment at baseline and 8 months.
Main Results:
- No significant difference in MACE rates between MV (2.9%) and MV+SB (3.4%) groups at 6 months.
- MV+SB group had longer procedure/fluoroscopy times and higher contrast volumes.
- No significant difference in combined angiographic endpoint at 8 months (MV 5.3% vs. MV+SB 5.1%).
Conclusions:
- Sirolimus-eluting stents provide excellent clinical and angiographic outcomes for de novo coronary artery bifurcation lesions, irrespective of stenting strategy.
- The simpler MV stenting strategy is associated with reduced procedural burden and biomarker elevation.
- The MV strategy is recommended for routine bifurcation stenting.
Background:
The optimal stenting strategy in coronary artery bifurcation lesions is unknown. In the present study, a strategy of stenting both the main vessel and the side branch (MV+SB) was compared with a strategy of stenting the main vessel only, with optional stenting of the side branch (MV), with sirolimus-eluting stents.
Methods And Results:
A total of 413 patients with a bifurcation lesion were randomized. The primary end point was a major adverse cardiac event: cardiac death, myocardial infarction, target-vessel revascularization, or stent thrombosis after 6 months. At 6 months, there were no significant differences in rates of major adverse cardiac events between the groups (MV+SB 3.4%, MV 2.9%; P=NS). In the MV+SB group, there were significantly longer procedure and fluoroscopy times, higher contrast volumes, and higher rates of procedure-related increases in biomarkers of myocardial injury. A total of 307 patients had a quantitative coronary assessment at the index procedure and after 8 months. The combined angiographic end point of diameter stenosis >50% of main vessel and occlusion of the side branch after 8 months was found in 5.3% in the MV group and 5.1% in the MV+SB group (P=NS).
Conclusions:
Independent of stenting strategy, excellent clinical and angiographic results were obtained with percutaneous treatment of de novo coronary artery bifurcation lesions with sirolimus-eluting stents. The simple stenting strategy used in the MV group was associated with reduced procedure and fluoroscopy times and lower rates of procedure-related biomarker elevation. Therefore, this strategy can be recommended as the routine bifurcation stenting technique.
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