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Double versus single stenting for coronary bifurcation lesions: a meta-analysis
Demosthenes G Katritsis1, George C M Siontis, John P A Ioannidis
1Department of Cardiology, Athens Euroclinic, Athens, Greece.
Insights
Double stenting for coronary bifurcation lesions increases risks of myocardial infarction and potentially stent thrombosis compared to single stenting. Further research is needed to confirm stent thrombosis findings.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Coronary artery disease management involves complex decisions regarding bifurcation lesions.
- The optimal stenting strategy for bifurcation lesions remains debated.
Purpose of the Study:
- To compare the safety and efficacy of double stenting versus single stenting in patients with coronary bifurcation lesions.
Main Methods:
- A meta-analysis of randomized controlled trials was performed.
- Included studies involved patients undergoing percutaneous coronary intervention for bifurcation lesions.
- Six trials with 1642 patients were analyzed.
Main Results:
- Double stenting significantly increased the risk of myocardial infarction (RR 1.78, P=0.001).
- A trend towards increased stent thrombosis with double stenting was observed, though not statistically significant (RR 1.85, P=0.19).
- No significant differences were found in mortality or target lesion revascularization rates.
Conclusions:
- Stenting both the main vessel and side branch in bifurcation lesions may elevate risks of myocardial infarction and stent thrombosis.
- Single stenting of the main vessel appears to be a safer strategy regarding myocardial infarction.
Background:
Several trials have addressed whether bifurcation lesions require stenting of both the main vessel and side branch, but uncertainty remains on the benefits of such double versus single stenting of the main vessel only.
Methods And Results:
We have conducted a meta-analysis of randomized trials including patients with coronary bifurcation lesions who were randomly selected to undergo percutaneous coronary intervention by either double or single stenting. Six studies (n=1642 patients) were eligible. There was increased risk of myocardial infarction with double stenting (risk ratio, 1.78; P=0.001 by fixed effects; risk ratio, 1.49 with Bayesian meta-analysis). The summary point estimate suggested also an increased risk of stent thrombosis with double stenting, but the difference was not nominally significant given the sparse data (risk ratio, 1.85; P=0.19). No obvious difference was seen for death (risk ratio, 0.81; P=0.66) and target lesion revascularization (risk ratio, 1.09; P=0.67).
Conclusions:
Stenting of both the main vessel and side branch in bifurcation lesions may increase myocardial infarction and stent thrombosis risk compared with stenting of the main vessel only.
