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Published on: September 22, 2020
A randomized trial of bifurcation stenting technique in chronic total occlusions percutaneous coronary intervention
Vitaly I Baystrukov1, Evgeniy I Kretov, Marouane Boukhris
1aE.N. Meshalkin Siberian Federal Biomedical Research Center, NovosibirskbMoscow Regional Research and Clinical Institute ('MONIKI'), MoscowcPavlov First Saint Petersburg State Medical University, Saint PetersburgdPrimorskiy Regional Hospital No. 1, Vladivostok, RussiaeDivision of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, GermanyfDepartment of Clinical and Experimental Medicine, University of Catania, Catania, ItalygDepartment of Cardiology, University Heart Center, University Hospital Zurich, Zurich, SwitzerlandhDepartment of Cardiology, Abderrahmen Mami Hospital, ArianaiFaculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
Insights
The mini-crush technique shows better outcomes for treating bifurcation lesions within chronic total occlusions compared to T-provisional stenting. This approach improves major adverse cardiac and cerebrovascular event-free survival at one year.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Optimal treatment strategies for bifurcation lesions (BFLs) during percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) are not well-established.
- Bifurcation lesions are common in CTO interventions, necessitating effective management techniques.
Purpose of the Study:
- To compare the efficacy and safety of the T-provisional stenting technique versus the mini-crush technique for treating BFLs within CTO vessels.
- To assess clinical and angiographic outcomes at one year post-intervention.
Main Methods:
- A prospective, randomized study involving 146 patients with successful CTO guidewire crossing and a BFL within the target CTO vessel.
- Patients were randomly assigned to either T-provisional stenting (N=73) or mini-crush technique (N=73).
- One-year follow-up assessed major adverse cardiac and cerebrovascular events (MACCE), defined as cardiovascular death, myocardial infarction, target vessel revascularization, and stroke.
Main Results:
- Bifurcation lesions were present in 54.3% of CTO interventions.
- Angiographic and clinical success rates were comparable between T-provisional (91.8%) and mini-crush (97.2%) groups (P=0.27).
- The mini-crush technique demonstrated significantly higher MACCE-free survival at 1 year (89.1% vs. 64.9%, P=0.007) for BFLs within the CTO body or near caps, while T-provisional showed a non-significant trend towards lower MACCE for lesions far from the CTO (9.3% vs. 22.2%, P=0.426).
Conclusions:
- The mini-crush technique is associated with improved 1-year clinical and angiographic outcomes in treating bifurcation lesions within CTOs.
- This benefit is particularly pronounced for BFLs located within the CTO body or close to the proximal or distal caps.
- The findings suggest mini-crush as a potentially superior strategy for complex bifurcation lesions in CTO interventions.
Background:
The optimal strategy to treat bifurcation lesions (BFLs) in a percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) remains unknown.
Aims:
We sought to assess whether T-provisional or mini-crush is appropriate for BFLs within CTO vessels.
Patients And Methods:
From January 2011 to December 2013, patients who underwent successful CTO guidewire crossing and with a BFL within the CTO target vessel were enrolled prospectively and assigned randomly to either T-provisional stenting or the mini-crush technique for BFL treatment. One-year clinical follow-up was performed. Major adverse cardiac and cerebrovascular events (MACCE) were defined as the composite of cardiovascular death, myocardial infarction, target vessel revascularization, and stroke.
Results:
The prevalence of BFLs was 54.3%. A total of 146 patients with BFLs within CTO vessel were enrolled prospectively and assigned randomly to either T-provisional stenting (N=73) or the mini-crush technique (N=73). Angiographic and clinical success rates were similar in the two groups: 91.8 versus 97.2% (P=0.27) and 91.8 versus 94.5% (P=0.67), respectively.Although T-provisional stenting was associated with a nonsignificantly lower incidence of MACCE in case of BFLs located far from the CTO (9.3 vs. 22.2%; P=0.426), the mini-crush technique resulted in higher MACCE-free survival at 1 year in the presence of BFLs within the CTO body or close to the proximal or the distal cap (89.1 vs. 64.9%; P=0.007).
Conclusion:
The mini-crush technique appeared to be associated with improved 1-year clinical and angiographic outcomes, particularly when used to treat BFLs located within the CTO body or close to the proximal or the distal cap.
