Culotte stenting for coronary bifurcation lesions with 2nd and 3rd generation everolimus-eluting stents: the CELTIC...

Area of Science:

• Interventional Cardiology
• Biomedical Engineering
• Clinical Trials

Background:

• Coronary artery disease (CAD) management often involves percutaneous coronary intervention (PCI) for complex lesions.
• The culotte two-stent technique is utilized for specific bifurcation lesions.
• Comparing modern drug-eluting stent (DES) platforms is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate contemporary outcomes of the culotte stenting technique in de novo coronary artery disease (CAD) with Medina 1,1,1 lesions.
• To compare the performance of two specific DES platforms: 3-connector XIENCE and 2-connector SYNERGY.

Main Methods:

• A randomized controlled trial comparing XIENCE and SYNERGY DES in 170 patients with Medina 1,1,1 bifurcation lesions.
• Patients were randomized 1:1 to receive either XIENCE or SYNERGY DES.
• The primary endpoint was a composite of death, myocardial infarction, cerebrovascular accident, target vessel failure, stent thrombosis, and binary angiographic restenosis at nine months.

Main Results:

• Technical success and final kissing balloon inflation were achieved in over 96% of cases.
• Major adverse cardiovascular or cerebrovascular events (MACCE) occurred in 5.9% of patients by nine months.
• The primary endpoint occurred in 19% of XIENCE patients and 16% of SYNERGY patients, demonstrating non-inferiority (p=0.003).

Conclusions:

• Culotte stenting with contemporary everolimus-eluting DES is associated with low MACCE rates at nine months.
• The XIENCE and SYNERGY DES platforms exhibited comparable performance in this patient cohort.
• These findings support the use of both stent platforms for complex bifurcation lesions treated with the culotte technique.