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Comparison of simple versus complex stenting in patients with true distal left main bifurcation lesions
Cheol Hyun Lee1, Jung-Min Ahn2, Do-Yoon Kang2
1Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea.
Insights
For complex distal left main (LM) bifurcation lesions, single-stenting and dual-stenting strategies showed similar 3-year outcomes for target-lesion failure (TLF). This suggests comparable effectiveness for both percutaneous coronary intervention (PCI) approaches in this challenging patient group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Distal left main (LM) bifurcation lesions present significant challenges for percutaneous coronary intervention (PCI).
- The optimal stenting strategy for these complex lesions remains a subject of debate.
- True distal LM bifurcation disease requires careful consideration of stenting techniques.
Purpose of the Study:
- To compare the clinical outcomes of single versus dual stenting for true distal LM bifurcation lesions.
- To evaluate the efficacy and safety of different stenting strategies in complex LM PCI.
- To provide insights into the management of challenging distal LM bifurcation disease.
Main Methods:
- Retrospective analysis of patients with true distal LM bifurcation lesions undergoing PCI with drug-eluting stents (DES).
- Comparison of target-lesion failure (TLF) rates between single-stent and dual-stent groups.
- Propensity score and inverse probability-weighting adjustments were used to mitigate treatment selection bias.
Main Results:
- A total of 1,002 patients were analyzed; 43.9% received single stents and 56.1% received dual stents.
- The 3-year target-lesion failure (TLF) rates were 20.3% for single stenting and 24.1% for dual stenting (p=0.18).
- Adjusted analysis revealed no significant difference in TLF, cardiac death, MI, repeat revascularization, or stent thrombosis between the two groups.
Conclusions:
- Single- and dual-stent strategies demonstrate similar adjusted risks for target-lesion failure (TLF) at 3 years in patients with true distal LM disease.
- The findings suggest comparable clinical outcomes for both stenting approaches in this complex PCI subset.
- Further validation through large, randomized clinical trials is recommended to confirm these results.
Introduction:
Distal left main (LM) bifurcation disease is one of the most challenging lesion subsets for percutaneous coronary intervention (PCI) and optimal stenting strategy for such complex lesions is still debated. This study aimed to compare clinical outcomes following single versus dual stenting for true distal LM bifurcation lesions.
Methods:
Patients with true distal LM bifurcation lesions (type 1,1,1 or 0,1,1: both left anterior descending and circumflex artery >2.5 mm diameter) receiving PCI with drug-eluting stents (DES) from two large clinical registries were evaluated. The primary outcome was target-lesion failure (TLF), defined as a composite of cardiac death, target-vessel myocardial infarction (MI), or target-lesion revascularization (TLR). Outcomes were compared with the use of propensity scores and inverse probability-weighting adjustment to reduce treatment selection bias.
Results:
Among 1,002 patients undergoing true distal LM PCI, 440 (43.9%) and 562 (56.1%) were treated with single and dual stents, respectively. The TLF rates at 3 year was 20.3% in the single-stent group and 24.1% in the dual-stenting group (log-rank p = 0.18). The adjusted risk for TLF did not differ significantly between two groups (hazard ratio [HR] with dual-stent vs. single-stent: 1.27, 95% confidence interval [CI]: 0.95-1.71). The adjusted risks for death, MI, repeat revascularization, or stent thrombosis were also similar between the single- and dual-stenting groups.
Conclusions:
In patients undergoing PCI for true distal LM disease, single- and dual-stent strategies showed a similar adjusted risk of TLF at 3 years. Our findings should be confirmed or refuted through large, randomized clinical trials.
