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Proximal to Distal Y-Stent Deployment for Coronary Bifurcation Lesions: Procedure and Three-Year Clinical Outcomes
Patricia Ying Jia Ding1, Sudhakar George, John A Ormiston
1Cardiology Department, Level 3, Building 32, 2 Park Road, Grafton, Auckland 1010, New Zealand. patriciading@hotmail.com.
Insights
The proximal to distal Y-stent technique for coronary bifurcation disease shows good medium-term outcomes. This approach is widely applicable with infrequent complications, though further randomized trials are needed for comparison.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Percutaneous coronary intervention (PCI) for coronary bifurcation disease using Y-stenting is not a common procedure.
- The proximal to distal Y-stent technique offers a potential solution for complex bifurcation lesions.
Purpose of the Study:
- To review the procedural and medium-term clinical outcomes of coronary bifurcation lesions treated with the proximal to distal Y-stent technique.
- To assess the safety and efficacy of this specific Y-stenting approach in a real-world setting.
Main Methods:
- Retrospective observational study of 167 consecutive PCI procedures for bifurcation lesions.
- Inclusion of patients treated with provisional Y or full-coverage strategies between January 2013 and July 2018.
- Review of medical records and coronary angiograms with 3-year clinical follow-up for 162 patients.
Main Results:
- The composite endpoint (cardiovascular death, MI, TLR, nontarget-lesion TVR, ST) occurred in 15% of patients at 3 years.
- Specific secondary endpoints included all-cause mortality (12%), spontaneous MI (7%), and target-lesion revascularization (1%).
- Stent thrombosis and nontarget-lesion TVR were infrequent (0.6% and 0%, respectively).
Conclusions:
- The proximal to distal Y-stent technique is a broadly applicable method for treating coronary bifurcation lesions.
- The technique demonstrates favorable medium-term clinical outcomes across diverse patient and lesion complexities.
- Further randomized controlled trials are recommended to compare this technique against other bifurcation stenting strategies.
Aims:
Percutaneous coronary intervention with Y-stenting of coronary bifurcation disease is not commonly undertaken. The procedural and medium-term clinical outcomes of coronary bifurcation lesions treated with the proximal to distal Y stent technique by a single experienced operator were reviewed.
Methods:
A total of 167 consecutive procedures using either provisional Y strategies or full-coverage options performed at Auckland City Hospital, New Zealand, between January 2013 and July 2018 were included in this retrospective observational study. All medical records and coronary angiograms were reviewed.
Results:
Three-year clinical follow-up data were available in 162 of 167 patients. The primary endpoint, defined as the composite of cardiovascular death, spontaneous myocardial infarction (MI), target-lesion revascularization (TLR), target-vessel nontarget-lesion revascularization (nontarget-lesion TVR), and stent thrombosis (ST) occurred in 25 patients (15%) at 3 years. Secondary endpoints were all-cause mortality (12%), including cardiovascular mortality (6%), noncardiovascular mortality (4%), undetermined death (2%), spontaneous MI (7%), TLR (1%), nontarget-lesion TVR (0%), and ST (0.6%).
Conclusions:
The proximal to distal Y-stent technique is a widely applicable approach to bifurcation lesions, with good medium-term clinical outcomes when used in a heterogeneous group of clinical and anatomical scenarios. Complications related to the stented site were infrequent. Randomized, controlled trials are needed to assess its efficacy compared with other bifurcation interventional techniques.
