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Real-World Experience of Coronary Bifurcation Stenting in a Single Centre in Western India
Avinash D Arke1, Akshay Kawadkar1, Shishir Kumar Roul1
1Cardiology, Jagjivanram Hospital, Mumbai, IND.
Insights
Coronary bifurcation stenting (COBIS) using appropriate techniques and lesion assessment demonstrates high success rates and favorable outcomes. This real-world study highlights effective strategies for managing complex coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary bifurcation lesions (CBLs) present complex challenges in percutaneous coronary interventions (PCIs) due to intricate anatomy and variable flow dynamics.
- Drug-eluting stents (DESs) have improved PCI outcomes, but concerns regarding bifurcation stenting techniques and side branch (SB) occlusion persist.
Purpose of the Study:
- To present single-center, real-world experience with coronary bifurcation stenting (COBIS).
- To highlight procedural strategies, clinical outcomes, and learning points from routine practice in managing CBLs.
Main Methods:
- A descriptive observational study conducted at a cardiac center in western India.
- Analysis of 70 patients undergoing PCI for coronary bifurcation lesions.
Main Results:
- The most common CBL location was the left anterior descending (LAD)/diagonal artery. Medina types 1,1,1 and 1,1,0 were the predominant subtypes.
- Provisional stenting (PS) was the most frequent technique (65.7%), followed by Double-Kissing (DK) crush (17.1%).
- Major adverse cardiac events (MACE) at one year were 7.1%, with no statistical significance observed over time.
Conclusions:
- Coronary bifurcation stenting, guided by lesion anatomy and meticulous technique, achieves high procedural success.
- Favorable clinical outcomes are attainable with appropriate strategy selection and execution in routine practice.
Background:
Coronary bifurcation lesions (CBLs) are recognised as an intricate form of coronary artery disease. The anatomic complexity and variable flow dynamics at branch points pose unique challenges, often contributing to suboptimal outcomes if not managed appropriately. Introduction of drug-eluting stents (DESs) in percutaneous coronary interventions (PCIs) practice had been a major breakthrough. However, there are some concerns in bifurcation coronary stenting like choice of bifurcation stenting technique and issue related to side branch (SB) occlusion. This study aimed to present the single-centre real-world experience with bifurcation stenting, highlighting procedural strategies, outcomes and learning points from routine clinical practice.
Methods:
This descriptive observational study was carried out at a cardiac centre located in western India.
Results:
Among the 70 patients who underwent PCI for CBL, 72.8% were male, mean age being 65.6 ± 2.8 years. Most frequently encountered CBL was in left anterior descending (LAD)/diagonal (n=24, 34.3%). Out of 70 patients, most prevalent CBL subtypes were Medina 1,1,1 (n = 26, 37.1%) and Medina 1,1,0 (n=20, 28.6%), reflecting the predominance of complex anatomical involvement. The most common coronary bifurcation technique utilised was provisional stenting (PS) (n=46, 65.7%), followed by Double-Kissing (DK) crush technique (n=12, 17.1%). Major adverse cardiac events (MACE) at one month, six months and one year occurred in 4.3% (95% confidence interval (CI): 1.5-11.9), 7.1% (95% CI: 3.1-15.8) and 7.1% (95% CI: 3.1-15.8) patients, respectively; there was no statistical significance.
Conclusion:
Coronary bifurcation stenting (COBIS), when guided by lesion anatomy, sound strategy selection and meticulous technique, yielded high procedural success and favourable clinical outcomes.
