scholarly journals Stent strategies in left main bifurcation lesions: the simpler, the better?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Oliveira Campos ◽  
L Leite ◽  
M Santos ◽  
L Paiva ◽  
E Jorge ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Cardiac Death ◽  
Global Analysis ◽  
Artery Bypass ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Syntax Score ◽  
Left Main ◽  
Bifurcation Lesions ◽  
Provisional Stenting

Abstract Introduction Although percutaneous coronary intervention (PCI) for ostial or midshaft lesions in left main (LM) disease has shown similar results as compared with coronary artery bypass grafting (CABG), distal LM bifurcations are associated with an increase in procedural complexity and higher rates of target lesion revascularization. Several studies have investigated the optimal stenting strategy in patients with coronary bifurcation lesions and showed no benefit for systematic two-stent approach in comparison with provisional stenting. This is reflected in the current guidelines that recommend provisional stenting of the side branch as the preferred approach for most bifurcation lesions. However, there is still debate about the optimal strategy according to lesion location. Objectives This analysis aimed to compare the clinical outcomes of LM bifurcation PCI using a provisional strategy versus a two-stent strategy. Methods Retrospective, observational study including patients submitted to LM bifurcation (Medina 1,1,1) PCI between January 2010 and December 2019. Data was collected from the emergency department and hospitalization registries. Patients were divided according to the stenting approach. We made a global analysis including baseline clinical and angiographic data. The primary endpoint was target lesion failure (TLF), defined as the composite of myocardial infarction, cardiac death, and target lesion revascularization (TLR). Secondary endpoints included the individual components. Results A total of 106 patients were included (median age 74 [66–82], 79 (74.5%) males), 57 (53.8%) submitted to provisional stenting and 49 (46.2%) to a two-stent technique. Baseline characteristics were well matched (table 1). The mean SYNTAX score was 29.6±10.0 and LM stenosis grade was ≥70% in all lesions. Median follow-up was 26.6 [12.0–48.6] months. No differences were found regarding the primary endpoint (TLF in provisional stenting was 21.7% vs 21.4%, HR 2.432; 95% confidence interval, 0.472–12.450; p=0.233.). Although target lesion revascularization within the LM complex was numerically higher in the two-stent group (10.2% vs. 3.5%, p=0.245), the opposite was found in cardiac death (provisional group 10.5% vs. 4.3%, p=0.289). Conclusions Besides being a “simpler” technique, provisional stenting had no significant differences in outcomes compared to two-stent techniques. Without further evidence, revascularization strategies should primarily rely on operator expertise. FUNDunding Acknowledgement Type of funding sources: None.

279Clinical outcome after coronary bifurcation stenting: a systematic review and network meta-Analysis of PCI bifurcation techniques comprising 5572 patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Di Gioia ◽  
J Sonck ◽  
I Colaiori ◽  
T Mizukami ◽  
M Kodeboina ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Cardiac Death ◽  
Meta Analysis ◽  
Evaluation Framework ◽  
Left Main ◽  
Coronary Bifurcation ◽  
Bifurcation Lesions ◽  
Provisional Stenting ◽  
Crush Technique

Abstract Background The optimal PCI technique for bifurcation lesions remains a matter of debate. Several RCT have compared different bifurcation PCI techniques. Provisional stenting has been recommended as the default technique for most bifurcation lesions. However, emerging data suggests that double-kissing crush technique can be considered in true left main bifurcation lesions and has been endorsed by the European Society of Cardiology Guidelines. Purpose To compare the clinical outcome between different bifurcation PCI techniques. Methods We searched MEDLINE for randomized clinical trials (RCT) comparing PCI bifurcation techniques for coronary bifurcation lesions. Outcomes of interest were major adverse cardiovascular events (MACE) defined as the composite of cardiac death, myocardial infarction (MI) and target vessel or lesion revascularization (TVR/TLR), and the individual components of MACE. Stent thrombosis was assessed as defined by the ARC. Stratification based on left-main or distal bifurcations was performed. We evaluated the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We estimated summary odds ratios (ORs) using pairwise and Bayesian network meta-analysis. Results We identified 263 studies and of these included 19 RCT including 5572 patients treated with 5 bifurcation PCI techniques namely provisional stenting, systematic T-stenting, crush, culotte and double-kissing crush. Median follow-up was 12 months (IQR 8 to 36). When all bifurcation lesions were combined, double-kissing crush technique reduced the occurrence of MACE (OR 0.42; CrI 0.28 to 0.61) compared to provisional stenting. This difference was driven by a reduction in TVR/TLR (OR 0.39; CrI 0.25 to 0.65). No differences were found in cardiac death, MI or stent thrombosis among analyzed PCI techniques. No differences in MACE were observed between provisional stenting, systematic T-stenting, crush. In distal bifurcations (n=17 studies, 4634 patients), double-kissing crush also showed to reduce MACE (OR 0.48; CrI 0.29 to 0.67 vs. Provisional). In left-main bifurcations (n=3 studies, 938 patients) no differences in MACE were found between PCI techniques. Conclusions In this network meta-analysis, PCI bifurcation techniques were similar with respect to the occurrence of cardiac death, myocardial infarction and stent thrombosis. When all coronary bifurcations were combined, an advantage of double-kissing crush was observed in terms of MACE driven by lower rate of repeated revascularization. Further studies are required to define the best PCI bifurcation technique for left main coronary artery disease.

Abstract 2161: Impact of Target Lesion Revascularization During the First Year After Bare-Metal or Sirolimus-Eluting Stenting on Five-Year Cardiac Outcomes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Meredith Mulhearn ◽  
Victor Novack ◽  
Riya S Chacko ◽  
Lena Novack ◽  
Laura Mauri ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Cardiac Death ◽  
Bare Metal Stents ◽  
Target Lesion ◽  
Adverse Outcomes ◽  
Target Lesion Revascularization ◽  
Metal Stents ◽  
Bare Metal ◽  
Cardiac Outcomes ◽  
Increased Risk

Background: The association of restenosis requiring target lesion revascularization (TLR) and late cardiac outcomes after drug-eluting versus bare metal stents (BMS) has not been previously assessed. Methods: We hypothesized that restenosis requiring TLR within 1 year after stenting would be associated with increased risk of adverse cardiac outcomes during the next 4 years. Of 1058 patients randomized to sirolimus-eluting (SES) or BMS in the SIRIUS trial, 37 were excluded due to multivessel (6) or SVG (1) stenting or the occurrence of TLR within the first 30 days (30), leaving 515 SES and 506 BMS. Patients with TLR for restenosis indication between 31–360 days after the index procedure (TLR group) were compared with all others (Non TLR group) for outcomes during years 2–5. The primary endpoint was a composite of cardiac death, any MI or any repeat revascularization. The secondary endpoint was cardiac death or any MI. All events were adjudicated by an independent committee. Event rates were estimated using Kaplan-Meier (KM) method and compared using log rank. The correlates of the primary and secondary endpoints were tested using Cox proportional hazards regression. Results: TLR occurred in 120 (11.8%) patients. TLR patients had lower frequency of SES (24.2% vs. 53.9%, p<0.001), more diabetes (35.8% vs. 25.2%, p=0.02) and smaller diameter vessels (2.7±0.5 vs. 2.8±0.5 mm, p=0.04). TLR presented with MI in 7 (5.8%) patients, including CKMB >5 times normal in 6 (5.0%) patients. The primary endpoint occurred in 42 (36.1%) TLR and 211 (24.3%) Non TLR patients (log-rank p = 0.002). Cardiac death or MI occurred in 16 (13.8%) TLR patients and 57 (6.6%) Non TLR patients (log-rank p = 0.005). TLR was an independent predictor of the primary endpoint (Hazard ratio [HR] 1.6, 95% CI 1.2–1.9) and of cardiac death or MI (HR 1.9, 95% CI 1.3–2.4). Other independent predictors of cardiac death or MI were diabetes (HR 2.2, 95% CI = 1.7–2.6) and prior MI (HR 1.9, 95% CI 1.3–2.4). SES compared with BMS was not significantly associated with the primary endpoint or cardiac death or MI. Conclusions: Restenosis requiring TLR during 31–360 days after successful stenting is associated with an increased risk of adverse outcomes, including cardiac death or MI, in subsequent years.

scholarly journals Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial

2020 ◽  
Vol 41 (27) ◽  
pp. 2523-2536 ◽  
Author(s):  
Jun-Jie Zhang ◽  
Fei Ye ◽  
Kai Xu ◽  
Jing Kan ◽  
Ling Tao ◽  
...  
Keyword(s):  
Cardiac Death ◽  
Target Lesion ◽  
Stent Group ◽  
Coronary Bifurcation ◽  
Coronary Bifurcation Lesions ◽  
Safety Endpoint ◽  
Bifurcation Lesions ◽  
Provisional Stenting ◽  
Target Lesion Failure

Abstract Aim The present study aimed to assess the benefits of two-stent techniques for patients with DEFINITION criteria-defined complex coronary bifurcation lesions. Methods and results In total, 653 patients with complex bifurcation lesions at 49 international centres were randomly assigned to undergo the systematic two-stent technique (two-stent group) or provisional stenting (provisional group). The primary endpoint was the composite of target lesion failure (TLF) at the 1-year follow-up, including cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularization (TLR). The safety endpoint was definite or probable stent thrombosis. At the 1-year follow-up, TLF occurred in 37 (11.4%) and 20 (6.1%) patients in the provisional and two-stent groups, respectively [77.8%: double-kissing crush; hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.30–0.90; P = 0.019], largely driven by increased TVMI (7.1%, HR 0.43, 95% CI 0.20–0.90; P = 0.025) and clinically driven TLR (5.5%, HR 0.43, 95% CI 0.19–1.00; P = 0.049) in the provisional group. At the 1 year after indexed procedures, the incidence of cardiac death was 2.5% in the provisional group, non-significant to 2.1% in the two-stent group (HR 0.86, 95% CI 0.31–2.37; P = 0.772). Conclusion For DEFINITION criteria-defined complex coronary bifurcation lesions, the systematic two-stent approach was associated with a significant improvement in clinical outcomes compared with the provisional stenting approach. Further study is urgently warranted to identify the mechanisms contributing to the increased rate of TVMI after provisional stenting. Study registration http://www.clinicaltrials.com; Identifier: NCT02284750.

scholarly journals Crush is superior to Culotte in two-stent strategy for treatment of left main coronary artery bifurcations: A systematic review and meta-analysis

2020 ◽  
Vol 43 (2) ◽  
pp. E35-46
Author(s):  
Xiao-Rui Chen, MD Chen ◽  
Di-Yu Cui ◽  
Yun-Qing Chen, MD, PhD Chen ◽  
Tie-Sheng Niu
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Stent Thrombosis ◽  
Cardiac Death ◽  
Left Main Coronary Artery ◽  
Target Lesion ◽  
Left Main ◽  
Cardiac Events ◽  
Target Vessel Revascularization ◽  
Bifurcation Lesions

Purpose: Crush and Culotte techniques have been used increasingly to treat patients with complex unprotected left main coronary artery bifurcation lesions. This article compares published data on these two techniques. Methods: Databases, including PubMed, Embase, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure, were searched for articles published before Aug 21, 2019 to identify all relevant studies on left main coronary artery bifurcation lesions treated by Crush versus Culotte techniques. The pooled data were analyzed using either fixed- or random-effects model depending on heterogeneity (assessed via the I2 index). The endpoints were major adverse cardiac events, target lesion revascularization, cardiac death, stent thrombosis, myocardial infarction and target vessel revascularization. Results: Eight articles with a total of 1,283 patients were included, and 710 patients were treated with Crush, and 573 ones with Culotte. Crush group was trend to decreased major adverse cardiac event compared with Culotte group [Relative ratio (RR) 0.63,95% confidence interval(CI) 0.39-1.04, I2 =72.7%], mainly driven by decreased cardiac death [RR 0.49, 95% CI(0.25-0.99), I2 =0%], decreased myocardial infarction [RR 0.40, 95% CI(0.21-0.76), I2 =21.6%],and lower stent thrombosis [RR 0.39, 95% CI(0.16-0.98), I2 =39.4%]. There was no significant difference in target lesion revascularization and target vessel revascularization between Crush and Culotte [RR 0.77, 95% CI 0.46-1.28, I2=61.1%; RR 0.78, 95% CI (0.30-2.02), I2 =73.1%, respectively]. Conclusion: Crush was superior to Culotte for treatment of left main coronary artery bifurcation lesions with a trend of lower incidence of long-term major adverse cardiac events, mainly derived from decreased myocardial infarction, stent thrombosis and cardiac death.

scholarly journals Randomized non-inferiority TrIal comParing reverse T And Protrusion versus double-kissing and crush Stenting for the treatment of complex left main bifurcation lesions

2021 ◽  
Author(s):  
Maximilian Olschewski ◽  
Helen Ullrich ◽  
Maike Knorr ◽  
Giulio Makmur ◽  
Majid Ahoopai ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Side Branch ◽  
Interventional Treatment ◽  
Syntax Score ◽  
Left Main ◽  
Group 14 ◽  
Coronary Bifurcation Lesions ◽  
Stent Expansion ◽  
Procedural Time ◽  
Bifurcation Lesions

Abstract Background The treatment of left main bifurcation stenoses remains challenging. Aims We compare the “Reverse T and Protrusion” (reverse-TAP) technique to Double-Kissing and crush (DK-crush). Methods The study was designed as non-inferiority trial, the primary endpoint was percentage stent expansion in the ostial side branch at optical coherence tomography. Results 52 consecutive patients (13 females, 17 diabetics, Syntax score 25 [22–29]) with complex coronary bifurcation lesions of the left main were randomized in a 1:1 ratio to Reverse-TAP or DK-crush stenting. The intervention was performed according to protocol in all patients in both randomization groups. Side branch stent expansion was 75 [67–90]% in the DK-crush group and 86 [75–95]% in the reverse-TAP group (one-sided 97.5% lower parametric confidence interval: − 0.28%; P < 0.01 for non-inferiority; P = 0.037 for superiority). Side branch balloon pressure during final kissing was higher in the DK-crush group (14 [12–16] vs. reverse-TAP: 13 [12–14]; P = 0.043). Procedural time was shorter with reverse-TAP (DK-crush: 32 [24–44] min vs reverse–TAP: 25 [22–33] min; P = 0.044). Other procedural parameters were not different between groups. There was no difference in any of the safety endpoints up to 1 month. Conclusions A reverse-TAP strategy for the interventional treatment of complex coronary lesions was non-inferior and superior to DK-crush for the primary endpoint side branch expansion while requiring less time. A larger study testing long-term clinical outcomes is warranted. Trail Registration NCT: NCT03714750. Graphical abstract

scholarly journals Randomized Clinical Comparison of the Dual Therapy CD34 Antibody-Covered Sirolimus-Eluting Combo Stent with the Sirolimus-Eluting Orsiro Stent in Patients Treated with Percutaneous Coronary Intervention: The SORT OUT X Trial

Circulation ◽  
2021 ◽  
Author(s):  
Lars Jakobsen ◽  
Evald H. Christiansen ◽  
Phillip Freeman ◽  
Johnny Kahlert ◽  
Karsten Veien ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Endpoint ◽  
Cardiac Death ◽  
Large Scale ◽  
Dual Therapy ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Intention To Treat ◽  
Increased Risk ◽  
Target Lesion Failure

Background: Target lesion failure remains an issue with contemporary drug eluting stents. Thus, the dual therapy sirolimus-eluting and CD34+ antibody coated Combo stent (DTS) was designed to further improve early healing. The aim of this study was to investigate whether the DTS is non-inferior to the sirolimus-eluting Orsiro stent (SES) in an all-comers patient population. Methods: The SORT OUT X trial, was a large-scale randomized, multicenter, single-blind, two-arm, non-inferiority trial with registry-based follow-up. The primary endpoint target lesion failure (TLF) was a composite of cardiac death, myocardial infarction or target lesion revascularization within 12 months, analyzed using intention to treat. The trial was powered for assessing TLF non-inferiority of the DTS compared with the SES with a predetermined non-inferiority margin of 0.021. Results: 3,146 patients were randomized to treatment with the DTS (1,578 patients, 2,008 lesions) or the SES (1,568 patients 1,982 lesions). At 12 months, intention-to-treat analysis showed that 100 patients (6.3%), who were assigned the DTS, and 58 patients (3.7%), who were assigned the SES, met the primary endpoint (absolute risk difference 2.6% [upper limit of one-sided 95% confidence interval (CI) 4.1%]; p(non-inferiority)=0.76). The SES was superior to the DTS (Incidence rate ratios (IRR) for target lesion failure=1.74 [95% CI, 1.26-2.41]; P=0.00086). The difference was mainly explained by a higher incidence of target lesion revascularization in the DTS group compared to the SES group (53 [3.4%] vs 24 [1.5%], IRR=2.22 [95% CI, 1.37-3.61]; P=0.0012). Conclusions: The DTS did not confirm non-inferiority to the SES for target lesion failure at 12 months in an all-comer population. The SES was superior to the DTS mainly because the DTS was associated with an increased risk of target lesion revascularization. However, rates of death, cardiac death, and myocardial infarction at 12 months did not differ significantly between the two stent groups. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03216733.

Percutaneous coronary intervention with everolimus-eluting stents versus coronary artery bypass surgery in patients with stable angina and an isolated proximal left anterior descending artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Matsoukis ◽  
A Karanasos ◽  
C Patsa ◽  
N Anousakis-Vlachochristou ◽  
K Triantafyllou ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Stable Angina ◽  
Cardiac Death ◽  
Artery Bypass ◽  
Composite Index ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Percutaneous Coronary ◽  
Secondary Endpoints

Abstract Background/Introduction Revascularization of the proximal segment of left anterior descending artery (pLAD) demonstrates an additional prognostic significance in survival for patients with multivessel disease. It is also indicated for symptomatic relief in patients with stable angina who are receiving optimal medical treatment in the presence of limiting angina or angina equivalent. Both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are still commonly needed as therapeutic options for pLAD disease. Moreover, Everolimus-eluting stents (EES) have demonstrated superiority in safety and efficacy among other types of second or new generation drug-eluting stents. Purpose We aim to evaluate the long-term outcomes of PCI with EES compared to CABG surgery with left internal mammary artery, in patients with stable angina and an isolated single vessel pLAD disease. Methods The sample consisted of 824 patients with isolated pLAD and chronic stable angina; 445 participants were included in the EES-PCI group, and 379 were included in the CABG group. The study's primary endpoint was the occurrence of major adverse cardiac events (MACEs), namely, cardiac death, myocardial infarction (MI) not attributed to a non-target vessel and target lesion revascularization as a composite index. Secondary endpoints were Patient-Related Outcome (PRO; a composite index of all-cause mortality, any MI related to any coronary artery, any revascularization conducted to any coronary artery), individual components of MACEs, recurrence of stable or unstable angina or a nonfatal arrhythmia and disease progression of other lesions. For the comparisons between the two groups, chi-square tests and Fisher's exact tests, were used, as appropriate. Results During the 4.6 years of follow-up period, no statistically significant difference was observed between the two study groups in respect to the primary endpoint MACE (8.1% versus 7.4%, p=0.71). Concerning secondary endpoints, repeat revascularization (3.6% versus 2.9%, p=0.58), cardiac death (2.9% versus 3.2%, p=0.84), MI (1.6% versus 1.3%, p=0.76) and PRO (16.9% versus 17.7%, p=0.76) did not significantly differ between the two groups. Recurrence of angina was more frequent in the EES-PCI group (14.9% versus 8.4%, p=0.005) even though higher Class of angina was found less common in EES patients than in CABG patients (p&lt;0.001). Patients treated with EES-PCI had lower rates of onset of arrhythmias compared to those treated with CABG (6.3% versus 11.9%, p=0.005). Finally, revascularization in other than target lesion was more frequent in the stent than in the surgery arm (6.3% versus 3.2%, p=0.04); as a consequence, higher rates of revascularization in any vessel was recorded in the PCI group than the CABG one (9.9% versus 5.8%, p=0.03). Conclusion PCI with EES seem to have similar long-term clinical outcomes compared with CABG in patients with isolated pLAD disease. Funding Acknowledgement Type of funding source: None

Percutaneous Revascularization of Grafts Versus Native Coronary Arteries in Postcoronary Artery Bypass Graft Patients

Angiology ◽  
2008 ◽  
Vol 60 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Julio Garcia-Tejada ◽  
Maite Velazquez ◽  
Felipe Hernandez ◽  
Agustín Albarran ◽  
Sergio Rodriguez ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Artery Bypass Graft ◽  
Percutaneous Interventions ◽  
Procedural Success ◽  
Percutaneous Revascularization ◽  
Native Group

In patients with previous coronary artery bypass graft surgery, it is unknown whether better results may be obtained with percutaneous interventions of grafts versus native arteries. The clinical outcomes in 84 patients undergoing percutaneous interventions of either grafts (n = 31) or native arteries (n = 53) were compared. Procedural success rate was 95.3% (96.8% in the graft group vs 94.4% in the native group, P = .3). Mean follow-up was 19 ± 7 months. The incidence of major adverse events was 14.2% (12.9% vs 15.1% in the graft and native groups, respectively; P = .8), mortality rate was 3.5% (6.4% vs 1.8% in the graft and native groups, respectively; P = .3), and target-lesion revascularization was performed in 4.7% (6.4% vs 3.7% in the graft and native groups, respectively, P = .6). In conclusion, both graft or native percutaneous interventions were similar for immediate and midterm clinical outcomes. The relatively low risk need for target-lesion revascularization obtained with both strategies is encouraging.

scholarly journals Stentless Strategy by Drug-Coated Balloon Angioplasty following Directional Coronary Atherectomy for Left Main Bifurcation Lesion

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Norihiro Kobayashi ◽  
Masahiro Yamawaki ◽  
Shinsuke Mori ◽  
Masakazu Tsutsumi ◽  
Yohsuke Honda ◽  
...  
Keyword(s):  
De Novo ◽  
Artery Bypass ◽  
The Other ◽  
Bleeding Complications ◽  
Left Main ◽  
Other Hand ◽  
Bifurcation Lesion ◽  
Bifurcation Lesions ◽  
Directional Coronary Atherectomy ◽  
Drug Coated Balloon

Aims. We aimed to evaluate the efficacy of stentless strategy by drug-coated balloon (DCB) angioplasty following directional coronary atherectomy (DCA) for left main (LM) bifurcation lesions. Methods. A total of 38 patients who underwent DCB angioplasty following DCA for LM bifurcation lesions were retrospectively enrolled. The primary endpoint was target vessel failure (TVF) at 12 months. Secondary endpoints included procedure-related major events during the hospitalization, major adverse cardiac events at 12 months, ischemia-driven target lesion revascularization (TLR) at 12 months, and bleeding complications defined as the Bleeding Academic Research Consortium criteria ≥2 at 12 months. Results. Among these 38 lesions, 31 lesions were de novo LM bifurcation lesions and 7 lesions were stent edge restenosis at the left anterior descending (LAD) ostium. The mean % plaque area (%PA) after DCA was 44.0 ± 7.4%. TVF at 12 months occurred in 1 lesion (3.2%) of de novo LM bifurcation lesion and in 3 lesions (42.9%) of stent edge restenosis at the LAD ostium. All events of TVF were ischemia-driven TLR by percutaneous coronary intervention. Among 4 TLR cases, %PA after DCA was high (55.9%) in the de novo LM bifurcation lesions; on the other hand, %PA after DCA was low (42.4%, 38.7%, and 25.7% in the 3 cases) in stent edge restenosis at the LAD ostium. No procedure-related major events were observed during hospitalization. There was no cardiac death, no myocardial infarction, no coronary artery bypass grafting, and no bleeding complications at 12 months. Conclusions. Stentless strategy by DCB angioplasty following DCA for de novo LM bifurcation lesions resulted in acceptable outcomes. On the other hand, its efficacy was limited for stent edge restenosis at the LAD ostium even after aggressive debulking by DCA.

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