P5752Which is the best stenting technique for coronary bifurcation lesions? Evidence from a network meta-analysis of randomized clinical trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Chiabrando ◽  
M Lombardi ◽  
G M Vescovo ◽  
G Biondi Zoccai ◽  
A Abbate ◽  
...  

Abstract Background Bifurcation lesions represent 20% of all coronary lesions treated by percutaneous coronary interventions (PCI). Although provisional technique with 1 stent in the main branch and balloon angioplasty of the side branch is considered the standard approach, the implantation of 2 stents is often being pursued with a wide variety of bifurcation stenting techniques. We thus conducted a systematic review and network meta-analysis of randomized clinical trials (RCTs) to compare clinical cardiovascular outcomes involving stenting techniques in coronary bifurcation lesions. Methods We searched on Pubmed, Google Scholar, Embase and Cochrane Library, up to October 2018 for published and unpublished RCTs that compared clinical cardiovascular outcomes in patients with bifurcation lesions treated with 7different techniques (crush [Cr]; culotte [Cu]; double kissing crush [DKCr], mini-crush [mCr], routine T-stenting [RTS], T-stenting and small protrusion [TAP], and provisional (1 stent technique)). We performed a frequentist fixed-effect network meta-analysis to estimate relative risks (RR) of major adverse cardiovascular events (“MACE”, typically defined as death, myocardial infarction and target vessel revascularization), target vessel revascularization (TVR), target lesion revascularization (TLR), and stent thrombosis (ST). Results We identified 14 studies, yielding data on 4285 patients. DKCr and mCr yielded significant reductions in MACE, TVR, and TLR when compared with the 1-stent technique (RR 0.31–0.55 [all P<0.01] and RR 0.42–0.45 [all P<0.02], respectively) and with the rest of the bifurcation techniques (RR 0.44–0.55 [all P<0.05] for DKCr and RR 0.37–0.45 [all P<0.05] for mCr). On the other hand, Cu and Cr were associated with an increased risk for ST compared to 1-stent technique (RR 3.25–4.27 [both P<0.05]) and to DKCr (RR 3.02–3.99 [both P<0.05]). We found no heterogeneity nor inconsistency between studies. Conclusions The various PCI bifurcation stenting techniques are associated with different cardiovascular outcomes, with double kissing crush and mini crush being more effective than others, including the 1-stent approach, whereas culotte and crush are associated with increased risk of stent thrombosis. Acknowledgement/Funding None

2018 ◽  
Vol 28 (02) ◽  
pp. 137-141 ◽  
Author(s):  
Bogie Putra Palinggi ◽  
Doni Firman

AbstractSide branch occlusion has been implicated as a complication after percutaneous coronary intervention in coronary bifurcation lesions. The role of carina bifurcation angle as one of the characteristics of the coronary bifurcation lesions in causing side branch occlusion after percutaneous coronary intervention is still debated. This study aims to assess the correlation between carina bifurcation angles as one of the characteristics of the coronary bifurcation lesions and side branch occlusion in elective percutaneous coronary intervention. This is a cross-sectional study which utilizes CAAS 5.1 software to measure carina bifurcation angle. We collected 113 lesions in 108 patients that met the inclusion criteria from January 2016 to October 2016. Side branch occlusion occurred in 15 lesions (13.3%), with median carina bifurcation angle 19.17 degrees (p < 0.001). Multivariate analysis showed there is a correlation between carina bifurcation angle with side branch occlusion, OR (odds ratio) 0.86 (95% CI [confidence interval]: 0.80–0.92) with ≤ 33.71 degrees cut off value. Increased risk of side branch occlusion was found in small carina bifurcation angle.


Author(s):  
Peter Mortier ◽  
Matthieu De Beule ◽  
Denis Van Loo ◽  
Benedict Verhegghe ◽  
Pascal Verdonck

A common technique to improve the local blood flow through stenotic arteries involves the implantation of a metallic scaffold known as a stent. These devices have shown excellent results in unbranched vessels. However, the treatment of coronary bifurcation lesions remains an enormous challenge and is generally associated with an increased complication rate. Many different techniques have been proposed in clinical literature, but all the suggested methodologies have specific limitations [1]. In many cases, a stent is deployed in the main branch (MB) and logically, this compromises the side branch (SB) patency. This is a frequently encountered situation that can be improved by balloon dilatation through the side of the MB stent (fig. 1). However, such balloon inflation may result in unwanted distortions of the stent [2].


2010 ◽  
Vol 139 (1) ◽  
pp. 80-91 ◽  
Author(s):  
Giampaolo Niccoli ◽  
Giuseppe Ferrante ◽  
Italo Porto ◽  
Francesco Burzotta ◽  
Antonio M. Leone ◽  
...  

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