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Mini-Crush Versus T-Provisional Techniques in Bifurcation Lesions

Clinical and Angiographic Long-Term Outcome After Implantation of Drug-Eluting Stents

Department of Internal Medicine and Systemic Disease, Clinical Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy

^_* Reprint requests and correspondence: Prof. Alfredo R. Galassi, Via Antonello da Messina 75, Acicastello, 95021, Catania, Italy (Email: argalassi{at}virgilio.it).

Objectives: This retrospective study sought to assess the clinical and angiographic long-term outcome after implanting drug-eluting stents in bifurcation lesions with the T-provisional (T-prov) technique and mini-crush (MC) technique.

Background: The best option on the treatment of coronary bifurcation lesions is a subject of considerable debate. However, recent evidence suggests that bifurcation lesions might be treated by drug-eluting stent on both branches using the MC technique with a low rate of major adverse cardiac event and restenosis.

Methods: From April 2004 to July 2006, 457 patients were consecutively treated with either MC technique (n = 199) or T-prov technique (n = 258). Of these latter, 170 patients were treated with 1 stent and 88 patients with 2 stents. The 9-month angiographic follow-up was completed in 188 of 229 (82.1%) bifurcation lesions of MC patients and in 207 of 266 lesions (77.8%) of T-prov patients.

Results: After a propensity score adjustment, 2-year cumulative major adverse cardiac events were similar between groups (p = 0.16). The MC group compared with the T-prov 1-stent group had significantly lower main and side branches restenosis (hazard ratio [HR]: 0.52, 95% confidence interval [CI]: 0.27 to 0.99; p = 0.047; and HR: 0.41, 95% CI: 0.20 to 0.85; p = 0.016, respectively). However, the MC group compared with the T-prov-only group had significantly lower side branch restenosis (HR: 0.55, 95% CI: 0.37 to 0.82; p = 0.004).

Conclusions: Both techniques of bifurcation treatment met high procedural success with low complication rates and similar major adverse cardiac event long-term outcome. However, the MC technique yields a lower restenosis rate at both main and side branches. These results may confirm the advantage of using prescheduled 2-stent technique to give a complete coverage of the side branches' ostium.

Key Words: DES • stent • bifurcation lesions • mini-crush • T-provisional

Abbreviations and Acronyms   AMI = acute myocardial infarction   CI = confidence interval   HR = hazard ratio   MACE = major adverse cardiac event   MC = mini-crush   TBR = target bifurcation revascularization   TLR = target lesion revascularization   T-prov = T-provisional stenting

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