2-Year Outcome of Patients Treated for Bifurcation Coronary Disease With Provisional Side Branch T-Stenting Using Drug-Eluting Stents
Helen C. Routledge, MD, MRCP,
Marie-Claude Morice, MD, FESC, FACC*,
Thierry Lefèvre, MD, FESC, FSCAI,
Philippe Garot, MD, FESC,
Federico De Marco, MD,
Beatriz Vaquerizo, MD,
Yves Louvard, MD, FSCAI
ICPS Institut Cardiovasculaire, Paris Sud, Massy, France.
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Figure 1 Procedure for Treatment of Bifurcations Using a Provisional T-Stenting Strategy
1. Wires are advanced in both the distal main vessel and 2. the side branch; 3. The main vessel is pre-dilated if deemed necessary. Pre-dilation of the side branch is avoided where possible; 4. A stent is deployed in the main vessel, jailing the wire in the side branch; 5. Once the main vessel result is seen to be satisfactory, wires are exchanged with the main vessel wire being withdrawn and advanced through the stent struts into the side branch; 6. A kissing inflation is systematically performed in order to open the stent struts to cover the ostium of the side branch, while preserving the result in the main vessel; 7a. If at this point there is normal (Thrombolysis In Myocardial Infarction flow grade 3) flow in the side branch and <50% residual angiographic stenosis, this marks the end of the procedure; 7b. If this is not achieved, a second stent is deployed in the side branch. The side branch stent crosses the struts of the first stent and is deployed in a T configuration; followed by 7c. a final kissing inflation to optimize 7d. the final result in both branches.
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Figure 2 Kaplan-Meier Survival Curves Illustrating Outcome After Bifurcation Intervention
Freedom from cardiac death (red line), freedom from death (black line), freedom from death or target vessel revascularization (blue line), and major adverse cardiac event-free survival (green line) at 2 years. Cum = cumulative.
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Figure 3 DES Thrombosis After Bifurcation Intervention
Incidences of stent thrombosis (ST) according to Academic Research Consortium definitions, up to 2 years after drug-eluting stent (DES) deployment in bifurcation lesions. CCF = congestive cardiac failure; LVF = left ventricular failure; MI = myocardial infarction; PCI = percutaneous coronary intervention; SCD = sudden cardiac death; TVR = target vessel revascularization; VF = ventricular fibrillation.
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