title: Coronary bifurcation lesions: to stent one branch or both?
abstract: OBJECTIVE
  The purpose of this study was to evaluate two different stent placement techniques for bifurcation lesions: 1) stenting of the main branch and balloon dilatation of the sidebranch versus 2) stenting of both branches.
  
  
  BACKGROUND
  Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains challenging, and limited information is available regarding whether stent placement is necessary in both branches of the bifurcation using bare-metal stents. Methods. We prospectively followed all patients who underwent PCI for symptomatic bifurcation lesions at our center. All patients were carefully followed for subsequent clinical events.
  
  
  RESULTS
  Between March 2001 and November 2002, a total of 50 patients were treated with either stenting of both vessels (double stent group; n = 32) or stenting of the parent vessel and balloon angioplasty of the sidebranch (single stent group; n = 18). Optimal angiographic success was 87.5% in the single stent group and 100% in the double stent group (p = 0.1). The post-procedure percent diameter stenosis of the sidebranch vessel was significantly higher in the single stent group (18 +/- 25% versus 4 +/- 8%; p = 0.005). At 6 months, the incidence of clinically driven repeat target lesion revascularization was 37.6% with 2 stents as compared to 5.6% using 1 stent (p = 0.01). Angiographic restenosis was documented in 40.6% using 2 bifurcation stents, as compared to 11% when using 1 stent (p = 0.05). By multivariable analysis adjusted for baseline differences, stenting the sidebranch was a borderline predictor for major adverse cardiac events at 6 months (odds ratio = 10.3; 95% confidence interval, 0.9-116; p = 0.053).
  
  
  CONCLUSIONS
  For the treatment of true bifurcation lesions, a strategy of stenting both vessels using bare metal stents seems to be associated with worse long-term results, as compared to stenting only the parent vessel.
authors.affiliation: Department of Cardiology, Rabin Medical Center (Campus Belinson), Petach Tikva (49100), Israel.
authors.forename: Abid R
authors.initials: AR
authors.lastname: Assali
authors.forename: Igal
authors.initials: I
authors.lastname: Teplitsky
authors.forename: David
authors.initials: D
authors.lastname: Hasdai
authors.forename: Eldad
authors.initials: E
authors.lastname: Rechavia
authors.forename: Alejandro
authors.initials: A
authors.lastname: Solodky
authors.forename: Ofer
authors.initials: O
authors.lastname: Sela
authors.forename: Nader
authors.initials: N
authors.lastname: Butto
authors.forename: Nurit
authors.initials: N
authors.lastname: Shor
authors.forename: Shmuel
authors.initials: S
authors.lastname: Fuchs
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D000800:Angioplasty, Balloon / Q000379:methods; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography; D003327:Coronary Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome