Predictors of restenosis after treatment of bifurcational lesions with paclitaxel eluting stents: a multicenter prospective registry of 150 consecutive patients.
OBJECTIVE
The aim of the study was the assessment of the clinical, angiographic and procedural characteristics correlated with freedom from adverse events at 1 year in a real life setting of consecutive bifurcation lesions.


BACKGROUND
Even if stent implantation has shown to be superior to conventional balloon angioplasty in most coronary lesions, bifurcation treatment with stent implantation both in main and in side branch (SB) still raises controversy.


METHODS
We reviewed the results obtained in a prospective multicenter registry of 150 patients with 158 bifurcation lesions involving a SB of sufficient diameter to be treated, if necessary, with a polymer based paclitaxel eluting stent (PES, TAXUS). Two stents were used in 118 lesions (74.7%). Final kissing balloon inflation was performed in 87/118 lesions (73.7%) and in 30/40 lesions (75.0%) of the 2 and 1 stent group respectively.


RESULTS
At 1-year clinical follow-up we observed 4 stent thromboses, all involving the SBs of the 2 stents group (2.7%). Unlike previous reports, revascularization involved the main vessel in the majority of patients (21/150, 14.0%). After an exploratory multivariable analysis the only parameter predictive of target lesion revascularization (TLR) (HR 0.52; CI 95% 0.11-0.86; p = 0.02) and target vessel revascularization (TVR) (HR 0.47; CI 95% 0.14-0.90; p = 0.03) was postprocedural main branch minimal lumen diameter (MB-MLD).


CONCLUSIONS
In a real life setting of consecutive bifurcation lesions, thrombosis rate, concentrated in the SB and the 2-stents group, and need for target lesion revascularization remain higher than in less complex lesion subgroups treated with PES. No differences in immediate success and TLR were observed between 2 stents and 1 stent groups. The frequently observed suboptimal stent expansion and final MB-MLD predict 1 year revascularization.
Di Mario
Carlo
C
Catheterization Laboratory, Royal Brompton Hospital, Sydney Street, London, UK. c.dimario@rbh.nthames.nhs.uk
Morici
Nuccia
N
Godino
Cosmo
C
Goktekin
Omer
O
Tamburino
Corrado
C
Barbagallo
Rossella
R
Antoniucci
David
D
Grube
Eberhard
E
Airoldi
Flavio
F
Zoccai
Giuseppe Biondi
GB
Colombo
Antonio
A
Sangiorgi
Giuseppe M
GM
D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000145:classification / Q000628:therapy; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017239:Paclitaxel / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D012044:Regression Analysis; D012107:Research Design; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency
D020099:Coated Materials, Biocompatible; D017239:Paclitaxel