title: Provisional T-drug-eluting stenting technique for the treatment of bifurcation lesions: clinical, myocardial scintigraphy and (late) coronary angiographic results.
abstract: BACKGROUND
  Treatment of bifurcation stenoses (BS) by percutaneous coronary intervention (PCI) remains challenging, even with drug-eluting stents (DES). We aimed to appraise clinical, myocardial scintigraphy and late (>9 months) exploratory angiographic outcomes of provisional T-stenting in the management of BS.
  
  
  METHODS
  We enrolled 53 consecutive patients with BS in the proximity of a greater than or equal to 2 mm side branch (SB). The provisional T-technique was performed in all cases, with implantation of DES in the main branch (MB), SB balloon-only dilatation, and final kissing in the event of >50% SB stenosis. Provisional SB-stenting (using another DES) was reserved to cases with persisting >50% stenosis/dissection and reduced TIMI flow. Further kissing inflation was recommended in such patients. Stress/rest single-photon emission computed tomography (MIBI) and coronary angiography follow up were scheduled >6 and 9 months after PCI, respectively.
  
  
  RESULTS
  Major adverse cardiac events at 14 +/- 3 months occurred in 5 patients (9.4% [95% confidence interval 0.1-17.4%]: 1 (1.9% [0.1-5.8%]) non-Q-wave myocardial infarction for subacute stent thrombosis, 2 (3.8% [0.1-9.0%]) target lesion revascularizations and 2 (3.8% [0.1-9.0%]) target vessel revascularizations. Six-month MIBI was performed in 51 patients (96.3%): 4 patients had positive results (7.8% [0.2-15.4%]). Angiography was performed in 4 of these patients and in another 27 patients, with clinical restenosis occurring overall in only 5 (16.1% [8.9-23.3%]), 1 case of clinical restenosis in the MB (3.2% [0.6-9.4%]), and 4 in the SB (12.9% [5.1-24.9%]).
  
  
  CONCLUSIONS
  This study suggests the safety and efficacy of provisional T-drug-eluting stent implantation in bifurcation coronary lesions, and supports the use of follow-up myocardial scintigraphy, with angiography reserved for selected patients and lesions.
authors.affiliation: Department of Cardiology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy. carlovigna@libero.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Vigna
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Cesare M
authors.initials: CM
authors.lastname: Amico
authors.forename: Pompeo
authors.initials: P
authors.lastname: Lanna
authors.forename: Mario
authors.initials: M
authors.lastname: Stanislao
authors.forename: Tiberio
authors.initials: T
authors.lastname: Santoro
authors.forename: Guido
authors.initials: G
authors.lastname: Valle
authors.forename: Raffaele
authors.initials: R
authors.lastname: Fanelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Loperfido
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D016503:Drug Delivery Systems; D004867:Equipment Design; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon