Randomized trial on routine vs. provisional T-stenting in the treatment of de novo coronary bifurcation lesions.
OBJECTIVE
We investigated whether routine T-stenting reduces restenosis of the side branch as compared with provisional T-stenting in patients with de novo coronary bifurcation lesions.


RESULTS
Our randomized study assigned 101 patients with a coronary bifurcation lesion to routine T-stenting with sirolimus-eluting stents (SES) in both branches and 101 patients to provisional T-stenting with SES placement in the main branch followed by kissing-balloon angioplasty and provisional SES placement in the side branch only for inadequate results. Primary endpoint was per cent diameter stenosis of the side branch at 9 month angiographic follow-up. Angiographic follow-up in 192 (95%) patients revealed a per cent stenosis of the side branch of 23.0 +/- 20.2% after provisional T-stenting (19% with side-branch stent) and of 27.7 +/- 24.8% (P = 0.15) after routine T-stenting (98.2% with side-branch stent). The corresponding binary restenosis rates were 9.4 and 12.5% (P = 0.32), prompting re-intervention in 5.0 and 7.9% (P = 0.39), respectively. In the main branch, binary restenosis rates were 7.3% after provisional and 3.1% after routine T-stenting (P = 0.17). The overall 1 year incidence of target lesion re-intervention was 10.9% after provisional and 8.9% after routine T-stenting (P = 0.64).


CONCLUSIONS
Routine T-stenting with SES did not improve the angiographic outcome of percutaneous coronary intervention of coronary bifurcation lesions as compared with stenting of the main branch followed by kissing-balloon angioplasty and provisional side-branch stenting.
Ferenc
Miroslaw
M
Herz-Zentrum Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany. miroslaw.ferenc@herzzentrum.de
Gick
Michael
M
Kienzle
Rolf-Peter
RP
Bestehorn
Hans-Peter
HP
Werner
Klaus-Dieter
KD
Comberg
Thomas
T
Kuebler
Piotr
P
Büttner
Heinz Joachim
HJ
Neumann
Franz-Josef
FJ
D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000628:therapy*; D003331:Coronary Vessels / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D020123:Sirolimus / Q000008:administration & dosage; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D020123:Sirolimus