Long-term clinical and angiographic outcomes after implantation of sirolimus-eluting stents with a "modified mini-crush" technique in coronary bifurcation lesions.
OBJECTIVE
We aimed to evaluate long-term outcomes of a modified mini-crush technique for treating bifurcation lesions.


BACKGROUND
Coronary bifurcation lesions continue to show a relatively high restenosis rate despite the use of a drug-eluting stent (DES).


METHODS
We enrolled 52 consecutive patients treated with sirolimus-eluting stent implantation using the modified mini-crush technique for 56 coronary bifurcation lesions (MEDINA 1, 1, 1, 89.2%; left main lesion, 28.6%). To minimize crushing, the proximal marker of the side branch (SB) stent was located in contact with the main vessel (MV) stent. After SB stenting, we drew the SB balloon proximally and dilate the SB ostium at a rated burst pressure. After MV stenting, both vessels were redilated at a high pressure before final kissing balloon (FKB) inflation. Clinical and angiographic follow-ups were performed at 9 months.


RESULTS
Immediate procedural success was obtained in all cases including a FKB success rate of 98%. At 9 months, there was no death or myocardial infarction. The incidences of major adverse cardiac events and target lesion revascularization were 11.8 and 7.8%, respectively. The in-stent restenosis (ISR) rate was 14.9% (SB ostium, 10.6%) and most ISRs were of the focal type and the cause of ISR was intimal hyperplasia but not chronic stent recoil by an intravascular ultrasound study. There was one case (2.0%) of late stent thrombosis without any ischemic symptoms during the follow-up period of 9 months.


CONCLUSIONS
Modified mini-crush technique provides excellent technical and angiographic success immediately and it also provides acceptable long-term outcomes.
Department of Cardiology, Ajou University Medical Center, Suwon, Republic of Korea.
Hyoung-Mo
HM
Yang
Seung-Jea
SJ
Tahk
Seong-Ill
SI
Woo
Hong-Seok
HS
Lim
Byoung-Joo
BJ
Choi
So-Yeon
SY
Choi
Myeong-Ho
MH
Yoon
Jin-Sun
JS
Park
Mingri
M
Zheng
Gyo-Seung
GS
Hwang
Soo-Jin
SJ
Kang
Joon-Han
JH
Shin
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D054855:Drug-Eluting Stents; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D011474:Prosthesis Design; D018570:Risk Assessment; D020123:Sirolimus / Q000008:administration & dosage*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D002317:Cardiovascular Agents; D020123:Sirolimus