[Clinical and angiographic outcomes after implantation of drug-eluting stents in bifurcation lesions with the crush stent technique].
The most common approach in the treatment of bifurcation lesions is stenting only the main branch (MB) with provisional T-stenting of the side branch (SB). However, some bifurcation lesions may have extensive disease within a large SB requiring stenting of this vessel. The "crush" technique, which has been proposed as an alternative approach to other strategies to treat complex bifurcations, is a relatively simple technique that ensures complete coverage of the SB ostium. Previous series have reported its safety and feasibility, but limited data are available about the long-term outcomes. We report our experience on 21 consecutive patients (pts) treated with the "crush" technique with drug-eluting stents (DES) between November 2005 and March 2007. Clinical follow-up was 18+/-7 months for 19 pts (90%), and angiographic follow-up was completed in 66% of pts (N=14), at a mean time of 8.5+/-4 months. Mean pt age was 70+/-11 years; 33% (N=7) had diabetes mellitus, and mean preoperative logistic EUROSCORE predicted 11% mortality rate. The left anterior descending artery/diagonal and the distal left main were the most frequent bifurcation locations (52 and 43% of cases respectively), with a type 1,1,1 of the Medina classification of bifurcation lesions in 62% of pts, and an angulation MB-SB below 50 degrees in 66% of cases. Final kissing balloon dilation was performed in 90% of pts (N=20). Stent diameter and length were similar between MB and SB. The procedure was successfull in 100% of cases in the MB and 95% of cases in the SB. Procedure-related CK elevation above 2 ULN was seen in two pts (9.5%), without ECG modification. One pt had subacute stent thrombosis 5 days after his procedure. At the end of follow-up, target vessel revascularization (TVR) was required in four pts (19%), and target lesion revascularisation (TLR) in three pts (14%) whom had focal restenosis in the SB ostium (one pt) and in the MB and SB ostia (one pt). Sudden death occurred in one pt 14 months after his procedure. In conclusion, when an effective strategy for stenting both branches is planned, the "crush" technique with final kissing balloon can be safely used by experienced operators to treat complex bifurcation lesions with DES. The safety profile and TLR rate in our small series of "crush" stenting were similar to that of other studies reported thus far.
Cohen
R
R
Service de cardiologie, centre hospitalier de Lagny-Marne-la-Vallée, 31, avenue du Général-Leclerc, 77000 Lagny-sur-Marne, France. remycohen@hotmail.com
Foucher
R
R
Sfaxi
A
A
Hakim
M
M
Domniez
T
T
Elhadad
S
S
D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome