Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study.
BACKGROUND
In a number of coronary bifurcation lesions, both the main vessel and the side branch need stent coverage. Using sirolimus eluting stents, we compared 2 dedicated bifurcation stent techniques, the crush and the culotte techniques in a randomized trial with separate clinical and angiographic end-points.


RESULTS
A total of 424 patients with a bifurcation lesion were randomized to crush (n=209) and culotte (n=215) stenting. The primary end point was major adverse cardiac events; cardiac death, myocardial infarction, target vessel revascularization, or stent thrombosis after 6 months. At 6 months there were no significant differences in major adverse cardiac event rates between the groups; crush 4.3%, culotte 3.7% (P=0.87). Procedure and fluoroscopy times and contrast volumes were similar in the 2 groups. The rates of procedure-related increase in biomarkers of myocardial injury were 15.5% in crush versus 8.8% in culotte group (P=0.08). A total of 324 patients had a quantitative coronary assessment at the index procedure and after 8 months. The angiographic end-points of in-segment and in-stent restenosis of main vessel and/or side branch after 8 months were found in 12.1% versus 6.6% (P=0.10) and in 10.5% versus 4.5% (P=0.046) in the crush and culotte groups, respectively.


CONCLUSIONS
Both the crush and the culotte bifurcation stenting techniques were associated with similar and excellent clinical and angiographic results. Angiographically, there was a trend toward less in-segment restenosis and significantly reduced in-stent restenosis following culotte stenting.
Erglis
Andrejs
A
Latvian Centre of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia. a.a.erglis@stradini.lv
Kumsars
Indulis
I
Niemelä
Matti
M
Kervinen
Kari
K
Maeng
Michael
M
Lassen
Jens F
JF
Gunnes
Pål
P
Stavnes
Sindre
S
Jensen
Jan S
JS
Galløe
Anders
A
Narbute
Inga
I
Sondore
Dace
D
Mäkikallio
Timo
T
Ylitalo
Kari
K
Christiansen
Evald H
EH
Ravkilde
Jan
J
Steigen
Terje K
TK
Mannsverk
Jan
J
Thayssen
Per
P
Hansen
Knud Nørregaard
KN
Syvänne
Mikko
M
Helqvist
Steffen
S
Kjell
Nikus
N
Wiseth
Rune
R
Aarøe
Jens
J
Puhakka
Mikko
M
Thuesen
Leif
L
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D003718:Denmark / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007844:Latvia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009664:Norway / Q000453:epidemiology; D011474:Prosthesis Design; D020123:Sirolimus / Q000008:administration & dosage*; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D002317:Cardiovascular Agents; D020123:Sirolimus