title: Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study.
abstract: 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.
authors.affiliation: Latvian Centre of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia. a.a.erglis@stradini.lv
authors.forename: Andrejs
authors.initials: A
authors.lastname: Erglis
authors.forename: Indulis
authors.initials: I
authors.lastname: Kumsars
authors.forename: Matti
authors.initials: M
authors.lastname: Niemelä
authors.forename: Kari
authors.initials: K
authors.lastname: Kervinen
authors.forename: Michael
authors.initials: M
authors.lastname: Maeng
authors.forename: Jens F
authors.initials: JF
authors.lastname: Lassen
authors.forename: Pål
authors.initials: P
authors.lastname: Gunnes
authors.forename: Sindre
authors.initials: S
authors.lastname: Stavnes
authors.forename: Jan S
authors.initials: JS
authors.lastname: Jensen
authors.forename: Anders
authors.initials: A
authors.lastname: Galløe
authors.forename: Inga
authors.initials: I
authors.lastname: Narbute
authors.forename: Dace
authors.initials: D
authors.lastname: Sondore
authors.forename: Timo
authors.initials: T
authors.lastname: Mäkikallio
authors.forename: Kari
authors.initials: K
authors.lastname: Ylitalo
authors.forename: Evald H
authors.initials: EH
authors.lastname: Christiansen
authors.forename: Jan
authors.initials: J
authors.lastname: Ravkilde
authors.forename: Terje K
authors.initials: TK
authors.lastname: Steigen
authors.forename: Jan
authors.initials: J
authors.lastname: Mannsverk
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
authors.forename: Knud Nørregaard
authors.initials: KN
authors.lastname: Hansen
authors.forename: Mikko
authors.initials: M
authors.lastname: Syvänne
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
authors.forename: Nikus
authors.initials: N
authors.lastname: Kjell
authors.forename: Rune
authors.initials: R
authors.lastname: Wiseth
authors.forename: Jens
authors.initials: J
authors.lastname: Aarøe
authors.forename: Mikko
authors.initials: M
authors.lastname: Puhakka
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
mesh_terms: 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
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D020123:Sirolimus