title: Hemodynamic changes of fractional flow reserve after double kissing crush and provisional stenting technique for true bifurcation lesions.
abstract: BACKGROUND
  Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is associated with fewer unfavorable events. However, the hemodynamic change in FFR after different stenting approaches for bifurcation lesions is still not fully studied. The aim of this study was to analyze the hemodynamic changes in FFR after double kissing (DK) crush and provisional side branch (SB) stenting (PS) for true coronary bifurcation lesions.
  
  
  METHODS
  Seventy-five patients with true bifurcated lesions were randomly divided into DK (n = 38) and PS (n = 37) groups. Additional SB stenting in the PS group was required if there was any pinched SB ostium > 70% stenosis, or ≥ type B dissection, or TIMI flow < grade 3. FFR at hyperemia in the main vessel (MV) and SB was measured prior- and post-stenting, and at 8 months follow-up.
  
  
  RESULTS
  Baseline clinical, angiographic and lesion characteristics were matched well between the two groups, with the exception of the final kissing balloon inflation (FKBI, 100.0% in the DK vs. 83.8% in the PS group, P < 0.001). Baseline FFR was comparable between the DK and the PS groups, however, the acute gain and late loss of SB FFR at 8-month follow-up in the DK group were 0.18 ± 0.15 and -0.06 ± 0.11, compared to 0.12 ± 0.18 (P = 0.044) and -0.002 ± 0.07 (P = 0.037) in the PS group, respectively. MV FFR post-stenting > 0.94 was seen in about 40% of patients. There was no significant difference in the clinical events at 1-year follow-up between the two groups.
  
  
  CONCLUSIONS
  DK crush was associated with improved acute gain and late loss of SB FFR. The lower rate of FFR > 0.94 after stenting underscored the further improvement of stenting quality.
authors.affiliation: Department of Cardiology, Nanjing First Hospital of Nanjing Medical University, Nanjing, Jiangsu 210006, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Zhong-Sheng
authors.initials: ZS
authors.lastname: Zhu
authors.forename: Jing
authors.initials: J
authors.lastname: Kan
authors.forename: Nai-Liang
authors.initials: NL
authors.lastname: Tian
authors.forename: Song
authors.initials: S
authors.lastname: Lin
authors.forename: Zhi-Zhong
authors.initials: ZZ
authors.lastname: Liu
authors.forename: Wei
authors.initials: W
authors.lastname: You
authors.forename: Hai-Mei
authors.initials: HM
authors.lastname: Xu
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000628:therapy*; D023921:Coronary Stenosis / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult