title: Immediate and long-term results of a modified simultaneous kissing stenting for percutaneous coronary intervention of coronary artery bifurcation lesions.
abstract: OBJECTIVE
  We propose a modified simultaneous kissing stenting technique (MSKS) based on systematic implantation of a protective stent in the proximal main vessel (PMV) proximally to the bifurcation before simultaneous kissing stenting (SKS).
  
  
  BACKGROUND
  SKS has been proposed in large-size coronary vessel bifurcation lesions (BLs) when the PMV can accommodate two stents. SKS implies, however, low-pressure simultaneous final balloon inflations to avoid retrograde PMV dissection or rupture and therefore may not ensure optimal final stent apposition.
  
  
  METHODS
  From January 2005 to May 2008, a total of 97 patients with 100 BLs (true bifurcation in 92%) who underwent MSKS were enrolled in a prospective registry. Drug-eluting stents were used for distal main vessel and side branch. Drug-eluting or large-size bare-metal stents were used as proximal protective stents.
  
  
  RESULTS
  Immediate procedural success rate was 100%. Global restenosis rate was 10% (5% in the main vessel and 8% in the side branch) at follow-up angiogram performed at 7 months in all patients (100%). No patient had early or late stent thrombosis. Two cases of non-fatal very late stent thrombosis occurred at 46 and 64 months. Over a mean 4.5-year follow-up period, target lesion revascularization rate was 11%, with only 3% driven by clinical ischemia.
  
  
  CONCLUSIONS
  Protective stent systematic implantation in the PMV represents a newly modified SKS technique that allows safe finalization of the procedure by high-pressure kissing balloon final inflation, ensuring optimal stent apposition with high immediate procedural success and low rates of long-term events.
authors.affiliation: Division of Cardiology, University of Saint Etienne, Saint Etienne, France. isaaz@univ-st-etienne.fr
authors.forename: Karl
authors.initials: K
authors.lastname: Isaaz
authors.forename: Sandrine
authors.initials: S
authors.lastname: Bayle
authors.forename: Michel
authors.initials: M
authors.lastname: Lamaud
authors.forename: Christophe
authors.initials: C
authors.lastname: Robin
authors.forename: Alexis
authors.initials: A
authors.lastname: Cerisier
authors.forename: Norbert
authors.initials: N
authors.lastname: Mayaud
authors.forename: Laure
authors.initials: L
authors.lastname: Richard
authors.forename: Mohamed Hassan
authors.initials: MH
authors.lastname: Sabry
authors.forename: Hazem
authors.initials: H
authors.lastname: Khamis
authors.forename: Ahmad
authors.initials: A
authors.lastname: Abd-Alaziz
authors.forename: Antoine
authors.initials: A
authors.lastname: Da Costa
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008670:Metals; D008875:Middle Aged; D017239:Paclitaxel; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus