Approach to coronary bifurcation lesions using the everolimus-eluting stent: comparison between a simple strategy and a complex strategy with T-stenting.
OBJECTIVE
Coronary bifurcation lesions can be approached using a simple or a complex strategy. In clinical trials with first-generation drug-eluting stents, the complex strategy was not superior to the simple approach. However, to date, the best strategy when using second-generation drug-eluting stents has not been defined.


METHODS
We performed a prospective randomized study comparing a simple vs a complex strategy involving T-stenting for the percutaneous revascularization of bifurcation lesions using the everolimus-eluting stent. Angiographic and clinical follow-up were performed at 9 months.


RESULTS
We included 70 lesions in 69 patients, who were randomized to the simple (34 lesions, 33 patients) or complex strategy (36 lesions and patients). In all, 85.6% of the lesions included were true bifurcations. The crossover rate was 17.1%. The binary restenosis rate was 12.1%, with no differences between the groups. Side branch restenosis tended to be higher with the simple strategy in the intention to treat analysis (10.7% vs 0%) but not in the per protocol analysis (5.9% vs 4.2%). The incidence of major adverse cardiac events (cardiac death, myocardial infarction, and target vessel revascularization) was 9.2%, with no differences between groups. There were no cases of stent thrombosis.


CONCLUSIONS
According to the clinical and angiographic findings, the complex strategy was not significantly superior to the simple approach in the revascularization of bifurcation lesions with second-generation everolimus-drug eluting stents.
Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain. Electronic address: rjruizsalmeron@yahoo.es.
Rafael J
RJ
Ruiz-Salmerón
Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain.
Luis F
LF
Valenzuela
Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain.
Inés
I
Pérez
Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain.
Marco
M
Fuentes
Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain.
Sergio
S
Rodríguez-Leiras
Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain.
Manuel
M
Vizcaíno
Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain.
César
C
Carrascosa
Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain.
Francisco
F
Marcos
D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000628:therapy*; D023903:Coronary Restenosis; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus
Angioplastia coronaria; Coronary angioplasty; DES; EES; Revascularización; Revascularization; Stent; drug-eluting stent; everolimus-eluting stent