title: COmplex coronary Bifurcation lesions: RAndomized comparison of a strategy using a dedicated self-expanding biolimus-eluting stent versus a culotte strategy using everolimus-eluting stents: primary results of the COBRA trial.
abstract: OBJECTIVE
  We aimed to compare healing responses with optical coherence tomography, and clinical and angiographic outcome after treatment of coronary bifurcation lesions with a dedicated stent versus a conventional culotte technique.
  
  
  RESULTS
  Forty patients with true and complex coronary bifurcation lesions were randomly assigned to treatment with the Axxess™ bifurcation stent in the proximal main vessel (MV) and additional BioMatrix™ stents in the branches (Biosensors Europe SA, Morges, Switzerland), versus a culotte technique using XIENCE™ stents (Abbott Vascular, Santa Clara, CA, USA). The primary endpoint of percentage of uncovered struts at nine months was similar with the dedicated strategy vs. culotte in the proximal MV (median 17.8 [IQR 3.3-24.7] vs. 6.8 [2.0-20.5]; p=0.19), bifurcation core (9.5 [5.7-19.5] vs. 4.0 [0.7-17.6]; p=0.17), distal MV (2.6 [2.3-18] vs. 2.2 [0.5-6.0]; p=0.09) and side branch (5.7 [1.5-11.5] vs. 1.9 [0-5.8]; p=0.14). As compared with culotte, a strategy using Axxess resulted in a significantly larger lumen in the proximal MV both acutely (minimum lumen diameter 3.03±0.51 vs. 2.71±0.44 mm, p=0.04) and at follow-up (mean lumen area 10.0±2.1 vs. 7.1±1.8 mm2, p<0.001), and in a lower angiographic late lumen loss (p=0.05). Both strategies resulted in good clinical outcomes at one year, and no stent thromboses.
  
  
  CONCLUSIONS
  As compared with a culotte strategy with XIENCE stents, complex bifurcation stenting using a dedicated strategy combining Axxess and BioMatrix stents results in similar stent strut coverage at nine-month follow-up, and a significantly larger lumen and lower angiographic late lumen loss in the proximal MV.
authors.affiliation: Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Dubois
authors.forename: Johan
authors.initials: J
authors.lastname: Bennett
authors.forename: Joseph
authors.initials: J
authors.lastname: Dens
authors.forename: Dries
authors.initials: D
authors.lastname: De Cock
authors.forename: Walter
authors.initials: W
authors.lastname: Desmet
authors.forename: Ann
authors.initials: A
authors.lastname: Belmans
authors.forename: Giovanni J
authors.initials: GJ
authors.lastname: Ughi
authors.forename: Peter
authors.initials: P
authors.lastname: Sinnaeve
authors.forename: Mathias
authors.initials: M
authors.lastname: Vrolix
authors.forename: Jan
authors.initials: J
authors.lastname: D'hooge
authors.forename: Tom
authors.initials: T
authors.lastname: Adriaenssens
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D020123:Sirolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus