title: Culotte stenting vs. TAP stenting for treatment of de-novo coronary bifurcation lesions with the need for side-branch stenting: the Bifurcations Bad Krozingen (BBK) II angiographic trial.
abstract: In percutaneous coronary intervention for de-novo coronary bifurcation lesions, the optimal technique for provisional side-branch stenting is still a matter of debate. We tested whether in this setting culotte stenting reduces the incidence of restenosis as compared with T-and-protrusion (TAP) stenting.
  
  
  
  This trial included 300 patients with a coronary bifurcation lesion requiring a side-branch stent. Patients were randomly assigned to culotte stenting or TAP stenting using drug-eluting stents in a 1:1 fashion. Primary endpoint was maximal per cent diameter stenosis of the bifurcation lesion at 9-month angiographic follow-up. As clinical endpoints we assessed target lesion re-intervention (TLR) and target lesion failure (composite of cardiac death, target vessel myocardial infarction, and TLR).Angiographic follow-up was available in 91% of the patients. After culotte stenting, the maximum per cent diameter stenosis in the treated bifurcation lesion was 21 ± 20% as compared with 27 ± 25% after TAP stenting (P = 0.038). The respective corresponding binary restenosis rates were 6.5 and 17% (P = 0.006). The 1-year incidence of TLR was 6.0% after culotte stenting vs. 12.0% after T-stenting (P = 0.069). Target lesion failure occurred in 6.7% of the culotte group and in 12.0% of the TAP group (P = 0.11). Only one patient of the culotte group incurred a definite stent thrombosis during 1-year follow-up.
  
  
  
  Compared with the TAP stenting, culotte stenting was associated with a significantly lower incidence of angiographic restenosis.
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany miroslawferenc@aol.com.
authors: Miroslaw
authors: M
authors: Ferenc
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Michael
authors: M
authors: Gick
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Thomas
authors: T
authors: Comberg
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Jürgen
authors: J
authors: Rothe
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Christian
authors: C
authors: Valina
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Aurel
authors: A
authors: Toma
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Nikolaus
authors: N
authors: Löffelhardt
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Willibald
authors: W
authors: Hochholzer
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Florian
authors: F
authors: Riede
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Rolf-Peter
authors: RP
authors: Kienzle
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Amar
authors: A
authors: Achtari
authors: The Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors: Franz-Josef
authors: FJ
authors: Neumann
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease; D023903:Coronary Restenosis; D054855:Drug-Eluting Stents; D006801:Humans; D020123:Sirolimus; D016896:Treatment Outcome
chemical_list: D020123:Sirolimus
keywords: Bifurcations ; Coronary disease ; Culotte stenting ; Drug-eluting stents ; Restenosis; TAP stenting 