Clinical outcome of treatment with or without a final kissing balloon technique for bifurcation in-stent restenosis lesions.
BACKGROUND
The treatment strategy for in-stent restenosis (ISR) with bifurcation lesions has not been well explored. We examined the clinical outcomes between final kissing balloon technique (FKBT) after stent implantation and single-stent implantation without FKBT for bifurcation ISR lesions.


METHODS
We identified 115 consecutive ISR with bifurcation lesions among 108 patients who underwent drug-eluting stent implantation. The patients were divided into the FKBT group (34 patients, 35 lesions) and the non-FKBT group (74 patients, 80 lesions).


RESULTS
Thrombolysis in myocardial infarction flow grade of side branch was significantly greater in the patients with FKBT than those without FKBT after coronary intervention (2.80±0.46 vs. 2.65±0.68, p=0.04), but this difference was attenuated and was no longer statistically significant at the time of follow-up (2.80±0.48 vs. 2.80±0.60, p=0.97). During a mean follow-up of 47.8±23.6 months, there were no significant differences in the incidence of major adverse cardiac events (MACE). In multivariate analysis, estimated glomerular filtration rate (hazard ratio: 0.96, 95% confidence interval: 0.92-0.99, p=0.02) was an independent predictor of MACE. Contrast volume (170.71±47.17ml vs. 136.46±55.56ml, p=0.002) and radiation dose (1.44±1.65Gy vs. 0.96±0.46Gy, p=0.02) were significantly higher in the FKBT group than in the non-FKBT group.


CONCLUSIONS
Single-stent implantation without FKBT may be a sufficient treatment strategy for bifurcation ISR lesions.
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan. Electronic address: takayuki.yabe@med.toho-u.ac.jp.
Takayuki
T
Yabe
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Mikihoto
M
Toda
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Rine
R
Nakanishi
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Daiga
D
Saito
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Ippei
I
Watanabe
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Ryo
R
Okubo
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Hideo
H
Amano
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Takanori
T
Ikeda
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D016896:Treatment Outcome
Bifurcation; Drug-eluting stent; In-stent restenosis; Percutaneous coronary intervention