Approach to coronary bifurcation lesions using the everolimus-eluting stent: comparison between a simple strategy and a complex strategy with T-stenting.

Autor: Ruiz-Salmerón RJ; Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain. Electronic address: rjruizsalmeron@yahoo.es., Valenzuela LF; Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain., Pérez I; Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain., Fuentes M; Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain., Rodríguez-Leiras S; Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain., Vizcaíno M; Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain., Carrascosa C; Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain., Marcos F; Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain.
Jazyk: angličtina
Zdroj: Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2013 Aug; Vol. 66 (8), pp. 636-43. Date of Electronic Publication: 2013 Jun 06.
DOI: 10.1016/j.rec.2013.03.005
Abstrakt: Introduction and Objectives: 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.
(Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)
Databáze: MEDLINE
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