A randomized trial of bifurcation stenting technique in chronic total occlusions percutaneous coronary intervention
| Autor: | Alexey Biryukov, Dmitriy D. Zubarev, Marouane Boukhris, Evgeniy I. Kretov, Kambis Mashayekhi, Vladimir V. Verin, Alfredo R. Galassi, Vitaly Baystrukov, Alexey A. Prokhorikhin, Alexander Bogachev-Prokophiev, Alexander G. Osiev, Ivan A. Naryshkin, Hatem Najjar, Igor O. Grazhdankin |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Target vessel revascularization Target vessel T-provisional 030204 cardiovascular system & hematology bifurcation chronic total occlusion mini-crush Cardiology and Cardiovascular Medicine law.invention 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Randomized controlled trial law Internal medicine Myocardial Revascularization medicine Humans 030212 general & internal medicine Myocardial infarction Stroke Aged business.industry Percutaneous coronary intervention General Medicine Middle Aged medicine.disease Coronary Occlusion Cardiovascular Diseases Coronary occlusion Chronic Disease Conventional PCI Cardiology Female Stents business |
| Popis: | BACKGROUND The optimal strategy to treat bifurcation lesions (BFLs) in a percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) remains unknown. AIMS We sought to assess whether T-provisional or mini-crush is appropriate for BFLs within CTO vessels. PATIENTS AND METHODS From January 2011 to December 2013, patients who underwent successful CTO guidewire crossing and with a BFL within the CTO target vessel were enrolled prospectively and assigned randomly to either T-provisional stenting or the mini-crush technique for BFL treatment. One-year clinical follow-up was performed. Major adverse cardiac and cerebrovascular events (MACCE) were defined as the composite of cardiovascular death, myocardial infarction, target vessel revascularization, and stroke. RESULTS The prevalence of BFLs was 54.3%. A total of 146 patients with BFLs within CTO vessel were enrolled prospectively and assigned randomly to either T-provisional stenting (N=73) or the mini-crush technique (N=73). Angiographic and clinical success rates were similar in the two groups: 91.8 versus 97.2% (P=0.27) and 91.8 versus 94.5% (P=0.67), respectively.Although T-provisional stenting was associated with a nonsignificantly lower incidence of MACCE in case of BFLs located far from the CTO (9.3 vs. 22.2%; P=0.426), the mini-crush technique resulted in higher MACCE-free survival at 1 year in the presence of BFLs within the CTO body or close to the proximal or the distal cap (89.1 vs. 64.9%; P=0.007). CONCLUSION The mini-crush technique appeared to be associated with improved 1-year clinical and angiographic outcomes, particularly when used to treat BFLs located within the CTO body or close to the proximal or the distal cap. |
| Databáze: | OpenAIRE |
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