EUROPCR 2019 - Stenting for Bifurcation Leisons
CBSMD

Treatment of Coronary bifurcation DKCRUSH-II 5 years

OBJECTIVE - to report the clinical outcomes of double kissing crush (DK crush) vs provisional stenting (PS) of coronary bifurcation lesions

STUDY DESIGN - multicenter randomized trail

POPULATION - symptomatic patients with Medina 1,1,1 or 0,1,1 bifurcation lesions

RESULTS - MACE at 5 years 15.7% for DK crush group and 23.8% for PS group, HR =1.67 (95% CI ; 0.99 -2.83), p= 0.051

CONCLUSION - the DK crush technique is associated with a lower 5-year MACE rate as compared to provisional stenting for treatment of bifurcation lesions.

Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left Main Bifurcation Lesions: The 3-Year Follow-Up Results of

the DKCRUSH-III Study

OBJECTIVE - to report the differences in clinical outcomes of treatment of distal left main bifurcation lesions with double kissing crush vs culotte stenting technique

STUDY DESIGN - prospective multicenter randomized study

POPULATION - patients with distal left main bifurcation Medina 1,1,1 or 0,1,1

ENDPOINTS - MACE as composite of cardiac death, MI or TVR at 3 years.

RESULTS - MACE rate at 3 year: 8.2% for DK crush stenting vs. 23.7% for culotte stenting

CONCLUSION - DK crush stenting for distal left main bifurcation lesions is associated with better 3-year clinical outcome than culotte stenting.

Double Kssing Crush vs. provisional stenting for left main bifurcations : DKCRUSH-V

OBJECTIVE - to determine whether DK crush - 2 stent technique is superior to PS for treatment of bifurcation lesions

STUDY DESIGN - prospective, randomized international multicenter trail

POPULATION - symptomatic patients (stable, unstable AMI > 24h) with left main bifurcation lesions (Medina 1,1,1 or 0,1,1)

ENDPOINTS - target lesion failure: cardiac death, TV-MI or clinical TLR at 12 months

RESULTS -  TLR at 1-year: 5.0% for DK crush group vs. 10.7% for PS group, HR = 0.42, 95% CI 0.21 - 0.85, p=0.02

CONCLUSION - a planned DK crush - 2 stent technique was superior to provisional stenting for the treatment of left main bifurcation lesions.

Bifurcation stent vs provisional stenting for bifurcation lesions: TRYTON

OBJECTIVE - to compare the outcome of a dedicated bifurcation stent ( TRYTON Medical) with side-branch balloon angioplasty with DES for treatment of left main bifurcation lesions

STUDY DESIGN - single blind, multicenter, randomized trial - non-inferiority with margin 5.5%

POPULATION - patients with de novo true left main bifurcation lesion

ENDPOINTS - TVF: cardiac death, MI, clinical driven TVR (MB or SB) at 9 months

RESULTS - TVF at 9-months 17.4% for TRYTON group vs. 12.8% for provisional group, p_{non-inferiority}= 0.42 (not within 5.5% margin), p=0.11_; SB in-segment diameter restenosis at 9 months, 31.6% for TRYTON vs. 38.6% for provisional group, p=0.002

CONCLUSION - provisional stenting is preferred strategy over TRYTON for treatment of left main bifurcation lesions.

Provisional T- stenting vs routine T-stenting: BBK-1 5 years

OBJECTIVE - to compare the 5-year clincial outcome of treatment of de novo bifurcation lesions with provisional T-stenting as compared with routine T-stenting

STUDY DESIGN - multicenter randomized trial

POPULATION - patients with de novo bifurcation lesions

ENDPOINTS - incidence of target lesion revascularization at 5 years

RESULTS - TLR at 5-year 16.2% for provisional T- stenting vs 16.3% for routine T-stenting, p=0.97

CONCLUSION - the 5-year TLR rate was similar using provisional T- stenting compared to routine T-stenting for de novo left main bifurcation lesions.

Bifurcation lesions: SMART-STRATEGY 3 years

OBJECTIVE - to report the 3-year clinical outcome of a conservative strategy compared to aggressive strategies for provisional side branch intervention

STUDY DESIGN - non-blinded, single center, randomized trial

POPULATION -patients with stable angina or NSTEMI and large de novo bifurcation lesion

ENDPOINTS - TVF as composite cardiac death, MI or TVR at 3-years

RESULTS - TVF at 3-year 11.7% for conservative strategy vs 20.8% for aggressive strategy, p=0.049

CONCLUSION - a conservative strategy for provisional SB intervention is associated with better 3-year outcome compared to an aggressive strategy.

Bifurcation lesion treatment : EBC Two Study

OBJECTIVE - to compare a provisional strategy with a systematic 2-stent technique for percutanous treatment of true bifurcation lesions with significant large sized ostial disease length side branches

STUDY DESIGN - multicenter randomized control study

POPULATION - symptomatic patients with true bifurcation lesions: SB diameter

≥ 2.5mm, ostial disase length ≥ 5mm

ENDPOINTS - composite of death, MI and TVR at 12 months

RESULTS - Primary endpoint at 12 months 7.7% for provisional group vs 10.3% for 2-stent technique,  HR=1.02, 95% CI 0.78-1.34, p=0.53

CONCLUSION - the composite death, MI and TVR at 12 months is not different between provisional stenting and 2-stent technique for treatment of true bifurcation leisons.