Double DES in bifurcations, double thrombosis risk

Original title: Late Thrombosis After Double Versus Single Drug-Eluting Stent in the Treatment of Coronary Bifurcations A Meta-analysis of Randomized and Observational Studies. Reference: Marco Zimarino et al. J Am Coll Cardiol Intv 2013. Article in press.

In the era of drug-eluting stents, (DES), several randomized and observational studies have been conducted trying to find the best strategy to deal with a bifurcation. Since most of the individual studies failed to arrive at any definitive conclusions, meta-analyzes were performed to understand the association between a double drug-eluting stent technique at a bifurcation and an increased risk of stroke but the mechanisms behind this risk were not clear.

The hypothesis of this study is that the increased risk on events using a double stent would be related to the increased rate of thrombosis. Twelve studies, (five randomized trials and seven observational), were analyzed in this meta-analysis with a total of 6,961 patients, of whom 1,868 received DES and 5,093 one single DES to treat bifurcation lesions. 

The double DES group had a higher risk of thrombosis compared with the single DES group, (RR 2.31, 95% CI, 1.33 to 4.03). This significantly increased the risk of thrombosis according primarily to observational studies, while randomized studies only showed a trend in this direction. There was also an increased risk of stroke in the double stent group, (RR 1.86, 95% CI, 1.34 to 2.35), and this significant difference was observed in all jobs. Despite the above, the all-cause mortality was similar to target vessel revascularization

Conclusion: 

Routinely, two DES implants to treat a bifurcation is associated with an increased risk of myocardial infarction compared with the technique of a single stent in the main vessel and a provisional stent in the accessory vessel. The higher incidence of infarction appears to be related to increased thrombosis. 

Comment: 

With bifurcations, as ever, the conclusion is again less is more. The second stent should always be implemented taking into account that we are doubling the chance of thrombosis and also doubling the chance of restenosis. If it is necessary, we must consider a more aggressive platelet aggregation

SOLACI.ORG

More articles by this author

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....