Original title: Dedicated two-stents technique in complex bifurcation percutaneous coronary intervention with use of everolimus-eluting stents: The EES-bifurction study. Reference: Nisharamed I. Kherada, et al. International Journal of Cardiology 2014;174:13-17

Bifurcation PCI, especially 1.1.1 Medina bifurcation lesions PCI, is particularly challenging and has been associated with increased restenosis. The use of drug eluting stents (DES) associated to better outcomes have resulted in the use of one stent strategies whenever possible. 

From 319 patients undergoing PCI with everolimus eluting stent (EES) for true bifurcation lesions, 175 (54.8%) received the one-stent (1S) strategy and 144 (45.2%) the two stent (2S) strategy. Primary end point was MACE (the composite of death, infarction and target vessel revascularization) at twelve months.

Baseline characteristics were similar, most patients presented stable chronic angina. Syntax score was

There were no differences in calcification, ulceration or tortuosity. Side branch dilatation, the use of rotational atherectomy and final kissing balloon were more frequent in the 2S strategy group.  The most frequent stent implantation technique was simultaneous kissing stent. 

Quantitative angiography showed similar bifurcation angulation in both groups. The 2S strategy group saw lower residual stenosis, larger minimal lumen diameter and greater acute post procedural benefit. In hospital evolution was similar in both groups. 

At 12 months, primary end point was similar in both groups (18.3% for 1S and 13.2% for 2S). There was no difference in death (2.3% vs 2.1%), infarction (12.2% vs 7.8%), target lesion revascularization (4.8% vs 5.9%) or target vessel revascularization (7.4% vs 5.8%).

Conclusion

True bifurcation PCI with EES was associated with a better angiographic outcome of the side branches with no major complications or ischemic events at 12 months.

Comment

This analysis is not conclusive as to what bifurcation lesions will benefit from dedicated 2 EES strategy, improving efficacy and safety and reducing contrast with a better angiographic result. 

The observed angiographic benefit may have resulted from the combination of new stent technology and greater interventional expertise. Bifurcation PCI still requires further analysis. 

Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation
Buenos Aires, Argentina

Dr. Carlos Fava para SOLACI.ORG