Provisional vs Dual Stenting in Left Main: An Endless Discussion?

True left main stem bifurcation patients have shown fewer adverse events with stepwise provisional stenting vs systematic dual stenting as first strategy, even though the difference was not significant.

Stent provisional o doble stent en el tronco de la coronaria izquierda

Usually, for any other vessel, the preferred technique is provisional stenting. However, when it comes to the left main, there is a randomized, dedicated, well designed study that favored systematic dual stenting.

The EBC MAIN was carried out in 11 European countries including 467 true left main bifurcation patients (Medina 1.1.1 or 0.1.1). Patients were randomized to provisional stenting (n=230) or systematic dual stenting (n=237). 

Primary end point was a combination of death, MI and target vessel revascularization at 12 months and happened in 14.7% in the provisional stenting group vs 17.7% in the dual stenting group (HR 0.8, CI 95% 0.5 to 1.3; p=0.34).

Secondary end points produced the following results: death 3.0% SP vs 4.2% DS (p=0.48); MI 10% SP vs 10.1% DS (p=0.91); TV revascularization 6.1% SP vs 9.3% DS (p=0.16) and stent thrombosis 1.7% SP vs 1.3% DS (p=0.9). 

Procedural time, x-ray dose and materials were in favor of PS. 


Read also: TAVR vs Sutureless Surgical Aortic Valve Replacement in Low-Risk Patients.


Symptom improvement was excellent and identical in both groups. 

Conclusion

True left main stem bifurcation patients benefited from provisional stenting, though the difference did not reach statistical significance. The default strategy to treat the left main should continue to be provisional stenting. 

ehab283

Original Title: The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN).

Reference: David Hildick-Smith et al. Eur Heart J. 2021 Oct 1;42(37):3829-3839. doi: 10.1093/eurheartj/ehab283.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Andromeda Trial: Meta-Analysis of Drug Coated Balloon vs. DES in Small Vessel DeNovo Lesions

The use of coronary stents vs plain old balloon angioplasty (POBA), has allowed to reduce recoil and limiting flow dissection which were major limitation...

QFR vs. FFR: Is Coronary Revascularization Deferral Safe? Results from a FAVOR III Sub-Analysis

In cases of intermediate coronary lesions, functional assessment is recommended to aid the decision-making process regarding revascularization. There are several tools currently used to...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...