The prevalence of coronary lesions with bifurcation involvement is about 20% in patients undergoing coronary angiography (CTA). While provisional stenting is overall the most accepted technique, the 2018 myocardial revascularization guidelines recommend the 2-stent technique for complex bifurcation lesions, defined as side branch with lesion >5mm, distal reference diameter of the side branch ≥2.75, or…
EuroPCR 2021 | EBC MAIN: Provisional Stenting vs. Systematic Dual Stenting in Left Main Coronary Artery
Treating the left main coronary artery with provisional stenting was non-inferior to systematic dual stenting in the EBC MAIN trial, presented at EuroPCR 2021 and simultaneously published in the European Heart Journal. The composite primary endpoint of death, infarction, and target-lesion revascularization was 14.7% for provisional stenting vs. 17.7% for systematic dual stenting (hazard ratio:…
The Era of Provisional Stenting for Bifurcations Comes to an End
After the large studies which set provisional stenting as the preferred strategy to treat bifurcations comes the double kissing crush technique (DK crush) to break the mold once again. This time, the DK crush technique is tested against provisional stenting in the left main, with a 3-year follow-up. The DKCRUSH-V, soon to be published in…
DKCRUSH-V: What Is Simple Is Not Always Best for the Left Main Coronary Artery
Courtesy of the SBHCI. Angioplasty of true distal left main bifurcation lesions with a double-kissing (DK) crush two-stent strategy, compared with provisional stenting, results in lower rates of target lesion failure at 1 year. These findings were largely driven by lower rates of target vessel infarction and definite/probable stent thrombosis. Read also: “EXCEL-QOL Substudy: Similar Quality…
Double Kissing Crush vs. Provisional Stenting at 5 Years
Courtesy of Dr. Guillermo Migliaro. The Provisional Stenting technique (PS) consists of sequentially placing a stent in the main branch of the bifurcation and, only when faced with a suboptimal outcome (such as < 3 TIMI flow, flow limiting dissection or high residual stenosis), a second stent in the side branch. Several studies have shown…
Optimal Strategy for Side Branch Intervention in Bifurcations
Original Title: Optimal Strategy for Provisional Side Branch Intervention in Coronary Bifurcation Lesions. 3 – Year Outcomes of the SMART – STRATEGY Randomized Trial. Reference: Song YB et al. J Am Coll Cardiol Intv 2016;9:517-26. Courtesy of Dr. José A. G. Álvarez. The present publication is about the three year follow up outcomes of…