Abstract 18561: Late Restenosis After Treatment of Bifurcation Lesions Using the Two-stent Strategy

Abstract

Purpose: The purpose of this study was to evaluate serial angiographic outcomes in patients with bifurcation lesions that were treated with two DESs. Methods: From June 2004 to December 2010, 492 consecutive bifurcation lesions were treated with two DESs. We treated 217 lesions using a sirolimus-eluting stent (SES); 58 using a zotarolimus-eluting stent (ZES); 44 using a biolimus-eluting stent (BES); 40 using a everolimus-eluting stent (EES); 19 using a paclitaxel-eluting stent (PES); 66 with SES+BES; 30 with SES+PES; 7 with SES+ZES; 6 with EES+ZES. The bifurcation lesions were located in the left anterior descending coronary artery/diagonal branch (LAD/D) in 178 lesions, left main distal bifurcation (LM) in 192 lesions, left circumflex coronary artery/obtuse marginal branch (LCX/OM) in 65 lesions and right coronary artery (RCA) distal bifurcation in 57 lesions. The T-stenting technique was used to treat 251 bifurcation lesions, and the culotte stenting technique was used to treat 241 lesions. Angiographic follow-up was performed routinely 8 and 20 months after a successful procedure. Angiographic outcomes were compared between the T-stenting technique and the culotte stenting technique. Results: Of 492 lesions, 407 (83%) underwent 8-month follow-up angiography. The incidence of binary restenosis at 8-month follow-up was 22.8% (45/197) for the culotte stenting technique and 19.5% (41/210) for the T-stenting technique (p=0.5). The incidence of target lesion revascularization at 8-month follow-up was 12.2% (24/197) for the culotte stenting technique and 11.0% (23/210) for the T-stenting technique (p=0.8). Twenty-month follow-up angiography was performed in 297 lesions (78% of lesions without restenosis at 8-month follow-up angiography). Late restenosis was observed in 17 lesions (11%) with the T-stenting technique and in 5 lesions (3%) with the culotte stenting technique (p=0.014). The incidence of target lesion revascularization at 20-month follow-up was 1.4% (2/145) for the culotte stenting technique and 6.7% (10/152) for the T-stenting technique (p=0.035). Conclusions: The stenting technique affects the outcomes in patients with bifurcation lesions that are treated with two DESs.