Angiographic fate of side branch dissections in bifurcation lesions treated with a provisional single stenting strategy: A post‐hoc analysis of the international multicenter randomized DEBIUT study

Abstract

The provisional single stenting strategy is currently the preferred treatment strategy in bifurcation lesions. However, in case of nonflow limiting side branch (SB) dissections, it is not clear whether outcomes may be inferior to coronaries without a SB dissection, whether it can be safe to leave a SB dissection untreated, and whether bail-out SB stenting provides benefits over conservative treatment. Bifurcation lesions treated with a provisional single stenting in the randomized DEBIUT were screened according to the presence or absence of SB dissections. Additional treatment (with possible stent implantation) or conservative management was left to the discretion of the operator. Out of the 117 lesions included, 18 (15.4%) angiographic SB dissections were seen following intervention (type A = 3, B = 7, C = 6, D/E = 2), 9 (50%) were treated with additional stenting, while 9 (50%) were left untreated. At 6-month follow up, all dissections that were left untreated were healed. The late-luminal loss was similar (P = 0.33) between patients without dissection (0.11 mm [-0.22 to 0.43 mm]) and with dissection (0.29 mm [-0.28 to 0.88 mm]). The late-luminal loss was nonsignificantly lower (P = 0.40) in the nonstented dissection group (-0.01 mm [-0.33 to 0.87 mm]), than in the stented dissection group (0.41 mm [-0.20 to 0.97 mm]), while binary restenosis was 1 (13%) and 2 (25%), respectively. Coronary SB dissections have similar 6-month angiographic late-luminal loss as lesions without SB dissection, with complete angiographic healing of the dissections. Moreover, this study suggests that in case of a dissection, if operators consider it safe not to stent the dissection, this can lead to a satisfactory result at mid-term follow-up.