Angioplasty of bifurcation with one stent: The best technique to optimize the result?

Abstract

Bifurcation lesions account for 20% of all angioplasty performed. Several studies have shown that single-stent techniques compared to two-stent techniques offer better long-term results with less risk of restenosis and revascularization. However, there are little data about the best technique for optimizing the outcomes when performing single-stent angioplasty. The aim of the study was to compare the results of kissing, proximal optimization technique (POT), or combining the two techniques. Our study was retrospectively carried out over the period from January 2008 to December 2015 and included all patients who underwent true bifurcation angioplasty using the single-stent provisional technique. We compared the rate of restenosis and major cardiovascular events (MCV) in 3 groups: Group 1 = final kissing, group 2 = final POT alone and group 3 = kissing + POT. We included 125 patients with an average age of 61 ± 11 years, a male predominance was noted, 74% of our patients were diabetic and 68% were smokers. Angioplasty was performed in the context of stable coronary disease in 48%. Most of our patients have one vessel disease; the most frequently treated seat was the left anterior descending artery-diagonal bifurcation (72%). Most patients received kissing alone (group 1 = 82), 21 patients received POT alone and 22 patients were treated with kissing + POT. The MCV rate at 1 month ( P = 0.52) and 1 year ( P = 0.06) did not differ between the 3 groups. However, the target lesion revascularization rate was higher in the second group (group 1 = 12.06%, group 2 = 19.04% et group 3 = 13%, P = 0.04), this is because of a higher rate of restenosis in the side branch when performing POT. Our study asserts that during true bifurcation angioplasties, the POT technique is associated with a higher risk of restenosis of the side branch. Performing a final kissing balloon can reduce this risk.