ASSA14-12-11 Modified mini-crush versus Cullotte techniques in bifurcation lesions of left anterior descending artery: clinical and angiographic long-term outcome after implantation of drug-eluting stents

Abstract

Background The best option on the treatment of coronary bifurcation lesions is a subject of considerable debate. However, recent evidence suggests that bifurcation lesions might be treated by drug-eluting stent on both branches using the mini-crush (MMC) with a low rate of major adverse cardiac event and restenosis. This retrospective study sought to assess the clinical and angiographic long-term outcome after implanting drug-eluting stents in the bifurcation lesions of left anterior descending artery (LAD) with the Cullotte and MMC technique. Methods From April 2003 to January 2013, 445 patients were consecutively treated with either MMC (MMC group, n = 141) or Cullotte (Cullotte group, n = 304). The results of in-hospital and 12-month clinical follow-up were analysed. The indexes of in-hospital, angiographic restenosis at 12-months and major adverse cardiac events (MACE) including death, myocardial infarction or any target lesion revascularisation were evaluated. Results The mean 12-month angiographic follow-up was completed in 63 patients (44.7%) of MMC group and in 118 patients (38.8%) of Cullotte group. The MMC group compared with the Cullotte group had significantly shorter operative time and lower main or side branches restenosis (hazard ratio [HR]: 0.41, 95% confidence interval [CI]: 0.20 to 0.85; p = 0.016; and HR 0.52, 95% CI 0.27–0.99; P = 0 .047, respectively). So, the MMC group compared with the Cullotte group had significantly lower revascularisation (HR 0.57, 95% CI 0.31–0.97; p = 0.023). After a propensity score adjustment, 2-year cumulative major adverse cardiac events were similar between groups (p = 0.16). Conclusions The modified mini-crush technique with DES can be safely performed giving complete coverage of the ostium of side branches and optimising side branch access. Both techniques of bifurcation treatment met high procedural success with low complication rates and similar major adverse cardiac event long-term outcome. However, the MMC minimised the stent structs in main branch, yields a lower restenosis rate at main or side branches.