Abstract
ObjectivesTo perform detailed analysis of stent expansion, vessel wall stress, hemodynamics, re‐endothelialization, restenosis, and repeat PCI in the simultaneous kissing stents (SKS) technique of bifurcation left main stem (LMS) stenting.BackgroundThe SKS technique is useful to treat patients with true bifurcation disease of the LMS but remains controversial.Methods and ResultsComputational structural analysis of SKS expansion demonstrated undistorted and evenly expanded stents. Computational fluid dynamics modelling revealed largely undisturbed blood flow. 239 PCI procedures were performed on 217 patients with unprotected bifurcation LMS disease with SKS using DES (2004‐2017). We electively studied 13 stable patients from baseline to 10 years post‐SKS with repeat angiography and optical coherence tomography, and demonstrated tissue coverage of the stent struts at the carina, with no evidence of lacunae behind the stents. We studied all patients with symptomatic recurrence. Target lesion revascularization rate was 3.2% at 1 year and 4.6% at 2 years. Of all 20 patients with restenosis, the site was the LMS‐Cx stent in 7, the LMS‐LAD stent in 2 and both in 11. Two‐year recurrence rate was 7/32 (5.3%) for first, and 4/108 (3.7%) for second generation DES. Treatment with repeat kissing techniques was undertaken in 19/20, with sustained clinical results with re‐SKS.ConclusionThe SKS technique for treating unprotected LMS bifurcation disease does not distort the stents, is associated with favorable hemodynamics, tissue coverage of the exposed struts, and a low restenosis rate when performed with contemporary stents. Re‐PCI with repeat SKS appears feasible, safe, and durable.
Highlights
With modern drug-eluting stents, intravascular imaging, physiological guidance, improved patient selection, and insight from large contemporary trials such as EXCEL and NOBLE, percutaneous coronary intervention (PCI) is assuming an increasing role in the treatment of left main stem (LMS) disease [1,2].Approximately 70% of lesions affecting the LMS involve the bifurcation
239 PCI procedures were performed on 217 patients with unprotected bifurcation LMS disease with simultaneous kissing stents (SKS) using drug-eluting stents (DES) (2004-2017)
We electively studied 13 stable patients from baseline to 10 years post-SKS with repeat angiography and optical coherence tomography, and demonstrated tissue coverage of the stent struts at the carina, with no evidence of lacunae behind the stents
Summary
With modern drug-eluting stents, intravascular imaging, physiological guidance, improved patient selection, and insight from large contemporary trials such as EXCEL and NOBLE, percutaneous coronary intervention (PCI) is assuming an increasing role in the treatment of left main stem (LMS) disease [1,2].Approximately 70% of lesions affecting the LMS involve the bifurcation. With modern drug-eluting stents, intravascular imaging, physiological guidance, improved patient selection, and insight from large contemporary trials such as EXCEL and NOBLE, percutaneous coronary intervention (PCI) is assuming an increasing role in the treatment of left main stem (LMS) disease [1,2]. A single stent ‘provisional’ technique is the most widely used, especially if the circumflex (Cx) is large and minimally diseased, or small and nonsignificant. The results of this approach are excellent, provided crossover to a two-stent technique is avoided [4]. The SKS technique is useful to treat patients with true bifurcation disease of the LMS but remains controversial
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
