A randomized trial of bifurcation stenting technique in chronic total occlusions percutaneous coronary intervention. Issue 1 (January 2018)

• Record Type: Journal Article
• Authors: Baystrukov, Vitaly I.; Kretov, Evgeniy I.; Boukhris, Marouane; Osiev, Alexander G.; Grazhdankin, Igor O.; Biryukov, Alexey V.; Najjar, Hatem; Verin, Vladimir V.; Zubarev, Dmitriy D.; Naryshkin, Ivan A.; Bogachev-Prokophiev, Alexander V.; Mashayekhi, Kambis; Galassi, Alfredo R.; Prokhorikhin, Alexey A.
• Is Part Of: Coronary artery disease. Volume 29:Issue 1(2018:Jan.)
• Publication Date: 2018-01
• Subjects: bifurcation -- chronic total occlusion -- mini-crush -- T-provisional; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000000551
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : Background: The optimal strategy to treat bifurcation lesions (BFLs) in a percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) remains unknown. Aims: We sought to assess whether T-provisional or mini-crush is appropriate for BFLs within CTO vessels. Patients and methods: From January 2011 to December 2013, patients who underwent successful CTO guidewire crossing and with a BFL within the CTO target vessel were enrolled prospectively and assigned randomly to either T-provisional stenting or the mini-crush technique for BFL treatment. One-year clinical follow-up was performed. Major adverse cardiac and cerebrovascular events (MACCE) were defined as the composite of cardiovascular death, myocardial infarction, target vessel revascularization, and stroke. Results: The prevalence of BFLs was 54.3%. A total of 146 patients with BFLs within CTO vessel were enrolled prospectively and assigned randomly to either T-provisional stenting ( N =73) or the mini-crush technique ( N =73). Angiographic and clinical success rates were similar in the two groups: 91.8 versus 97.2% ( P =0.27) and 91.8 versus 94.5% ( P =0.67), respectively. Although T-provisional stenting was associated with a nonsignificantly lower incidence of MACCE in case of BFLs located far from the CTO (9.3 vs. 22.2%; P =0.426), the mini-crush technique resulted in higher MACCE-free survival at 1 year in the presence of BFLs within the CTO body or close to the proximal or the distal cap (89.1 vs. 64.9%; P =0.007). Conclusion: The mini-crush technique appeared to be associated with improved 1-year clinical and angiographic outcomes, particularly when used to treat BFLs located within the CTO body or close to the proximal or the distal cap.