SPC365

To Stent or Not To Stent in True Bifurcation: What is the best approach for the side branch in a Left Main Artery bifurcation?

Session: SESSÃO DE COMUNICAÇÕES ORAIS 09 - CARDIOLOGIA DE INTERVENÇÃO/ESTRUTURAL
Speaker: Rita Louro

Congress: CPC 2025
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: Rita Louro; Marta Figueiredo; Rafael Viana; Orlando Luquengo; António Almeida; Miguel Carias; Tânia Enereciano; David Neves; Ângela Bento; Renato Fernandes; Gustavo Sá Mendes; Lino Patrício

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>BACKGROUND: </strong><span style="font-family:&quot;Aptos Light&quot;,sans-serif">The left main (LM) bifurcation supplies the left ventricle, and effective management of the side branch necessitates a well-considered intervention technique. The gold standard for these lesions is the provisional stenting (PS) technique, however, in LM robust evidence comparing PS or two stent (2S) technique is scarce.</span><strong> </strong><span style="font-family:&quot;Aptos Light&quot;,sans-serif">New approaches such as drug-eluting balloons (DEB) offer promising alternatives, warranting further data comparing strategies. </span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>METHODS: </strong><span style="font-family:&quot;Aptos Light&quot;,sans-serif">Retrospective analysis, in a single centre between 2011 and 2024, of patients with true bifurcation of LM treated percutaneously (Medina 101, 111 or 011) to evaluate the non-inferiority strategy of side branch DEB versus PS and 2S techniques. Patients were allocated into 3 groups based on the side branch intervention: PS, 2S, or DEB. The primary outcome was composed of cardiovascular death, myocardial infarction (MI), stroke or target lesion revascularization (TLR). Secondary outcomes were length of stay, in-hospital mortality and total death. </span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>RESULTS: </strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-family:&quot;Aptos Light&quot;,sans-serif">A total of 113 patients underwent a percutaneous approach for bifurcating LM disease, 52 of those had side branch evolvement and were included in this analysis. A total </span><span style="font-family:&quot;Aptos Light&quot;,sans-serif">36 patients underwent PS, 10 DEB, and 6 a 2S strategy. Regarding b</span><span style="font-family:&quot;Aptos Light&quot;,sans-serif">aseline characteristics, the SYNTAX score and the presentation (acute versus chronic coronary syndromes) were similar across groups.&nbsp; DEB group included older patients (82.1&plusmn; 4.1 vs 70.6 &plusmn; 9.4). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-family:&quot;Aptos Light&quot;,sans-serif">DEB group experienced no events during the follow-up period (FUP). In contrast, the PS and 2S groups had higher cardiovascular death and myocardial infarction (table).&nbsp;</span></span></span></span><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><span style="font-family:&quot;Aptos Light&quot;,sans-serif">In the PS and 2S groups, most events occurred in early FUP (@1 year), reinforcing the favourable outcomes of DEB, with a median FUP of 19 months. The Kaplan-Meier curve illustrates superior survival in the drug-eluting balloon group compared to the other strategies.</span></span></span></span></p>

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<p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">CONCLUSIONS</span></span></strong><span style="font-size:12pt"><span style="color:#000000"><span style="font-family:&quot;Aptos Light&quot;,sans-serif">: Treating the LM bifurcation side branches remains a nuanced decision. This cohort study, illustrating our experience on LM true bifurcating lesions, DEB demonstrated non-inferiority of DEB strategy compared to PS and 2S, with no MACE during FUP, while providing complete revascularization of bifurcation in a safer mode with less foreign material. The sample size is small, as this represents an initial experience with DEB in the lateral vessel, with larger populations required to validate these findings and refine treatment strategies for LM bifurcations.</span></span></span></p>