SPC365

Single stenting versus double stenting technique in true bifurcation coronary lesions

Session: Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker: Mariana Ribeiro Silva

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Posters
FP Number: ---
Authors: Mariana Ribeiro Da Silva; Mariana Brandão; Alberto Rodrigues; Cláudio Guerreiro; Pedro Ribeiro Queirós; Gualter Santos Silva; Diogo Santos Ferreira; Gustavo Pires-Morais; Bruno Melica; Lino Santos; Pedro Braga; Ricardo Fontes-Carvalho

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The ideal treatment technique for coronary bifurcation lesions remains unknown. Although single-stenting strategy has been recommended by default, little evidence exists regarding clinical outcomes between single vs double-stenting in current practice.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To compare procedural details and clinical outcomes between single vs double-stenting techniques in true bifurcation coronary lesions.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective study of all patients (pts) referred for percutaneous coronary intervention (PCI) of true <span style="background-color:white"><span style="color:#2e2e2e">bifurcation lesions between June 2018 and June 2020. Only Medina X,X,1 lesions were included. Pts were split in 2 groups: group 1 (single-stenting) and group 2 (double-stenting). Procedural details and clinical outcomes were assessed. Acute and long-term adverse events included procedural complications (a composite outcome of side branch occlusion, coronary iatrogenic dissection and type 4 acute myocardial infarction (AMI)) and a composite of cardiovascular death, AMI, stroke, re-restenosis and reintervention, respectively. </span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results and Discussion: </strong></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 118 pts were included, 74,6% male, mean age of 66,4 &plusmn;11 years. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Ninety-five pts (80,5%) were treated with single-stenting (G1) and 23 pts (19,5%) with double-stenting technique (G2). Both groups were well matched regarding baseline characteristics and clinical presentation. T and protrusion (TAP) and minicrush were the most frequent double-stenting techniques (43,5% and 21,7%). &nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">G2 lesions mainly involved the left main (LM) and proximal left anterior descendent artery (LAD) (52,2%) and in G1 mid LAD (34,7%). LM lesions were more common in G2 (26,1% vs 8,4%; p=0,030). G1 had more lesions Medina 1,1,1 (75,8% vs 52,2%; p=0,025) and less Medina 0,1,1 (9,5% vs 30,4%; p=0,015). Proximal optimization technique and kissing balloon occurred more in G2 (p&lt;0,05). G2 had more intravascular ultrasound guided PCI (p=0,046). Femoral access, heparin, contrast and radiation dose, and fluoroscopy time were higher in G2 (p&lt; 0,05). Acute a<span style="background-color:white"><span style="color:#2e2e2e">dverse composite outcome was similar in both groups (G1 13% vs G2 14,3%; p=0,855). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Median follow-up was similar (G1 16,8 &plusmn;7,9 and G2 19,7 &plusmn;8,8 months; p=0,127). <span style="background-color:white"><span style="color:#2e2e2e">G1 had less occurrence of long-term adverse composite outcome (7,4% vs 26,3%; p=0,032).</span></span> Excluding interventions in LM, G2 had more significant incidence of acute events (20% vs 2,6%; p=0,028), and higher rate of long-term adverse events (20% vs 4,2%; p=0,056). In interventions of the LM only, no differences were noticed in acute and long-term composite events between groups. </span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Double-stenting techniques in true coronary bifurcation lesions included more often LM lesions and were complex procedures requiring frequently intracoronary imaging. Although acute adverse events were similar to those of single-stenting, long-term adverse outcomes were more frequent in double-stent group, except for LM lesions. </span></span></p>