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Am Heart J. 2014 Sep;168(3):374-80. doi: 10.1016/j.ahj.2014.05.014. Epub 2014 Jun 6.

Assessment of side branch predilation before a provisional T-stent strategy for bifurcation lesions. A randomized trial.

Author information

1
Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain. Electronic address: manuelpan@telefonica.net.
2
Dr Negrin Hospital, Department of Cardiology, University of Las Palmas, Las Palmas de Gran Canaria, Spain.
3
Reina Sofia Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Avenida Melendez Pidal 1, Cordoba, Spain.

Abstract

BACKGROUND:

A simple approach is the predominant strategy for the percutaneous coronary intervention of bifurcation lesions. Performing side branch (SB) predilation in this context is currently a matter of controversy. In this study, we assess the efficacy of SB predilatation before a provisional T-stent strategy for bifurcation lesions.

METHODS:

Between February 2009 and November 2012, 372 patients with true bifurcation lesions were randomized to either predilation of the SB (n = 187) or no predilatation (n = 185) before main branch (MB) stent implantation and a subsequent SB provisional stent strategy.

RESULTS:

There were no significant differences between the patient groups regarding the baseline characteristics. After MB stent implantation, the TIMI flow of the SB was higher in the patients with SB predilation: TIMI flow 0 to 1; 2 (1%) versus 18 (10%), P < .001; and TIMI flow III; 179 (96%) versus 152 (82%), P < .001. Side branch stenting rates were 4% versus 3%, P = not significant. In addition, 60 patients (32%) from the SB predilation group presented SB residual stenosis by visual inspection <50%, and TIMI flow ≥III did not require any additional treatment. The failure rate of SB rewiring, the time of rewiring, the number of wires used, and the incidence of major events were similar in both groups of patients.

CONCLUSIONS:

Predilation of the SB resulted in improved TIMI flow after MB stenting and less indication to subsequently treat the SB. If rewiring of the SB is required, predilation did not hinder this maneuver.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01090856.

PMID:
25173550
DOI:
10.1016/j.ahj.2014.05.014
[Indexed for MEDLINE]

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