Crush/culotte stenting may improve POCI of bifurcation lesions

15 August 2008

MedWire News: Crush/culotte stents for percutaneous coronary intervention (PCI) of bifurcation lesions may be associated with better long-term outcomes than main vessel stenting alone, although further study is required, conclude Canadian researchers.

Due to a lack of long-term follow-up and the heterogeneity of lesions, it is not clear which approach is optimal, explain Vladimír Džavík and colleagues from the University Health Network in Toronto, Ontario.

To examine the long-term outcomes of patients undergoing bifurcation PCI, the team compared outcomes for 266 patients who underwent main vessel stenting only and 140 who had crush/culotte stenting between 2003 and 2005.

There were no significant differences between the two treatment groups in terms of demographic features, the extent and severity of coronary artery disease, or the nature of the clinical presentation. Main vessel stenting was used to treat all bifurcation types, while crush/culotte treatment was used almost exclusively in patients with disease in the distal main vessel and side branch.

Drug-eluting stents were used in 89.2% of crush/culotte patients, but only 48.9% of those who received a main vessel stent only. The procedure duration, fluoroscopic time, and contrast volume were significantly lower with main vessel only procedures.

Over a median follow-up of 26.5 months, the combined outcome of major adverse cardiac events (MACE) or Canadian Cardiovascular Society (CSS) class ≥2 angina tended to occur less frequently with crush/culotte treatment, at 22.3% versus 28.5% for main vessel only stenting. Rates of MACE only were similar in the two groups, at 18.7% and 20.8%, respectively.

For patients in the crush/culotte group, a low bifurcation angle was associated with a significantly better outcome than a high angle. This association was not observed in patients who had main vessel stenting only.

Multivariate analysis revealed that crush/culotte treatment was associated with a significantly lower risk of combined MACE or CSS class ≥2 angina, at a hazard ratio of 0.55, the team reports in the American Journal of Cardiology.

While calling for more research, they conclude: "Our data suggest that crush and culotte stenting strategies can be used to treat bifurcation stenosis with a high degree of safety and long-term efficacy. This is reassuring given the reported association between bifurcation PCI and late stent thrombosis."

Am J Cardiol 2008; 102: 404-410