Long-term clinical and angiographic outcomes after implantation of sirolimus-eluting stents with a "modified mini-crush" technique in coronary bifurcation lesions

Hyoung-Mo Yang, Seung-Jea Tahk, Seong-Ill Woo, Hong-Seok Lim, Byoung-Joo Choi, So-Yeon Choi, Myeong-Ho Yoon, Jin-Sun Park, Mingri Zheng, Gyo-Seung Hwang, Soo-Jin Kang, Joon-Han Shin
Catheterization and Cardiovascular Interventions 2009 July 1, 74 (1): 76-84

OBJECTIVES: We aimed to evaluate long-term outcomes of a modified mini-crush technique for treating bifurcation lesions.

BACKGROUND: Coronary bifurcation lesions continue to show a relatively high restenosis rate despite the use of a drug-eluting stent (DES).

METHODS: We enrolled 52 consecutive patients treated with sirolimus-eluting stent implantation using the modified mini-crush technique for 56 coronary bifurcation lesions (MEDINA 1, 1, 1, 89.2%; left main lesion, 28.6%). To minimize crushing, the proximal marker of the side branch (SB) stent was located in contact with the main vessel (MV) stent. After SB stenting, we drew the SB balloon proximally and dilate the SB ostium at a rated burst pressure. After MV stenting, both vessels were redilated at a high pressure before final kissing balloon (FKB) inflation. Clinical and angiographic follow-ups were performed at 9 months.

RESULTS: Immediate procedural success was obtained in all cases including a FKB success rate of 98%. At 9 months, there was no death or myocardial infarction. The incidences of major adverse cardiac events and target lesion revascularization were 11.8 and 7.8%, respectively. The in-stent restenosis (ISR) rate was 14.9% (SB ostium, 10.6%) and most ISRs were of the focal type and the cause of ISR was intimal hyperplasia but not chronic stent recoil by an intravascular ultrasound study. There was one case (2.0%) of late stent thrombosis without any ischemic symptoms during the follow-up period of 9 months.

CONCLUSIONS: Modified mini-crush technique provides excellent technical and angiographic success immediately and it also provides acceptable long-term outcomes.

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