Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Coronary Intervention
Comparison of 2-Stenting Strategies Depending on Sequence or Technique for Bifurcation Lesions in the Second-Generation Drug-Eluting Stent Era　― Analysis From the COBIS (Coronary Bifurcation Stenting) III Registry ―
Jeehoon Kang, Jung-Kyu Han, Han-Mo Yang, Kyung Woo Park, Hyun-Jae Kang, Hyeon-Cheol Gwon, Woo Jung Chun, Seung-Ho Hur, Seung Hwan Han, Seung-Woon Rha, In-Ho Chae, Jin-Ok Jeong, Jung Ho Heo, Junghan Yoon, Do-Sun Lim, Jong-Seon Park, Myeong-Ki Hong, Joon-Hyung Doh, Kwang Soo Cha, Doo-Il Kim, Sang Yeub Lee, Kiyuk Chang, Byung-Hee Hwang, So-Yeon Choi, Myung Ho Jeong, Young Bin Song, Ki Hong Choi, Soon-Jun Hong, Chang-Wook Nam, Bon-Kwon Koo, Hyo-Soo Kim
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Keywords: 2-stenting technique, Adjunctive pharmacotherapy, Bifurcation, Drug-eluting stents, Left main disease
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2021 Volume 85 Issue 11 Pages 1944-1955

Editorial (85-11 pp. 1956-1958)
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Abstract

Background:It has not been determined which specific 2-stenting strategy is the best for bifurcation lesions. Our aim was to investigate the clinical outcomes of various 2-stenting strategies in the era of 2nd-generation drug-eluting stents (2G-DES).

Methods and Results:We analyzed 454 patients who finally underwent 2-stenting for a bifurcation lesion, from among 2,648 patients enrolled in the COBIS III registry. The primary outcome was target lesion failure (TLF). Patients were analyzed according to stenting sequence (provisional [main vessel stenting first] vs. systemic [side branch stenting first]) and stenting technique (crush vs. T vs. culotte vs. kissing/V stenting). Overall, 4.4 years’ TLF after 2-stenting treatment for bifurcation lesion was excellent: TLF 11.2% and stent thrombosis 1.3%. There was no difference in TLF according to 2-stenting strategy (11.1% vs. 10.5%, P=0.990 for provisional and systemic sequence; 8.6% vs. 14.4% vs. 12.9% vs. 12.2%, P=0.326 for crush, T, culotte, kissing/V technique, respectively). Only left main (LM) disease and a shorter duration of dual antiplatelet therapy (DAPT) were associated with TLF. The distribution of DAPT duration differed between patients with and without TLF, and the time-point of intersection was 2.5 years. Also, the side branch was the most common site of restenosis.

Conclusions:The stenting sequence or technique did not affect clinical outcomes, but LM disease and shorter DAPT were associated with TLF, in patients with bifurcation lesions undergoing 2-stenting with 2G-DES.

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© 2021, THE JAPANESE CIRCULATION SOCIETY

This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license.
https://creativecommons.org/licenses/by-nc-nd/4.0/
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