Abstract 21544: Long-Term Outcome of Provisional Side-Branch T-Stenting for the Treatment of Unprotected Distal Left Main Coronary Artery Diseas
Background: Percutaneous coronary intervention (PCI) on distal left main (LM) remains an independent predictor of poor outcome and is offset by the need to handle the bifurcation between LM and the main proximal left coronary branches. Based on the results of several randomised trials, the provisional approach of implanting one stent on the main branch with additional stenting on the side branch (SB) only in the case of an unsatisfactory result, has become the default approach to most bifurcation lesions. However, very long-term results on homogeneous series of patients treated with provisional stenting, especially on distal LM, are still lacking. Thus, the aim of the present study was to evaluate the long-term benefits of provisional side-branch for the treatment of unprotected distal LM disease in consecutive patients undergoing PCI.
Methods: From January 2006 to May 2009, 107 patients affected by unprotected distal LM disease underwent PCI at our center with the intent to use a provisional side-branch stenting technique. Patients with acute ST-elevation myocardial infarction or patients in whom, for anatomical reasons, a strategy with two stent implantation was initially planned, were excluded. We evaluated the rate of death and/or reinfarction, definite stent thrombosis (ST), and major adverse cardiac events (combined death and/or reinfarction and/or target lesion revascularization) at long-term follow-up (up to 12 to 41 months).
Results: The mean logistic EuroSCORE was 5±3% and the mean SYNTAX score was 22±11.Procedural success was obtained in 98% of patients. A final kissing balloon inflation was performed in 95% and IVUS in 83% of patients. Additional stenting on the SB after provisional stenting on MB was required in 29% of lesions. The very long-term follow-up (3.5 years; 25th to 75th percentile, 1.1 to 4.5 years) was completed in 97% of patients. The occurrence of ST was 5.6% and cardiac death 6.5%. The cumulative incidence of MACE was 32.7%: all-cause death was 15.8%, nonfatal MI 8.4%, and TLR 21.5%.
Conclusions: In patients with unprotected distal LM disease undergoing PCI a provisional strategy of stenting the MB only seems safe and effective at long-term follow-up.
- © 2010 by American Heart Association, Inc.