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Comparing Two Stents Technique Versus Provisional Stenting Technique in Bifurcation Coronary Artery Lesions in Beni-Suef University Hospital

Osama Ahmed Amin, Hesham Boshra Mahmoud, Yasser Ahmed Abdel Hady, Nader Galal Hussein

Background: Percutaneous Coronary Intervention (PCI) of bifurcation disease remains a challenge in terms of procedural success rate as well as long term Major Adverse Cardiac Events (MACE), Target Lesion Revascularization (TLR), restenosis, and Stent Thrombosis (ST). Bifurcation interventions, when compared with nonbifurcation interventions, have a lower rate of procedural success and a higher rate of restenosis.

Aim: The purpose of this study was to assess the in hospital and mid-term outcome of two different techniques of stent deployment in bifurcation coronary artery lesions in Beni-Suef University Hospital: Two stent technique versus provisional stenting technique.

Patients and Methods: This study was a prospective non-randomized study performed on 50 patients referred to cardiology department at Beni-Suef University hospital. This study included two different techniques of stent deployment using DES for elective treatment of stable patients with de novo native bifurcation coronary artery lesions. Patients were divided according to the operator decision based on vessel and lesion characteristics and also operator experience into two groups: group I (provisional stenting technique) and group II (2 stent technique), each group included 25 patients. All our study patients were subjected to clinical follow-up by office visit at 1 month and 6 months after treatment for MACE (The mid-term MACE: at 6 months and the in-hospital MACE). Myocardial Perfusion Imaging (MPI) was scheduled 6 months post procedure for asymptomatic patients or those with atypical symptoms. Follow-up angiography was planned for all patients at six months (or earlier for symptomatic patients or patients with positive stress MPI for ischemia).

Results: Both groups were well matched regarding baseline characteristics. The procedural in-hospital success was 100% in all the patients in both groups (P=1). Typical angina (CCS class 2–4) occurred in 4 patients during the 6 months follow up period in the whole study:1 patient (4%) in group I and 3 patients (12%) in group II (P=0.29). MPI was done at 6 months post procedure for 46 asymptomatic patients: 2 patients had positive MPI in group II and no patients in group I (P=0.18). Follow up coronary angiography was done for all patients at 6 months or earlier: Stent thrombosis was detected in 1 patient in group I and 3 patients in group II (P=0.29). Clinically and angiographically driven TVR occurred in 1 patient in group II and no TVR occurred in group I (P=0.31). Death did not occur in any patient during the 6 months follow up period. Myocardial infarction during the 6 months follow up period occurred in 1 patient in group I and 3 patients in group II (P=0.29). Total composite MACE at 6 months occurred in 1 patient in group I (4%) and 3 patients in group II (P=0.29).

Conclusion: In developing countries with limited resources; the strategy of DES implantation in the main branch with provisional stenting of the side branch for the treatment of bifurcation lesions should be the preferred strategy.