Bifurcation lesions: two stents versus one stent--immediate and follow-up results

J Am Coll Cardiol. 2000 Apr;35(5):1145-51. doi: 10.1016/s0735-1097(00)00534-9.


Objectives: The purpose of this study was to evaluate two different techniques of stent placement in bifurcation lesions.

Background: Although stent placement with dedicated techniques has been suggested to be a useful therapeutic modality for bifurcation lesions, limited information is available if stent placement on the side branch and on the parent branch provides any advantage over a simpler strategy of stenting the parent vessel and balloon angioplasty of the side branch.

Methods: Between March 1993 and April 1999, we treated a total of 92 patients with bifurcation lesions with two strategies: stenting both vessels (group B, n = 53) or stenting the parent vessel and balloon angioplasty of the side branch (group P, n = 39). Paired angiograms were analyzed by quantitative angiography, and clinical follow-up was obtained.

Results: Stent placement on both branches resulted in a lower residual stenosis (7.4 +/- 10.9% vs. 23.4% +/- 18.7%, p < 0.001) in the side branch. Acute procedural success was similar in the two groups (group B: 87% vs. Group P: 92%). In-hospital major adverse cardiac events (MACE) occurred only in group B (13% vs. 0%, p < 0.05). At the six-month follow-up, the angiographic restenosis rate (group B: 62% vs. Group P: 48%) and the target lesion revascularization rate (38% vs. 36%, respectively) were similar in the two groups. There was no difference in the incidence of six-month total MACE (51% vs. 38%).

Conclusions: For the treatment of true bifurcation lesions, a complex strategy of stenting both vessels provided no advantage in terms of procedural success and late outcome versus a simpler strategy of stenting only the parent vessel.

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / instrumentation*
  • Angioplasty, Balloon, Coronary / methods*
  • Coronary Angiography
  • Coronary Disease / classification
  • Coronary Disease / complications
  • Coronary Disease / diagnostic imaging
  • Coronary Disease / mortality
  • Coronary Disease / therapy*
  • Female
  • Follow-Up Studies
  • Hospital Mortality
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Recurrence
  • Risk Factors
  • Severity of Illness Index
  • Stents*
  • Treatment Outcome