Double-kissing Culotte Stenting Technique in Coronary Bifurcation Disease: Angiographic Follow-up And 12-month Clinical Outcomes
Xijing Hospital, Fourth Military Medical University, Xi’an, China
T. Hu, H.C. Wang, R.T. Wang, A.L. Lv, R.H. Luan, C.X. Li, H.X. Cheng, C.H. Xia, L. Tao
Background: Percutaneous treatment of coronary bifurcation disease remains challenging. Optimal treatment with PCI for bifurcation lesions has yet to be achieved. In patient subsets in which a two-stent strategy is necessary, the culotte technique is a widely used method. However, this technique has its own limitations. We therefore developed a double kissing (DK) balloon method to optimize the final result of culotte stenting. To study this technique, and to compare it to the classical crush stenting technique,we performed a prospective, randomized trial aimed at determining the differences in the rates of final kissing balloon inflation(FKBI) and long-term clinical outcomes from January 2010 to June 2012 at our institution.
Methods: We prospectively enrolled patients undergoing PCI of a true coronary bifurcation lesion with a Medina classification of (1, 1, 1) with drug-eluting stents (Firebird) in our institution. Patients were randomly selected to undergo treatment using either the classical Culotte stenting or the DK Culotte stenting technique with DES. Angiographic follow-up was scheduled between 6 and 9months. Clinical follow-up was available up to 12 months. All patients underwent monthly follow-up by telephone or clinic review.
Results: A total of 124 bifurcation lesions (58 patients with 63 lesions in the classical Culotte stenting group, and 59 patientswith 61 lesions in the DK Culotte stenting group were enrolled in this study. Procedural angiographic success was achieved in all lesions. FKBI were performed in 89 % of the classical Culotte group and in 100% of the DK Culotte group (p < 0.001),and there was a lower rate of unsatisfactory final kissing balloon inflations (16.51 vs. 3.3%, p < 0.01) in the DK Culotte stenting group; The overall restenosis rate was 19.6% the classical Culotte group,however, the restenosis rate for the DK Culotte group was only 9.7% (p < 0.001); The cumulative MACE were higher in the classic Culotte stent group than those in the DK Culotte group (22.18% vs. 4.71%, p=0.001,); Predictors of angiographic restenosis were older age, increasing bifurcation angle,more severe distal main branch stenosis, and smaller side branch reference diameter, kissing balloon post-dilatation tended to have a protective effect.
Conclusion: The DK Culotte stenting technique is associated with high procedural success by optimizing the FKBI rates and by allowing a complete stent expansion at the side branch ostium and a relatively low risk of angiographic restenosis. The improved clinical outcomes were sustained even at a 12 month follow-up period.
