Immediate and long-term results of a modified simultaneous kissing stenting for percutaneous coronary intervention of coronary artery bifurcation lesions

• Published in: The Journal of invasive cardiology 2013-03, Vol.25 (3), p.126-131
• Main Authors: Isaaz, Karl, Bayle, Sandrine, Lamaud, Michel, Robin, Christophe, Cerisier, Alexis, Mayaud, Norbert, Richard, Laure, Sabry, Mohamed Hassan, Khamis, Hazem, Abd-Alaziz, Ahmad, Da Costa, Antoine
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - methods; Cohort Studies; Coronary Angiography; Coronary Restenosis - epidemiology; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - therapy; Drug-Eluting Stents; Female; Follow-Up Studies; Humans; Incidence; Male; Metals; Middle Aged; Paclitaxel; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - methods; Prospective Studies; Retrospective Studies; Sirolimus - analogs & derivatives; Stents; Treatment Outcome
• ISSN: 1557-2501

We propose a modified simultaneous kissing stenting technique (MSKS) based on systematic implantation of a protective stent in the proximal main vessel (PMV) proximally to the bifurcation before simultaneous kissing stenting (SKS). SKS has been proposed in large-size coronary vessel bifurcation lesions (BLs) when the PMV can accommodate two stents. SKS implies, however, low-pressure simultaneous final balloon inflations to avoid retrograde PMV dissection or rupture and therefore may not ensure optimal final stent apposition. From January 2005 to May 2008, a total of 97 patients with 100 BLs (true bifurcation in 92%) who underwent MSKS were enrolled in a prospective registry. Drug-eluting stents were used for distal main vessel and side branch. Drug-eluting or large-size bare-metal stents were used as proximal protective stents. Immediate procedural success rate was 100%. Global restenosis rate was 10% (5% in the main vessel and 8% in the side branch) at follow-up angiogram performed at 7 months in all patients (100%). No patient had early or late stent thrombosis. Two cases of non-fatal very late stent thrombosis occurred at 46 and 64 months. Over a mean 4.5-year follow-up period, target lesion revascularization rate was 11%, with only 3% driven by clinical ischemia. Protective stent systematic implantation in the PMV represents a newly modified SKS technique that allows safe finalization of the procedure by high-pressure kissing balloon final inflation, ensuring optimal stent apposition with high immediate procedural success and low rates of long-term events.