Culotte versus T-stenting in bifurcation lesions: Immediate clinical and angiographic results and midterm clinical follow-up

• Published in: The American heart journal 2007-08, Vol.154 (2), p.336-343
• Main Authors: Kaplan, Sahin, MD, Barlis, Peter, MBBS, MPH, FRACP, Dimopoulos, Konstantinos, MSc, MD, La Manna, Alessio, MD, Goktekin, Omer, MD, Galassi, Alfredo, MD, Tanigawa, Jun, MD, Di Mario, Carlo, MD, PhD, FRCP, FESC, FACC, FSCAI
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Coronary Angiography; Coronary Stenosis - drug therapy; Coronary Stenosis - therapy; Diseases of the cardiovascular system; Drug Delivery Systems; Female; Follow-Up Studies; Heart attacks; Humans; Immunosuppressive Agents - administration & dosage; Investigative techniques, diagnostic techniques (general aspects); Male; Medical imaging; Medical sciences; Middle Aged; Paclitaxel - administration & dosage; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sirolimus - administration & dosage; Stents; Thrombosis
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2007.04.019

Background Stenting the main vessel with provisional stenting of the side branch (SB) is the method of choice for most bifurcation lesions. There is limited data on which of the two techniques of bifurcation stenting compatible with a provisional approach, culotte or T-stenting, offers the best outcome. Methods Between February 2004 and October 2005, 80 consecutive patients with bifurcation lesions requiring a second stent on the SB were treated with either culotte (n = 45) or T-stenting (n = 35). Coronary angiograms were analyzed using a quantitative angiography system dedicated to bifurcations. Propensity scores were used to adjust for baseline differences between groups. Results Acute procedural success was 100% for both groups. Residual diameter stenosis of the SB ostium was 3.44% ± 7.39% in the culotte group versus 12.55% ± 11.47% in the T-stenting group ( P < .0001). One patient (2.2%) in the culotte group had subacute thrombosis 2 days after the procedure. The culotte group had a lower target lesion revascularization rate compared with the T-stenting group (8.9% vs 27.3% propensity score adjusted; P = .014) and a trend toward lower major cardiac adverse events at 9 months (13.3% vs 27.3%; P = .051). Conclusion Both techniques of provisional SB stenting in bifurcation lesions achieve high procedural success with low complication rates. The culotte technique yields a better immediate angiographic result at the SB ostium, and, using drug-eluting stents, a better clinical outcome at 9 months.