Drug‐eluting stents in bifurcation lesions: To stent one branch or both?

Objectives : The objective of this study was to compare two techniques to treat bifurcation lesions: a single drug‐eluting stent (DES) implanted in the main branch combined with balloon dilatation for the side branch vs. stenting of both branches (double stent). Background : Percutaneous coronary intervention in coronary bifurcation lesions remains challenging. Although DES reduce restenosis in lesions, the double stent procedure has not shown clear advantages over a single stent with balloon dilation. Methods : Fifty‐three symptomatic patients with true bifurcation lesions were treated using either the double stent technique ( n = 25) or one stent in the parent vessel plus balloon angioplasty of the side branch ( n = 28). Procedural results and major adverse cardiac event rates (MACE: cardiac death, myocardial infarction, target vessel revascularization (TVR)) were compared. Results : Angiographic procedural success (residual stenosis <30% in both branches) was 75% in the single stent group and 100% in the double stent group ( P = 0.01). All differences were due to residual stenosis of the side branch. Clinical follow‐up (6–18 months) was available for all patients; 90.5% of patients had a coronary angiography or nuclear stress test. Three patients (11%) in the single stent group and two (8%) in the double stent group had ischemia‐driven TVR ( P = NS). Asymptomatic angiographic restenosis (>50% diameter stenosis) in the ostium of the side branch was seen in two patients in the double‐stent group. At 6 months, MACE‐free was comparable between groups (89.3% vs. 88%, P = 0.7). Conclusions : When treating bifurcation lesions with sirolimus‐eluting stents, restenosis following a single stent procedure is comparable to stenting both parent and side branch vessels. Thus, stenting the main‐branch lesion, coupled with balloon angioplasty in the side branch, produces a high success rate and good clinical outcomes at 6 months. © 2006 Wiley‐Liss, Inc.