Provisional T-drug-eluting stenting technique for the treatment of bifurcation lesions: Clinical, myocardial scintigraphy and (late) coronary angiographic results

BACKGROUND: Treatment of bifurcation stenoses (BS) by percutaneous coronary intervention (PCI) remains challenging, even with drug-eluting stents (DES). We aimed to appraise clinical, myocardial scintigraphy and late (>9 months) exploratory angiographic outcomes of provisional T-stenting in the management of BS. METHODS: We enrolled 53 consecutive patients with BS in the proximity of a ≥2 mm side branch (SB). The provisional T-technique was performed in all cases, with implantation of DES in the main branch (MB), SB balloon-only dilatation, and final kissing in the event of >50% SB stenosis. Provisional SB-stenting (using another DES) was reserved to cases with persisting >50% stenosis/dissection and reduced TIMI flow. Further kissing inflation was recommended in such patients. Stress/rest single-photon emission computed tomography (MIBI) and coronary angiography follow up were scheduled >6 and 9 months after PCI, respectively. RESULTS: Major adverse cardiac events at 14 ± 3 months occurred in 5 patients (9.4% [95% confidence interval 0.1 - 17.4%): 1 (1.9% [0.1 - 5.8%]) non-Q-wave myocardial infarction for subacute stent thrombosis, 2 (3.8% [0.1 - 9.0%]) target lesion revascularizations and 2 (3.8% [0.1 - 9.0%]) target vessel revascularizations. Six-month MIBI was performed in 51 patients (96.3%): 4 patients had positive results (7.8% [0.2 - 15.4%]). Angiography was performed in 4 of these patients and in another 27 patients, with clinical restenosis occurring overall in only 5 (16.1% [8.9 - 23.3%]), 1 case of clinical restenosis in the MB (3.2% [0.6 - 9.4%]), and 4 in the SB (12.9% [5.1 - 24.9%]). CONCLUSIONS: This study suggests the safety and efficacy of provisional T-drug-eluting stent implantation in bifurcation coronary lesions, and supports the use of follow-up myocardial scintigraphy, with angiography reserved for selected patients and lesions.