ICP en TCI Distal
Soledad Ojeda
H.U. Reina Sofía (Córdoba)
Estrategia?
Provisional Stenting
CONSENSUS DOCUMENTS
Provisional stenting or simple approach has been considered the preferred technique for the percutaneous treatment of most bifurcation lesions
DK-CRUSH V vs EBC MAIN trials
Chen SL et al. J Am Coll Cardiol. 2017 Nov 28;70(21):2605-2617.
DK-crush 🡪 lower ST (MI) and TLR than provisional stenting
482 patients with true distal LM bifurcation lesions (Medina 1,1,1 or 0,1,1) were randomized to DK-crush vs. provisional stenting
467 patients with true distal LM bifurcation lesions (Medina 1,1,1 or 0,1,1) were randomized to a 2-stent technique vs. provisional stenting
2-stent techniques: 53% culotte, 32% T/TAP, 5% DK-crush
1-year primary endpoint (death, MI, TLR): similar between the 2 strategies
HR 0.8, 95% CI (0.5–1.3); p=0.34
Procedural metrics favored the provisional approach
Provisional should remain the default approach for distal LM PCI
Variable | DK-CRUSH V | EBC-MAIN |
Primary endpoint | Cardiac death, TV-MI, TLR at 1 year | All-cause death, any MI, TLR at 1 year |
SYNTAX score | 31 | 23 |
IVUS | 41.7% | 32.5% |
SB lesion length | 16 mm | 7 mm |
SB stent length (2-stent) | 32 mm | 19 mm |
2-stent technique | DK-crush (100%) | Culotte (53%), T/TAP (32%), DK-crush (5%) |
Crossover 1-stent 🡪 2-stent | 47.1% | 21.7% |
POT prior to rewiring in 1-stent | 0% | 85% |
Final kissing (1-stent / 2-stent) | 78.9% / 99.6% | 89% / 93% |
Stent thrombosis (1-stent / 2-stent) | 3.3% / 0.4% | 1.7% / 1.3% |
Angiographic follow-up (at 1 year) | Yes | No |
KEY DIFFERENCES BETWEEN THE TWO TRIALS
Zhang JJ et al. EHJ 2020
OPN balloon
NC balloon
COMPLEX LM BIFURCATION {1,1,1} + long SB lesion
Baseline
DK CRUSH
Final Result
Final Result
LEFT MAIN
BIFURCATION
LAD
Cx
SIMPLIFY CRITERIA OF COMPLEX BIFURCATION LESIONS
L: LONG SB LESION>10mm. S:SHORT SB LESION<10mm
Up-front 2 stent technique (DK-Crush)
Provisional stenting
Medina: 1,1,1 S
Estrategia: Provisional Stenting