左主干末段分叉病变介入治 左主干末段分叉病变介入治 疗，对吻与否？ 疗，对吻与否？

南京市第一医院南京市第一医院南京市心血管医院南京市心血管医院

南京市心脏病研究所南京市心脏病研究所林松 陈绍良林松 陈绍良

Randomized Comparison of Provisional Side Branch Stenting versus a Two-stent

Strategy for treatment of True Coronary Bifurcation Lesions

Involving a Large Side Branch.

The Nordic-Baltic Bifurcation Study IV

Indulis Kumsars, Matti Niemelä, Andrejs Erglis, Kari Kervinen, Evald H. Christiansen, Michael Maeng, Andis Dombrovskis, Vytautas Abraitis,

Aleksandras Kibarskis, Terje K. Steigen, Thor Trovik, Gustavs Latkovskis, Dace Sondore, Inga Narbute, Christian Juhl Terkelsen, Markku Eskola, Hannu

Romppanen, Per Thayssen, Anne Kaltoft,Tuija Vasankari, Pål Gunnes, Ole Frobert, Fredrik Calais, Juha Hartikainen, Svend Eggert Jensen, Thomas

Engstrøm, Niels R. Holm, Jens F. Lassen and Leif ThuesenFor the Nordic-Baltic PCI Study Group

AimTo compare provisional stenting and two-

stent techniques for the treatment of ”true” coronary bifurcation lesions involving a large side branch.

HypothesisTwo stent techniques are superior to

provisional stenting in treatment of ”true” coronary bifurcation lesions involving a large side branch

Nordic-Baltic Bifurcation Study IVNordic-Baltic Bifurcation Study IVThe Nordic-Baltic PCI Study Group

Procedural dataProvisional(n=221)

Two-stent (n=229)

p

SB dilatation (%) 64.3 78.0 -

SB dilation or final kissing (%) 78.7 - -

Final kissing balloon dilatation (%)

36.1 91.2 -

SB stented (%) 3.7 96.0 -

Culotte - 65.6 -

T-stent - 7.0 -

Other - 26.4 -

Tx succesful* (%) 97.7 99.1 ns

* (Residual stenosis <30% of MV + TIMI flow III in SB)

Nordic-Baltic Bifurcation Study IVNordic-Baltic Bifurcation Study IVThe Nordic-Baltic PCI Study Group

Event-free survival at 6 months

4.6%

1.8%

p=0.09

Nordic-Baltic Bifurcation Study IVNordic-Baltic Bifurcation Study IV

NTL MI = 1 TLR= 2ST=1

NTL MI = 1 TLR= 6ST=2

vs.

P=0.09

RCTs of Provisional vs. Elective Stenting “Higher-Risk” Bifurcations

RCTs of Provisional vs. Elective Stenting “Higher-Risk” Bifurcations

Chen SL, et al. J Am Coll Cardiol 2011;57:914–20.

The Nordic-Baltic The Nordic-Baltic Bifurcation Study IIIBifurcation Study III

Conclusions:Conclusions: In coronary bifurcation lesions, MV In coronary bifurcation lesions, MV

stenting with and without FKBD was stenting with and without FKBD was associated with favorable and similar 6-month associated with favorable and similar 6-month clinical outcomes. The simple no-FKBD clinical outcomes. The simple no-FKBD procedure resulted in reduced use of contrast procedure resulted in reduced use of contrast media and shorter procedure and fluoroscopy media and shorter procedure and fluoroscopy times. Angiographic SB outcome was improved times. Angiographic SB outcome was improved by FKBD, especially in patients with true by FKBD, especially in patients with true bifurcation lesions. In nontrue bifurcation bifurcation lesions. In nontrue bifurcation lesions, no effect of FKBD was detected by lesions, no effect of FKBD was detected by either clinical or angiographic end pointseither clinical or angiographic end points. .