Predictive Factors For Branch Occlusion After Stent Placement In The Main Branch Of Coronary Artery Bifurcation Disease And Preliminary Discussion On The Application Of DR Crush Double Stent Technology

Part 1Clinical and Angiographic Predictors of Major Side Branch Occlusion after Main Vessel Stenting in Coronary Bifurcation LesionsObjectives:Major side branch(SB)occlusion is one of the most serious complications during percutaneous coronary intervention(PCI)for biforcation lesions.We aimed to characterize the incidence and predictors of major SB occlusion during coronary bifurcation intervention.Methods:We selected consecutive patients undergoing PCI(using one stent or provisional two stent strategy)for bifurcation lesions with major SB.All clinical characteristics,coronary angiography findings,PCI procedural factors and quantitative coronary angiographic analysis data were collected.Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion.SB occlusion after main vessel(MV)stenting was defined as no blood flow or any thrombolysis in myocardial infarction(TIMI)flow grade decrease in SB after MV stenting.Results:Among all 652 bifurcation lesions,32(4.91%)SBs occluded.No blood flow occurred in 18 lesions and TIMI flow grade decreasing occurred in 14 lesions.In multivanate analysis,diameter ratio between MV/SB(odds ratio[OR]:7.71,95%confidence interval[CI]:1.53-38.85,P=0.01),bifurcation angle(OR:1.03,95%Cl:1.02-1.05,P<0.01),diameter stenosis of SB before MV stenting(OR:1.05,95%Cl:1.03-1.07,P<0.01),TIMI flow grade of SB before MV stenting(OR:3.59,95%Cl:1.48-8.72,P<0.01)and left ventricular eject fraction(LVEF)(OR:1L06,95%Cl:1.02-1.11,P<0.01)were independent predictors of SB occlusion.Conclusions:Among clinical and angiographic findings,diameter ratio between MV/SB,bifiircation angle,diameter stenosis of SB before MV stenting,TIMI flow grade of SB before MV stenting and LVEF were predictive of major SB occlusion after MV stenting.Part 2Double Rewire Crush Technique and its Clinical Outcomes After Two Years of Follow-upObjectives:To describe procedural details of the Double Rewire(DR)crash technique,a novel modified crush technique,and report the clinical outcomes of Patients who underwent the procedure.Background:In the management of complex bifurcation lesions,there is a need to use elective two-stent techniques that stent the side branch(SB)before main vessel(MV)stenting and keep SB open.Methods:We studied 48 patients with 49 bifurcation lesions who underwent percutaneous coronary intervention(PCI)using the DR-crush technique between January and December 2013.Baseline,postprocedural,and follow-up quantitative coronary angiographic analyses were performed.Procedural characteristics and clinical outcomes at follow-up were assessed.Results:Majority of the patients(60.4%,29/48)had acute coronary syndrome.Most bifurcation lesions(77.6%,38/49)were classified as Medina 1,131.Final kissing balloon inflation was successfully performed in all patients.After PCI,MV and SB of all patients had Thrombolysis In Myocardial Infarction(TEMI)3 blood flow.None of the patients had MV or SB diameter stenosis>50%after PCI.At a mean follow-up period of 2.4 years,target vessel revascularization occurred in 2.1%and myocardial infarction in 2.1%.No deaths occurred in this period.Conchusions:The DR-crush technique is feasible in coronary bifurcation stenting.Patients who underwant this procedure had relatively low incidence of adverse events.Larger studies are warranted for further confirmation of the findings.