Coronary bifurcations may be best treated by culotte stenting when the procedure necessitates a side-branch stenting, according to the results of a new study.
The BBK II study, which had results published in the European Heart Journal, set out to evaluate culotte stenting and T-and-protrusion stenting in the 1st randomized trial to pit the 2 techniques against each other.
Data from the 300-patient trial indicated that for patients which required a side branch stent, those treated with culotte stenting had a mean maximal percent diameter stenosis of 21%, lower than the 27% for patients treated with TAP stenting.
“Treatment is often challenging and requires a high level of interventional qualification. This is the 1st head to head comparison of the 2 most commonly used techniques in patients needing side branch stenting and having suitable anatomy for both techniques, and it not only provides angiographic follow-up but also demonstrated a clear signal with respect to clinical outcome. There was a statistically significant difference in the primary study endpoint favouring culotte stenting. The lower angiographic restenosis rate in the bifurcation lesion after culotte stenting as compared with TAP stenting was also associated with lower rate of target lesion revascularisation (TLR) in the first year after PCI,” study investigator Dr. Miroslaw Ferenc of Bad Krozingen, Germany’s Univeristy Heart Center Freiburg said in a press release.
Other differences included rates of binary in-stent restenosis at the bifurcation lesion, which were 6.5% for the culotte group versus 17% for the TAP group. Rates of target bifurcation lesion revascularization at 1 year were at 6% for culotte stenting versus 12% for TAP stenting, according to teh study.
Death, target vessel myocardial infarction and stent thrombosis did not differ significatnly between the 2 groups at 1 year.
“Given the clear results of this trial together with the same trend for hard clinical endpoints, culotte stenting has now to be seen as the preferred approach for coronary bifurcations, when stenting of the site branch is needed,” Dr. Ferenc said in preapred remarks. “Interventional cardiologists can use now culotte stenting with more confidence knowing that this technique is associated with a very low angiographic restenosis rate and lower rate of TLR as compared with TAP stenting – even though it is slightly more challenging and requires appropriate training.”