Best Treated with Simple Approach

Implanting only one stent reduces
procedure time;
© NCI Visuals Online

When both a main artery in the heart and a smaller branch connected to it are narrowed by coronary artery disease, repairing the damage with the use of multiple stents is technically challenging. The use of drug-eluting stents coated with medicine to keep the artery from re-narrowing has improved the outcome of this kind of procedure, but the optimal method to treat bifurcation lesions has not been established.

This study examined two ways of treatment: by placing stents in both the main artery and the side branch or by stenting the main artery alone with the option of stenting the side branch. Researchers looked at major adverse coronary events (MACE) to determine which strategy would provide the best outcome.

A total of 413 patients with extensive cardiac artery disease were randomised in two groups in a multi-centre study: one treated with drug-eluting stent in both the main vessel and the side branch (206 patients), the other group treated with drug-eluting stent only in the main vessel (207 patients). The treatment was successful in nearly 100 percent of patients. Only 4.3 percent of patients in the group originally scheduled for stenting in only the main branch ultimately received stents in both branches.

At six months, clinical results show that patients in both groups had similar positive outcomes. But the patients who were stented in both the main artery and the side branch experienced a longer time in the cardiac catheterisation lab with more exposure to X-rays and contrast medium necessary to complete the procedure.

"Since the clinical results are equally good in both groups, you have to look at the advantages of one technique over the other," said Dr. Steigen, of University Hospital of Northern Norway, Tromsoe. "Due to the elevated markers, the prolonged procedure time and the increased volume of contrast used, it is probably wise to use the simpler strategy."

MEDICA.de; Source: The American College of Cardiology