Clinical Outcomes of Various Two Stent Bifurcation Techniques in Treating Coronary Bifurcation Lesions at Pakistan Institute of Medical Sciences (PIMS), Islamabad

Abstract

Objective: To determine the clinical outcomes of different two stent bifurcation techniques in the treatment of coronary bifurcation lesions, taking this as a challenge presented at the Pakistan Institute of Medical Sciences (PIMS), Islamabad.

Methods: This descriptive cross-sectional was done at the Cardiology Department, PIMS, Islamabad, from September 2017 to February 2018. Individuals aged 20–60 years with true bifurcation lesions (> 50% stenosis diameter) in both parent/main vessel side branch ostia from lesions and with a diameter of >2.5 mm via visual approximation, silent ischemia, un-stable or stable angina, and denovo coronary bifurcation lesions of either gender were included. For PCI of these lesions, a variety of methods have been developed, frequently involving the use of numerous balloons and the implantation of two or more stents, including the crush stent technique, the Cullotte stent technique, and the kissing stent technique to allow maximum apposition to the vascular wall with efficient drug delivery in situation of drug-eluting stents. Patients were observed for clinical outcomes like cardiac death, stent thrombosis, nonprocedural MI, and during operation complications like edge dissection and side branch closure, recurrent myocardial infarction (MI), unstable angina, and MACE. All the information was collected via a study proforma, and the analysis was done using SPSS version 20.

Results: The study included 100 cases, with an average age of 40 years and a range of 20 to 60 years. Out of all 58 (58%) males and 42 (42%) females. The T-Stent Technique was used in 30% of the study population, the Crush Stenting approach was used in 18% of the cases, the Culotte stenting approach was done in 22% of the cases, and kissing stenting approach was done in 30% of the study subjects. Amongst all the procedures, the Kissing Stent Technique was most successful in treating coronary bifurcating lesions 93.3%. As per procedures, complications were found to be statistically significant (p = 0.011).

Conclusions: As per the study conclusion, kissing stent technique has been observed to be the most successful and least complicated technique in treating coronary bifurcating lesions.