Intravascular ultrasound findings in coronary bifurcation lesions treated with single stenting versus double stenting strategies

Estudos comparativos prévios com inclusão de lesões de bifurcação selecionadas sugerem ausência de benefício de implante eletivo de dois versus stent único. No entanto, a aplicabilidade do técnica provisional parece ser dependente da complexidade da lesão de bifurcação. A área luminar da lesão após tratamento percutâneo, conforme medida pelo ultrassom intracoronário, tem demonstrado valor preditivo significante na evolução tardia dos pacientes submetidos a ICP. Os objetivos desta análise foram avaliar as dimensões luminares de lesões de bifurcação coronária complexas tratadas por ICP, conforme a análise pelo ultrassom, e correlacionar os achados com os resultados imediatos e tardios. Também objetivou-se identificar preditores angiográficos e ultrassonográficos de falência do ramo lateral nos diferentes passos do tratamento e seguimento. Entre maio de 2008 e agosto de 2009, 59 pacientes portadores de lesão de bifurcação complexa, com comprometimento significativo (estenose > 50%) dos dois ramos e lesão no ramo lateral extendendo-se além do óstio, foram abordados inicialmente com pré-dilatação do ramo lateral, a qual foi realizada com sucesso (estenose 50%, fluxo TIMI 50% stenosis) of both branches and side branch lesion length extending from its ostium, were approached initially with side branch predilatation, which was successful ( 50% residual stenosis, TIMI flow < 3 or dissection), given that 5 patients received an additional stent in the side branch in order to optimize the angiographic result. At final procedure, the mean value and standard deviation (SD) for minimum lumen area at the side branch ostium (primary endpoint) were 3.37 (1.62) mm2 in single stenting versus 5.50 (1.41) mm2 in double stenting (p < 0.001), according to the randomized allocation. In the angiographic follow-up at 9 months, the restenosis rates in the side branch were 21.7% in single stenting versus 4% in double stenting (p = 0.06), given that all recurrences involved the ostial location. Considering the treatment received, the side branch restenosis rate was significantly increase among patients treated with single stenting versus double stenting (27.8% versus 3.3%, p = 0.01). The predictors of provisional strategy failure were: lesion eccentricity (p = 0.02), minimum lumen area (p = 0.08) and minimum lumen diameter in the side branch ostium (p = 0.06), lesion length (p = 0.09) and percent diameter stenosis (p = 0.07) of the side branch. Regarding angiographic restenosis in the side branch, predictors were: minimum lumen area in the side branch ostium at final procedure (p = 0.03), treatment with double stenting (p = 0.02), minimum lumen diameter (p = 0.03) and percent diameter stenosis (p = 0.02) in the side branch ostium at final procedure, acute gain at the side branch ostium (p = 0.09) and side branch reference diameter (p = 0.03). These results suggest that complex coronary bifurcation lesions may benefit from a primary percutaneous approach with double stenting strategy, given that most such benefit was associated with a larger lumen area obtained at the side branch ostium