Comparison of Clinical Outcomes between Provisional Stenting and Two-Stent Approach for True Left Main Bifurcation Lesions in the Era of Imaging Guided Percutaneous Coronary Intervention

Ming Leo Lau, Department of Medicine, Yan Chai Hospital, 9-11, Yan Chai Street, Tsuen Wan, Tsuen Wan, New Territories, Hong Kong SAR, ChinaFollow
Ho Fai Daniel Fong, Department of Medicine, Yan Chai Hospital, 9-11, Yan Chai Street, Tsuen Wan, Tsuen Wan, New Territories, Hong Kong SAR, China
Nim Pong Kwong, Department of Medicine, Yan Chai Hospital, 9-11, Yan Chai Street, Tsuen Wan, Tsuen Wan, New Territories, Hong Kong SAR, China

Abstract

Background

Currently there are two strategies in Percutaneous Coronary Intervention (PCI) of the true left main (LM) bifurcation lesions: provisional stenting and two-stent technique. The optimal treatment strategy for true LM bifurcation lesions is undetermined. In addition, the percentage of use of imaging-guiding in these studies was low. We would like to undertake a retrospective cohort study to compare the clinical outcomes of provisional stenting versus two-stent technique in treating the true LM bifurcation lesions with the help of intravascular imaging.

Methods

Data of consecutive patients undergoing PCI of true LM bifurcation lesions in Yan Chai Hospital from January, 2018 to December, 2023 was studied. All LM PCI was done using imaging-guiding. The study endpoint was the composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction (MI), or clinically driven target lesion revascularization.

Results

A total of 57 patients were included, of which 28 (49.1%) used provisional stenting and 29 (50.8%) used two-stent technique. Two-stent technique group seemed to have lower TLF rates 13.8% as compared 21.4% in provisional stenting group (P =0.41). The differences were more obvious in complex true bifurcation group, in which two-stent technique group tended to be have lower TLF rates (33% in provisional stenting group and 9% in two-stent technique group, P =0.06).

Conclusions

In imaging guided PCI of true LM bifurcation lesion especially complex true bifurcation, two-stent technique seemed to have lower adverse cardiac event rates compared with provisional stenting, although it was not statistically significant.

Recommended Citation

Ming Leo Lau, Ho Fai Daniel Fong, Nim Pong Kwong, Comparison of Clinical Outcomes between Provisional Stenting and Two-Stent Approach for True Left Main Bifurcation Lesions in the Era of Imaging Guided Percutaneous Coronary Intervention Journal of the Hong Kong College of Cardiology 2025;32(3) https://doi.org/10.55503/2790-6744.1559