Coronary bifurcations – a type of coronary artery narrowing - are best treated with Culotte stenting as opposed to T-and-protrusion (TAP) stenting, when there is a need for side-branch stenting, according to the BBKII trial presented yesterday. The trial, published simultaneously in the European Heart Journal, represents the first ever head-to-head comparison of the two most commonly used techniques in side branch stenting with anatomy considered suitable for both techniques.
‘Interventional cardiologists can now use 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,’ said study presenter Miroslaw Ferenc, from the University Heart Center, Freiburg, Bad Krozingen, Germany, ‘even though it is slightly more challenging and requires appropriate training,’ In coronary bifurcation lesions side branch stenting is necessary in 5-36% of patients for optimal results.
In the Bifurcations Bad Krozingen (BBKII) study, 300 patients with stable or unstable angina were deemed amenable to both stenting techniques and were randomised to either TAP stenting (n=150) or Culotte stenting (n=150).
Results at nine months showed that the primary endpoint of maximal in-stent diameter stenosis of the bifurcation lesion (assessed by follow-up quantitative coronary) was 27% for Culotte stenting versus 20% for TAP stenting.The difference in the primary endpoint was driven almost entirely by differences in the side branch, where the mean percent diameter stenosis was 16% in the Culotte arm versus 22% in the TAP stenting arm.
Other important differences favouring Culotte stenting included a highly significant difference in binary in-stent restenosis at the bifurcation lesion, which occurred in 6.5% of the Culotte arm and 17% of the TAP arm as well as the target lesion rate of bifurcation lesion revascularization rate at one year, which occurred in 6% of the Culotte arm versus 12 % of the TAP arm.
‘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,’ concluded Ferenc.
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