The feasibility of double stent strategy in left main true bifurcation with small and large angle change between diastole and systole: The Milan and New-Tokyo (MITO) registry

Yusuke Watanabe; Toru Naganuma; Alaide Chieffo; Matteo Montorfano; Masaaki Okutsu; Satoko Tahara; Koji Hozawa; Sunao Nakamura; Antonio Colombo

doi:10.1002/ccd.31240

The feasibility of double stent strategy in left main true bifurcation with small and large angle change between diastole and systole: The Milan and New-Tokyo (MITO) registry

Catheter Cardiovasc Interv. 2024 Oct 27. doi: 10.1002/ccd.31240. Online ahead of print.

Authors

Yusuke Watanabe¹, Toru Naganuma¹, Alaide Chieffo², Matteo Montorfano², Masaaki Okutsu¹, Satoko Tahara¹, Koji Hozawa¹, Sunao Nakamura³, Antonio Colombo^{4

5}

Affiliations

¹ Interventional Cardiology Unit, New Tokyo Hospital, Matsudo, Chiba, Japan.
² San Raffaele Scientific Institute, Milan, Italy.
³ Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan.
⁴ Department of Biomedical Sciences, Humanitas University, Milan, Italy.
⁵ Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy.

PMID: 39463039
DOI: 10.1002/ccd.31240

Abstract

Background: Provisional single stenting strategy (PSS) is a default strategy for percutaneous coronary intervention (PCI) of unprotected left main distal bifurcation lesions (ULMD). Previous study reported that a bifurcation angle change (BAC) between end diastole and systole was associated with outcomes after PCI with double stent strategy (DSS) for ULMD. However, there are no data comparing outcomes after PCI with PSS versus DSS according the degree of BAC.

Objectives: We evaluated outcomes after PCI with PSS versus DSS for true ULMD with small and large BAC.

Methods: We identified 566 patients with true ULMD underwent PCI in three high-volume centers. We calculated the BAC in ULMD between end-diastole and systole before stenting with 2-dimensional quantitative coronary angiographic assessment. We defined small (BAC < 7.0°) and large BAC (≥7.0°) group. We compared clinical outcomes after PCI with PSS versus DSS in each cohort after propensity score adjustment. The primary endpoint was target-lesion failure (TLF), which was defined as a composite of cardiac death, target lesion revascularization, and myocardial infarction.

Results: In small BAC cohort, TLF rate was significantly lower in DSS group than in PSS group (12.5% vs. 20.1%, adjusted HR 0.45; 95% CI, 0.26-0.79; p = 0.006). In contrast, in large BAC cohort, TLF rate was significantly higher in DSS group than in PSS group (54.9% vs. 29.0%, adjusted HR 2.25; 95% CI, 1.50-3.38; p < 0.001).

Conclusions: The TLF rate after PCI with DSS was significantly lower in true ULMD with small BAC compared to PSS even after propensity score adjustment. In contrast, it was significantly higher in those with large BAC.

Keywords: bifurcation angle change; double stent strategy; percutaneous coronary intervention; target‐lesion failure; unprotected left main distal bifurcation lesions.